Inside: Labour wants to fix the NHS. Doesn’t everyone?
I have lived and breathed social care for 39 years for my now departed daughter (October 2022) and cared for her with my wife, who sadly died (September 2020), so I have been there and done that, not only on a personal family basis, but on behalf of other carers in Sheffield through also being involved, with many other carers and disability organisations and having my own network of Family Carers who I keep in touch with on a regualar basis, in most instances weekly through my own newsletter.
So, yes, we all want the NHS to be fixed, but how is part of the problem and does any politician really understand the NHS and the problems, as before anything can be fixed one has to fully understand all of the problems and that is the start of the problem with all politicians.
Yes, Starmer has relations in the NHS, but do they fully understand all of the problems or only some of the problems within their own areas. While the NHS is supposed to be National, in many respects it is not, for in many it is Local with the local ICBs (Integrated Care Boards) endeavouring to look at not just the NHS, but also social care.
I mention social care for there is and has been a drive to integrate the two, but that is far from easy. With social care being under Local Authorities and health under local health authorities. Then within each there are further splits.
In health there are
- community health
- primary care (GPs)
In each of the above there is public and private and in many instances a mixture of the 2 in many areas.
In health take GPs, the GP practice is NHS public, but GPs are self-employed, so while having a degree of NHS contract for the practice there are technically private in some degree. Similar to dentistry, but dentistry is in a so much worse state than GP practices, but how long will it be for GP practices to be in the same state as dentistry.
But in other areas of health there is a mix of public and private to some degree.
Now with social care there is also public and private, public is generally social workers, who are usually employed by Local Authorities, (LAs), but maybe not always so.
But care workers are generals employed through Private providers, but these providers get their main funding from LAs, with some from health through Continuing Health Care, (CHC). The providers then use this funding to provide social care to persons in need of social care either through contracts directly with the persons or some through contracts with LAs. But funding of LAs has been severely restricted through Tory Austerity Cuts since 2010 and to a very large extent still. This has led to LAs being extremely short of funding in an increasing Market, not only in social care, but all other essential service which should be provided by or through LAs.
Care workers are one of the professions who are paid the least in the UK, but there are others, agricultural workers and hospitality workers to name 2 more, but there will be others.
As in the NHS there are extreme staff shortages in social care, including social workers, but so much more so with care workers.
Many carer workers are only on or just above the National Living Wage of £10.42 per hour and with so many responsibilities, while they could be earning £4/5 per hour more in other occupations, such as Supermarkets, with much less responsibilities.
Many people assume that care workers only help to wash and dress people in need of care, toilet, and meal preparation, but the responsibilities are so much more, as they have to respect the choice and dignity of the persons they care for, respect the possessions and property of the person they care for, manage in many instances their finances and medication, manage the persons social outings, their safeguarding, provide empathy and support when and when needed and so much more.
So being a care worker is not as it is believed an unskilled profession for it should be and needs to be a highly skilled profession and they should be paid accordingly. By not doing so this is causing the shortages in staffing, but there is also insufficient travel expenses, recognition of holidays, including Bank Holidays, no sick pay except SSP (Statutory Sick Pay), which again is so insufficient and so much more.
As well as receiving carers from care providers, a person in need of care can apply to their LA to receive a Direct Payment and similarly with CHC (Personal Health Budget), (PHB).If you are successful in your application you can if you wish to employ your own carers, but you will need to due this yourself, but help may be available. Costs of recruiting could be included in the Direct Payment and costs related to payments will be be, but the rate of pay will need to be agreed with your LA or CHC, even costs to get an organisation to do so even the payroll and salary payments, all of which will be included in the Direct Payment or PHB, but if you wish you can do some or all of this yourself. However, the rates of pay will most likely mirror those which care providers pay their staff, so a major problem will be recruiting and sustaining, as it is for care providers.
Some people will say that care providers profit from the funding they receive from LAs, but that could have been so, but now is most unlikely and from a Direct Payment or PHB profiting is illegal and the accounts you hold or an organisation will be audited and at very regular intervals, at least half yearly and maybe earlier, especially from the outset of granting the payments.
This crisis in social care has a large bearing on the crisis in the NHS for it is leading to increasing health deteriorations through lack of social care, insufficient social care so patient discharges from hospitals are seriously delayed, this then leads to an inability for patients from A&E to be transferred to wards, so blocking new patients from waiting ambulances, which leads to insufficient ambulances to pick up other people in need of health care. But there is so much more.
I have only highlighted some of the problems in both social care and the NHS, but it goes so much deeper. So does Starmer understand the problems, do any politicans understand any of the problems, I do seriously doubt it.
Pushing funding down the road has gone on for far too long, Boris promised in 2019, now Rishi has push it further down to 2025, can social care funding wait that long, I so doubt it. Then when it comes will it be sufficient, well the real answer is a resounding no, for to be rally effective social care needs £12 billion now and not the little £millions the Tories promised and then halved it to then delay until 2025.
Starmer has said he will take steps to withdraw ‘Non-Dom status’ and yes, I agree, but this will only bring in around £3 billion and he has stated this is for the NHS, even if he had stated social care and NHS, it would not only be so insufficient, most, if not all would go to the NHS.
The NHS can’t survive without social care and social care can’t without the NHS, so integration is so essential, but will it be effectively achieved, I so doubt it.
1948 was a great year for that was when our great NHS was created and was it so welcome and needed, well yes, is the only answer. But a grave mistake was made and that was not including social care directly within the NHS, with each having it dependence on each other it makes sense to run it under one umbrella.
I say umbrella for the organisation would have been massive then and certainly so massive now, but there would have not been the infighting over who funds what between LAs and the NHS which there is currently and has been for years and in many respects duplications of management, staff and much more. Duplications have costs, so why pay twice for something much similar.
But in 1948 social care was seen as extensive as it is now, but then neither was the NHS. Since 1948 there have been great advances in medical understandings leading to many conditions where persons would not have survived, now have a good chance to do so. This has also lead to many more persons with disabilities living longer and many more disabilities being found, this is all welcome progression. Due to medical advances all of us are living longer, and again this creates greater demands on social care and the NHS.
So demand for social care and the NHS has not stood still and greatly increased while funding in real terms has been reducing, now does any of that make sense, well no, funding has to increase with demand and really well in front of demand.
Some may say where are families in all this with social care, well unlike what some government Ministers have and are may be still saying Families have been doing all they can and in many instances so much more, in that their own health starts to deteriorate, causing more demands on social care and the NHS.
Do you kown that families carers are currently (2021) saving the UK £193 billion how much more can they do, well they will do but causing much more health deteriorations.
These are just some of the areas in social care and the NHS, so I very much doubt Starmer or anyother politican know anywhere near the problems and so can’t say they do, but they do because they are either incapable or unwilling to understand the problems.
Social care and the NHS are in the hands of these politicians, but I very much doubt they are anywhere near safe hands.
Good luck for we all very much need it, but so doubtful it will ever come.
Source: Morning Call: Time to turn on the Starm