How to avoid the 'NHS crisis'? Fund social care properly

At the time, operators said their staff were being treated like "second class citizens" and "cannon fodder" as PPE resources were overwhelmingly directed into the health service.

By July of 2020, an analysis of Covid deaths by occupation among working age adults in Scotland found that, after adjusting for differences in age profile, social care workers were more than twice as likely to have died from the disease compared to their counterparts on the NHS frontline.

Problems had been exacerbated by a lack of virus testing as elderly patients were discharged from hospitals into care homes to free up beds, with subsequent investigations also finding that mortality rates were highest in homes with the largest capacities.

READ MORE: Is it time to reform the care sector in Scotland - and if so, how?

In a signal of the strain already facing the sector pre-pandemic, large care homes had become increasingly common as smaller operators folded or were bought up: in the decade to March 2019, for example, the number of care homes in Scotland fell by 22% but overall occupancy decreased by only 5%.

Now, 18 months into our battle with Covid, the vital interplay of health and social care - and the fragility of both - is back in the spotlight again as everything from ambulance delays to record A&E waits and hospital bed shortages can be traced back to social care and decades of underfunding in the face of an ageing population.

Dr John Thomson, vice president for Scotland of the Royal College of Emergency Medicine, said this week that it estimates the country's hospitals are short by 1000 acute beds.

'Field hospitals' may seem like the simple solution, but that only works if we have a surplus of people to staff them - and hospital wards are already stretched to the limits of what is safe.

In fact, the bed shortage could be resolved in an instant if "bed blocking" - patients well enough to leave but unable to be discharged until a care home place or a adequate home care package is in place - was magically eliminated.

As of September 22, according to the Scottish Government, there were 1,561 people delayed in hospital. That is the second highest figure since the beginning of March 2020 and up 54% since early May.

Free up those beds and you would go some way to ending the bottlenecks which have seen record numbers of patients spending 12 or more hours in A&E.

Likewise, moving patients out of A&E means the ambulances stacked outside can offload their patients and get back on the road to respond to 999 calls - reducing delays for people urgently needing paramedic attention.

READ MORE: Anger as Glasgow father-of-three dies at home after 40-hour wait for ambulance

Acute hospital beds in Scotland have been steadily cut as part of a well-intentioned drive to see more people being care for in the community instead, ideally in their own homes.

In reality - in Scotland as in the rest of the UK - the pace of NHS bed cuts has outstripped the increase in social care provision.

The number of care homes for older adults has reduced from 948 in 2009 to 829 by March 2019, with a corresponding reduction in registered places of 38,401 to 37,483.

It will only have shrunk further over the past two and a half years as an increasing number of providers went bust or were forced to close following adverse inspections.

A recent survey by Scottish Care, the umbrella body for private operators, found that 90% of care homes were facing recruitment problems with an average vacancy rate of 9% across the sector.

One care worker in Lanarkshire, speaking to our sister paper the Glasgow Times earlier this month, said care staff are increasingly worried about being suspended or struck off if something goes wrong due to inadequate staffing levels.

"We just aren’t able to give residents in our care the care and attention they need," she said.

Another said staff shortages had left nurses and care workers having to "mop the floors and wash the dishes" on top of their caring duties.

Given that unsafe staffing levels can lead to homes being forced to close - with a consequent loss of beds - this has knock-on implications for the NHS.

Community social care faces its own crisis.

By July this year, 40% of posts in Falkirk Council's home care service were empty due to vacancies or sickness absence, leaving 171 people waiting for a care package and existing care packages being reviewed to prioritise care to those most in need.

READ MORE: Pandemic is 'once in a generation' opportunity to overhaul health and care funding

And just as good social care keeps people well at home for longer, a lack of timely and adequate support equals deterioration and - inevitably - hospital.

Brexit has been blamed for an exodus of EU nationals, and the pandemic for staff burnout, but in truth social care was buckling long before either occurred.

We have simply failed to fund social care.

The experience of "free" healthcare makes Brits baulk at having to sell their parent's home or burn through inheritance money on £1000-a week nursing home fees, yet - as dementia expert Professor June Andrews notes - voters have not been "crying out to pay more taxes" instead.

Even Boris Johnson's National Insurance hike will funnel cash to the NHS first.

According to a major report in May by the London School of Economics and Lancet Commission, the UK's comparatively low health spending (13% below the G7 average) has been “compounded further by relatively low amounts of spending on social care”.

It urged year-on-year increases in spending of at least 4% in real-terms up to 2030 - not only in the NHS but on social care and public health too - funded by extra pennies on income tax, national insurance and VAT, plus increases in capital gains and corporation tax.

“Any decision not to increase funding risks the UK falling further behind other countries in terms of health outcomes," added the authors.

Is it happening? Of course not.

As the saying goes, "You pays your money and takes your choice".