Tackling the crisis in social care for older people – radical reforms proposed

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Care homes and domiciliary care are viewed as the poor relation to the NHS, says Prof Stephen Smith, in his latest book calling for urgent reform to health care in Britain, published by Radix Big Tent. 

In his book – Tackling the Crisis in Older People’s Care, volume six of his twelve book series on reforms to the NHS, A Better NHS – he proposes better career paths for staff, more integration for the NHS and the option of increased fees for providers.  He argues that such measures could reap huge benefits for patients and cost savings for the NHS.

Professor Smith recommends fee regulation through the Quality Care Commission, on a “utility Return on Investment basis”, allowing a reasonable but not excessive return on investment. “Care home providers should be required to invest in their buildings, or build new care homes, based on well-defined regulatory criteria”, he explains, which should attract private investment but protect the sector from the financial engineering of private equity firms.

He further recommends fees are increased and set at levels to allow care home providers to invest in the workforce, capital expenditure and new technology.

The social care sector has a staffing problem, unable to fill posts or retain staff due to low pay and excessive workloads, Professor Smith notes, proposing a three-pronged solution to the crisis:

  • A career path of ‘extended role carers’ incorporated in the NHS and separate to a nursing degree, providing a path in care with better conditions and pay;
  • Increased pay rates so that an entry level position is paid better than an unskilled role elsewhere;
  • Inclusion of care home workers in the Shortage Occupation List, offering lower visa requirements for migrants in these roles.

Professor Smith argues for better integration between health and social care, explaining that the latter has become expert in dementia care, continuous care planning and palliative care. Greater co-operation between the NHS, care homes and domiciliary care would prove mutually beneficial. He calls for a new post of Discharge and Community Chief Executive to be created to manage the care pathways across the various health and social care environments.

‘We can no longer kick the can down the road,” Professor Smith concludes. “We need to provide a better funded social care system and one that is more stable and agile in serving the needs of the vulnerable adult population’.

Tackling the Crisis in Older People’s Care is the sixth book in the series on NHS reform written by Prof Stephen Smith and published by Radix. The first five are

  1. An introduction to reforming the UK’s system of health and care
  2. What social care is and how it can be fixed
  3. Battling health and wealth inequalities
  4. Patient value, Incentives and Funding
  5. Managing the mental health crisis

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