Social care is vital to the NHS, but they are further apart than ever

http://www.theguardian.com/social-care-network/2016/jan/14/social-care-vital-nhs-divide

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There are many pitfalls to predicting what will happen in the future. Peter Drucker, the management guru, puts it like this: “Trying to predict the future is like trying to drive down a country road at night with no lights while looking out the back window.”

So, mindful that my glimpse into the new year is but a stab in the dark, I think we can still predict with reasonable confidence that 2016 will be every bit as difficult as 2015. Given what we now know about the spending review settlement, my sense is that we failed to convince the Treasury about the vital role of social care and get across the message that social care services are crucial to the effective operation of the NHS.

Related: A major care provider will fail in 2016

Understanding of the relationship between social care and health remains patchy at best. They are funded and commissioned separately: one is primarily a public sector provision and the other mainly a private sector offer. There are also fundamental differences in structure, culture and ideology. As a consequence there is still far too little evidence of really joined-up services.

These differences and the prejudices that defend the borders between health and social care are at the heart of the challenges faced by both sectors. It is a deep-rooted and paradoxical problem. Despite growing evidence that investing in prevention (social care) can save on more costly acute services (health care) and leads to better outcomes for people, change remains persistently slow. It will take more than a few successful vanguard projects to deliver any meaningful reform.

Our inability to bring social care and health together on any real scale means the future effectiveness of both sectors is undermined. As austerity measures bite further, and demand continues to rise, efforts to protect diminishing resources on both sides of the divide will make the situation even worse.

It is also important to remember that social care services were chronically underfunded before the 2010 austerity regime put further pressure on local authorities. Continuous cuts to public services and funding have undoubtedly worsened the situation. As these dynamics play out, most care providers have opted for a similar strategy of expanding the self-pay market to try and off-set the effect of diminishing public sector funding.

A two-tier market for social care has emerged as a result and it seems likely 2016 see the numbers of those paying the full cost of their own care growing further along with the expectation that a “top-up” will be needed to make the service viable. This cannot be sustainable and the situation will become ever more difficult ahead of the reform of funding promised by 2020.

Related: Softening the blow for residents when a care home closes

These market changes have created an insubstantial social care sector with instability for some services and some parts of the country. Homecare services are particularly exposed, which seems all the more ironic given the importance of a little bit of help to maintaining independence and protect people from more costly forms of care and support.

In 2016 care providers will also have to cope with the introduction of the new national living wage. There appears to be little evidence (as yet) that local authority fees will be increased to cover the added costs of implementing this significant policy change.

The reintroduction of the quality ratings system is influencing the market, both positively and negatively. Although a significant proportion of adult social care services are still to be rated it is my impression that regulation and inspection will remain a main priority for care providers. The combination of funding and regulation and further workforce costs has created a perfect storm – a cliche, but there is something in it.

At worst, care providers will exit the market in larger numbers as they endeavour to cope with these combined effects. But given adult social care is not one market, and is both fragile and immature, it is quite possible that the impact will be similarly patchy. The task of shaping the market for care will continue to be a major challenge in the year ahead.