In 1948, the welfare state was overhauled and councils were tasked with helping the most needy. Since then, social care has always been means tested with delivery left to town halls, the voluntary sector and private companies. The demand for social care continues to rise.
A government-commissioned report published in 1988 concluded that ‘community care is a poor relation: everybody's distant relative but nobody's baby’ (Griffiths, 1988). It acknowledged that funding was inadequate, but changes that were made centred on the organisation of care. The report set out proposals to achieve clearer lines of responsibility and accountability from the social services secretary to those delivering services to people.
The Department of Health and Social Care (DHSC) in England is responsible for overseeing health and social care. It plays a crucial role in shaping and implementing health and social care policies, ensuring the delivery of high-quality services and addressing public health challenges. Formulation of policy is one thing; its execution and bringing services to people and supporting the staff that deliver them is another.
Health and social care are indivisible. Often social care is glossed over and, on too many occasions, health care is excluded. Decades on there is still a crucial requirement to establish a framework, coupled with financial incentives, that would promote collaboration between health and social services rather than perpetually keeping them separate.
In 2022–2023, the adult social care sector comprised 18000 organisations across 39000 care-providing locations with 1.635 million filled posts. Full-time equivalent filled posts numbered 1.19 million, 1.52 million of which were in adult social care (Skills for Care, 2023). This is more than in the NHS, which has a headcount of 1.43 million. In adult social care, there are 152000 vacant posts (Skills for Care, 2023), reflecting 9.9% vacancy rate. Within the sector registered nurses had a relatively high turnover rate at 32.6% compared with other regulated professions, ie social workers (16.1%) and occupational therapists (14.1%). By comparison, the turnover rate for registered nurses and health visitors employed in the NHS stood at 10.9%, as of March 2023 (Skills for Care, 2023).
Skills for Care, which is a strategic workforce development and planning body for adult social care, collaborates with employers, government and partners to ensure the social care sector has the right people, skills and support, now and in the future. The Care Quality Commission (2023) has noted that accessing services remains a major problem. Along the health and care journey, people still face challenges to access the care they need, when they need it. Problems with access to care are persistent and abhorrent.
Record numbers are waiting for planned care and treatment, with over 7 million people on elective care waiting lists. The numbers may be much higher, as those who need treatment struggle to get a referral from their GP. Challenges persist in getting GP and dental appointments, leading some to use urgent care services as a first point of contact or not getting help until their condition deteriorates.
Hospital delays are rising year on year, with insufficient capacity in adult social care contributing to discharge delays. Persistent staffing and financial pressures in residential and community services have an impact on quality of care, with some people at greater risk of not receiving the care they need.
It is essential that the DHSC continually assesses and adapts its strategies to meet the changing needs of the population and overcomes the challenges faced in the health care and social care domains. This needs to be done today – we will certainly face the same issues tomorrow as we face today. As Griffiths stressed (1988): ‘There is nothing so outdated as to provide today's solution to today's problem.’
The NHS effectively serves as a social service, so it has a key role in addressing the shortcomings observed in community provision.