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Andrew Cozens: Cutting delayed discharges is not everything

Andrew Cozens
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The wrestling for control of the better care fund continued this month with the Local Government Association disassociating itself from the guidance on how it should be managed.

The key stumbling block was differing views on the so-called improved element paid directly to councils.

The argument rests on whether it is a fund for dealing with delayed transfers or recognition of the need for investment across social care. That it currently tapers to zero over three years adds to the complexity. Developing a league table and threatening to withhold the grant suggested the guidance was geared towards the delayed transfer model.

But recent events have demonstrated the need for attention to social care across all its manifestations.

The Grenfell tragedy and its awful consequences demonstrated the importance of social work support in its most practical form to address both immediate and longer-term effects.

Every day there are crises that need a flexible and human response from public services.

The Care Quality Commission backed up its concerns about the sector reaching a tipping point with new evidence that a fifth of the services it inspects are failing to meet minimum standards. This means people are receiving services deemed either unsafe or uncaring.

This connects with two priorities identified for the additional funding and within the grant terms. These are investments in stabilising the care market and addressing workforce shortages.

We also discovered more this month about the circumstances of those placed away from home in specialist treatment and assessment centres for people with learning disabilities. The often unjustified length of stay and the agonisingly slow progress in changing the pattern of care continues to shame us.

Finally we have seen the juxtaposition of National Coproduction Week with the publication of Quality Matters, a sector wide-commitment to ensure everyone plays their part in listening to and acting on the voice of people using services, their families and carers.

Margaret Willcox, president of the Association of Directors of Adult Social Services, tellingly suggested social care is designed and run by people who hope they will never have to use it. Improvements will come when we understand what matters to people who need care and support.

We must listen and respond to the experience of those unnecessarily delayed leaving hospital. But this must not be to the exclusion of those struggling to cope at home or the need for humanity in our response to those who care for them.

Andrew Cozens, independent social care and health specialist

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