NHS and social care integration

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2013 National Delegate Conference
1 January 2013

Conference condemns the failure of political leaders to grasp the nettle and implement a long-term sustainable solution to the funding deficit in social care.

The numbers of people who need social care and support are continuing to rise as a result of the ageing population and medical advances which have improved life expectancy. But the availability and quality of care is shrinking.

Conference notes that inevitably it will be women who will carry the burden of the cuts in social care, both as workers directly impacted by the cuts in the services which are primarily provided by women, and as carers

There is a conservative estimate of one in four women acting as unpaid carers, and as many as one in five men. This figure is likely to rise significantly as caring costs continue to increase and people are forced to leave work or reduce working hours to provide care themselves as they cannot afford the quality professional care their adult dependants need

Meanwhile the increased imposition of zero hours contracts for primarily women workers in the care sector severely impacts on their family income, their ability to budget and plan effectively and to contribute long term for an adequate pension, thus perpetuating in – work poverty into retirement

Continuing cuts to health and social care budgets, the fragmentation of services and increasing reliance on a struggling voluntary sector will have a devastating impact on individuals and families whose quality of life depends on social care support, and the hard-working dedicated staff who provide it

The Coalition government has announced the introduction of a £72,000 life time cap to help fund social care from 2016 in England and Wales (whilst the Scottish and Northern Irish governments have chosen different solutions)

On its own, a cap is not enough to sort out long-term care though it may help individuals with significant costs

The cap is unlikely to solve the current underfunding of social care. Instead it will encourage a private insurance market to develop but there will be no extra funds. We can’t dodge the fact that local authorities are already facing an estimated £1.89 billion cut to social care budgets, while the cost of social care already takes up more than 40 per cent of council budgets – for some it’s over 60 per cent – and this could increase further still in years to come

Conference further notes that there is little clarification of how the cap will work to integrate free NHS health care with a privately funded social care system. The UK is now diverging into four different devolved models of health and social care services, yet there has been little evidence based research on what is the best and most efficient model to deliver quality health and social care – either for those working in these services or service users:

1) the current cap proposals in England and Wales are a limited solution to funding long term sustainable care;

2) that nearly 800,000 older people with care-related needs continue to receive no formal support at all. Evidence is emerging that with Local Authority budgets being cut, care providers cannot meet the public’s expectations of quality, and a ‘two-tier’ service is developing that favours people who are self-funding. The Department of Health has responded by saying that allocation to social care budgets is a local decision. eligibility for services is being tightened;

3) charges are being increased;

4) prevention services are being cut;

5) the economic crisis is creating greater need;

6) privatisation is driving down care standards;

7) low pay, poor conditions and the lack of training are endemic;

8) personalisation and commissioning polices are driving cuts and workforce casualisation

Conference therefore agrees that the National Executive Council should commit to and lead the union’s work to:

a) continue to work with the National Pensioners’ Convention and promote UNISONs policy to support a national social care service free at the point of need based on the NHS model in all devolved countries of the UK which is regulated nationally and provides clear statutory accountability in professional health and social care roles with clear, beneficial outcomes for service users;

b) highlight the importance of workforce and equalities issues in response to government proposals on future funding, regulation and legislative frameworks for adult social care; a national portable assessment system; a personalised care service; a well-paid, skilled and registered workforce;

c) develop alliances at national, regional and local level with community, user and equality groups to campaign against cuts, and in favour of sustainable investment and action to tackle low pay and poor conditions to include highlighting the disproportionate impact of the cuts on women as workers and carers;

d) campaign about the impact of personalisation policies on the quality and reliability of services, on safeguarding of vulnerable people and the workforce;

e) campaign for a national debate to research, discuss and present the issues, concerns and best practice and ‘workable’ models of free national integrated health and social care services;

f) call on Labour Link to work with the Labour Party to promote a debate on integrated care and current devolved models;

g) campaign for public authorities and local providers to adopt the UNISON Ethical Care charter to raise employment and training standards in care work;

h) encourage cross national discussions and opportunities for learning that recognise the variety of practice across the devolved nations.