Speaking at the House of Lords Economic Affairs Committee last week, Health Secretary Matt Hancock dropped a big hint that the long-awaited social care green paper will outline proposals to shift people away from care homes and towards receiving care in their own home.
“More people go into residential care than is ‘clinically justified’ and there’s a big opportunity to make social care better for the individual being cared for and better value for money by a shift from residential to domiciliary care.”
Mr Hancock referenced a conversation with a Norwegian Minister, in which he discovered that the country had moved from 80% residential care to 80% domiciliary care in recent years.
Hancock told his peers that domiciliary care is cheaper than residential care and that people want to stay at home for as long as possible, saying: “That will get a mention in the green paper, I have no doubt.”
Norway – a beacon for healthcare reform?
Over the past 20 years, Norway has redefined the way it cares for its ageing population. Traditionally a nation that tended to place relatively high numbers into residential and nursing homes, it shifted its emphasis towards keeping older people in their own homes for longer by delivering care in the home as far as possible, although nursing homes remain an alternative in terminal stages.
The approach is multi-disciplinary with social workers and care professionals delivering comprehensive services at a local level for all citizens, interestingly irrespective of age, diagnosis, economic situation or social status.
Another key milestone in redefining health and social care in Norway was the 2012 Coordination Reform. This made municipalities more capable of addressing health issues through early intervention and aimed to halt the development of disease by educating those at risk of developing serious illnesses.
The Reform also made municipalities financially responsible for patients ready for discharge, which was enforced by the introduction of a daily fee of around £350. This was designed to reduce bed-blocking and was paid by the municipality to hospitals for patients declared ready for discharge but unable to leave the ward because municipal services were unavailable.
Initial research indicated that the fee reduced the length of stay in hospitals for patients, with no change in mortality and readmission rates, he said. The reform package also encouraged local authorities to build up services to tackle the increased care burden.
Is this the answer for the UK?
One major difference we can see in the setup of Health & Social care in the UK versus Norway is the size and rurality of the population. Compared to Norway, the UK population shows a much more even spread in rural areas across the countries, which will continue to offer up obstacles to providing high quality, affordable care at home.
In addition to the social care reform, Norway has also reduced the number of hospitals, concentrating on a number of centralised facilities that offer high quality integrated healthcare. Whilst better integration is clearly high on the UK agenda, developing a workable solution to successfully deliver it remains a significant challenge.
Bed-blocking certainly remains a problem, causing people to be discharged to unsuitable surroundings without the right support setup, but again this is often exaggerated by poor communication between health and social care services, and is an area that the effective implementation of data and technology could certainly have a huge impact on patient care and provision.
For what it’s worth, I believe there will continue to be a place for the whole spectrum of social care settings – what one person feels is the right place for them is very different to another person, so it is important to be able to offer that choice at the right moment in someone’s care journey and to be flexible as people continue through that journey, keeping pace with their changing needs.
Just as home care is a good solution for someone who enjoys the familiarity of home, so Live-In care and care homes can offer companionship and social opportunities. We are lucky to be able to see high quality care provided in all these settings and, having grown up in and around and worked in the sector for as long as I care to remember, I am always interested to see the innovative solutions that continue to be developed to offer further choice, control and independence to the end user, however complex their needs.
Of course, there is another danger that we dare not even consider… that with the amount of time that this green paper has taken to compile and the speed at which the sector is needing to move to keep up with changing demands, that its contents could already be out of date – as Care Minister Caroline Dinenage today admitted ‘every delay to the green paper has raised expectations to unrealistic levels’ and ‘the Green Paper is no silver bullet’ for social care challenges.
We continue to wait and wonder where we go from here…