I was struck this week by a number of reports that have come out focussing firstly on the geography of poverty, and secondly how central
and local government actions have impacted on communities of the most
disadvantaged adults around the country.
The first of these is the long awaited update to the Public
Health England, Health Profile for England.
Duncan Selbie, CEO of Public Health England states in his latest blog:
“The new report tells us that people are living longer and
are healthier at every age group, which is undeniably good news. However, it
also tells us, amongst many things, that the poor are experiencing the health
that the wealthy enjoyed twenty years ago, that our ageing population means the
number of people with long-term health conditions has increased…”
You only need to go to the core of the report to find more
concerning evidence around health inequalities including the following
“There is no evidence that inequalities in life expectancy
have narrowed in recent years. Inequality in life expectancy for females has
widened since 2001 to 2003, and for males, although inequality has fluctuated
over time, it remains the same as that in 2001 to 2003.”
“The gap in healthy life expectancy (years lived in good
health) between the most and least deprived areas of England was around 19
years for both males and females in 2014 to 2016. People living in the most
deprived areas spend nearly a third of their lives in poor health, compared
with only about a sixth for those in the least deprived areas.”
This is not ‘news’ in the sense we have understood for many
years that health inequality is a significant factor within England, and the
detailed research and wide ranging approaches outlined within the report ‘Fair
Society Healthy Lives’ by Sir Andrew Marmot in 2010 showed not only the
reality, but also how things could be changed.
However, another report released last week, showcased just
how far we are from implementing some of the key approaches advocated by
Marmot – particularly around care and housing. The report produced by the New
Policy Institute entitled, A
Quiet Crisis: Changes in local government spending on disadvantage,
tells the tale of just how significant regional variations to spending on non-statutory
preventative services have become.
Whilst the ADASS
budget survey 2018 showed the depth of concern amongst Directors
of Social Services about their ability to invest in prevention, the budget
survey represented that as a relatively universal concern. However, the NPI
report cites MHCLG figures which appear to show the actual reduction in
spend on prevention has been almost entirely (97%) focussed on the 20% more
deprived council areas.
This report particularly hones in on working age
adult care services, and how in recent years councils have sought, as a result
of budget reductions, to decrease spending through a range of mechanisms
including reducing services, reducing universality and introducing charges for
previously free services.
The well-made cost benefit case for prevention is
reiterated, plus of course, the well-researched and rehearsed argument that
‘given reductions in preventive work, there may be further pressures on need
coming down the line.’
I think for everyone working on the front line of social
care, the ‘may’ caveat of this sentence is not needed. Everyday NCF members see
the impact of reductions of vital community based preventive services which
have a central place in sustaining independence and keeping people well within
their own homes, or in residential settings.
I was very interested to read the latest think piece by
Future Care Capital that highlights just some of the challenges of locality
based care systems. The paper, Facilitating Insight to Developing Care
Economies, argues strongly for the increase in prevention but recognises the
ease with which it has been removed because of our inability to count the
Our reliance on monitoring systems that focus only on the
‘standard’ interactions means that the complexity of the care infrastructure is
not acknowledged and individual connections with the ecosystem are missed.
This invisibility from formal reporting could be seen to
be part of the picture that had allowed the reduction in funding of
preventative services with the impact felt be individuals in the short term and, inevitably, by both individuals and statutory services in the long term.
The paper points to the potential for data gathered
across the care infrastructure to enable localities to move beyond the politics
of ‘short termism’ and seeks government support to incentivise prevention. The
summary of the paper can be found here.
Matt Hancock, Secretary of State for Health and Social Care has highlighted prevention as his third key priority, and what all these reports show, is that this shift in emphasis to reinforce the centrality of prevention in government care and health policy cannot come soon enough.
The new workforce portal
championed by Secretary of State Matt Hancock has been running for just over a
week. If, like me, you have logged on to find out what it is all about, then
you will know that the structure of the site is intended to direct people to
comment on their own experience of the workforce under five specific themes.
- Feeling empowered and achieving their full potential
- Working without fear of bullying, discrimination or
- Having access to the training, development and support
- Belonging to an organisation that respects and values
- Getting the basics right
The portal is intended to
capture the views of both social care and health staff, and really seeking
views from the front line. Do take a look at some of the ideas and perspectives
shared on the site, and encourage those that you work with to get involved so
that we can ensure that the views of social care staff are heard loud and
clear. You can visit the site here.
Members may have noted that
the workforce portal was in fact launched during the Secretary of State’s visit
to an NHS Trust in Bristol. However, his earlier visit of the day received less
coverage – but was great to see – where he visited NCF member St Monica Trust,
and created a series of very positive footage of the excellent care and
services on site.