November 2024 Edition

In this month’s edition of the Casebook, we highlight a report by the CNN and the forgotten story of social care as well as an article on the urgent care gaps in rural England.  We also focus on the work of the Dispensing Doctor’s Association in lobbying for GPs over NI payments. Additionally, we exam key findings from a recent report on mental health in inpatient settings and finally highlight new government announcements about the NHS. Read on to find out more!

The Forgotten Story of Social Care

In a groundbreaking study released by the County Councils Network (CCN), alarming new insights reveal the significant financial and social pressures facing social care systems dedicated to working-age and lifelong disabled adults in England. The study, conducted in partnership with Newton and unveiled at this week’s CCN Annual Conference 2024, emphasises the urgent need for tailored reforms and increased governmental support.

While public attention often gravitates towards elder care, this new analysis illuminates a glaring reality: two-thirds of adult social care commissioning budgets are currently allocated to adults under the age of 65 who are disabled. This demographic, despite making up just 40% of all adult social care service users, incurs an estimated £11 billion in care costs annually—an increase of one-third over the past five years alone.

Key Findings:

• The costs of care for working-age and lifelong disabled adults have surged by 32% in the last five years, significantly outpacing the expenditure for elderly care.
• These adults face increased complexity in their needs, which has led to a dramatic rise in care placement costs by 32% on average, particularly for those with acute learning disabilities.

The CCN report projects that without significant reform, care and support spending for this group could exceed £17 billion by 2030, marking a 50% increase from current levels. This escalation is driven by the rising costs of placements and the inadequate housing options available, which often force councils to rely on expensive out-of-area placements.

Councillor Martin Tett, CCN Adult Social Care Spokesperson, highlighted the critical nature of these findings at the conference. He stressed the dichotomy facing these often overlooked individuals—between their increasing financial burden on local councils and their substantial contributions to community enrichment when adequately supported.

Policy Recommendations:

• A significant increase in funding to meet the rising costs of care and ensure the safety and quality of support services.
• A review of funding arrangements and a push for innovative housing solutions to promote independence and reduce costs.
• Enhanced integration of education and employment opportunities to improve life outcomes for working-age disabled adults.

The CCN urges the government to consider these findings in their deliberations on the proposed National Care Service, advocating for a system that goes beyond mere slogans to one that genuinely supports one of society's most vulnerable groups.

The full report, titled "The Forgotten Story of Social Care," can be accessed and downloaded HERE. This document provides a detailed analysis of the current challenges and additionally offers a blueprint for meaningful reform to improve the lives of working-age and lifelong disabled adults across the country.

Dispensing Doctors’ Association Lobbies Health Secretary Over GP NI Payments

The Dispensing Doctors’ Association (DDA) Chairman Dr Richard West has written to Health Secretary Wes Streeting over incoming changes to employers' NI contributions affecting GPs. 

Following confirmation that GPs will not be exempt from the charge announced in the Autumn Budget, the DDA has reacted on behalf of rural dispensing GP practices.

The letter points out that there is no justification for excluding practices from the compensation arrangements announced in the Budget for other NHS bodies. For historic reasons, GP practices are not NHS bodies, but they are classed as public bodies under the Freedom of Information Act.  In addition, they are entirely dependent on funding from the NHS to provide services to patients and will need to fund the increased contributions by reducing patient services and/or by making staff redundant.

Dr West concludes: "General practice is the front door to the NHS. The increases in employers’ NICS and Living Wage could close many of those doors for good."

The DDA also highlights existing financial challenges facing dispensing practices caused by a dispensing contract that has not been changed in over a decade. 

Dispensing practices are urged to copy the letter and send to local MPs, inserting relevant financial details where marked. 

MP contact details can be found online

View the letter 

CQC Report Highlights Urgent Care Gaps in Rural England

The latest Care Quality Commission (CQC) report on The State of Health Care and Adult Social Care in England (2023/24) highlights significant concerns and areas where care must improve to meet the needs of children and young people. This summary, with an emphasis on rural areas, highlights the significant concerns and areas where care must improve to meet the diverse needs of all age groups, including the unique challenges faced by children and young people.

Primary and Community Care in Rural Settings

The CQC report reveals a troubling trend in rural health care access. In 2023/24, the number of people waiting more than two weeks for a GP appointment increased by 18%, affecting primarily rural communities. The 10 integrated care system areas with the highest proportions of patients waiting over two weeks for a GP appointment were predominantly in rural areas, with half of these in the South West. This strain reflects broader national trends where demand for GP services has surged, yet the capacity to deliver timely care remains insufficient, especially in less urbanized regions.

Adult Social Care in Rural Communities

Similarly, adult social care services in rural areas are under pressure, with an increasing number of individuals requiring support but facing prolonged waits for services such as care home placements and homecare.

In April 2024, waits for care home beds and home-based care accounted for 45% of delays in discharging people who had been in an acute hospital for 14 days or more, with nearly 4,000 people delayed on an average day. This often results in extended hospital stays, which complicates patient flow and care continuity, particularly acute in rural settings where resources are typically more stretched.

Mental Health Services in Rural Areas

The availability of mental health services remains critically constrained in rural England. In 2023, 1 in 5 children and young people between the ages of 8 and 25 were estimated to have a mental health disorder. Rural youth face significant barriers to accessing necessary mental health support, underscoring a critical gap in timely interventions, which, if unaddressed, risk long-term implications for their health and well-being.

Urgent Call for Action

The findings of this report serve as a call to action for enhanced support and resource allocation to rural health and social care services. Without targeted improvements and strategic planning, disparities in care quality and accessibility are likely to continue widening, particularly affecting vulnerable populations in rural England.

For a deeper understanding of the CQC's findings and the specific challenges faced by health and social care services in rural areas, readers can access the full CQC report here and the easy read version here.

In conclusion, the CQC's 2023/24 report lays bare the urgent needs within England's health and social care sectors, highlighting the necessity for immediate and sustained action to ensure no rural community is left behind in accessing high-quality care.

Kerry Booth, Chief Executive, Rural Services Network "The CQC's latest report lays bare the stark realities and growing disparities in healthcare access across rural England. As our rural populations age and their needs become more complex, the urgency to address these challenges cannot be overstated. The RSN’s 'Delivering for Rural' campaign specifically calls for strategic, community-focused solutions that ensure no one in our rural areas is left behind. We are advocating for improved transport links to healthcare facilities, enhanced local care services that reduce the need for long-distance travel, and greater investment in digital health technologies that can bridge the gap for isolated communities. It’s essential that these solutions not only match the unique landscape of rural healthcare but are also integrated into the broader national health policy framework".

Understanding the Key Findings from the Recent Report on Mental Health Inpatient Settings

The Rural Services Network is committed to keeping our readers informed about critical issues affecting health and social care in rural communities. This week, we are keen to share insights from a significant report published by the Healthcare Safety Investigation Branch (HSIB) that investigates patient safety in mental health inpatient settings.

This report offers a comprehensive examination of the safety concerns and challenges faced by individuals in mental health facilities. It underscores the importance of understanding systemic issues that can lead to adverse events in these settings, highlighting the need for robust safety measures and protocols.

Key Messages from the Report:

1. Emphasis on Patient Safety: The investigation highlights the necessity of prioritising patient safety through improved practices and enhanced communication within mental health services.
2. Staff Training and Support: Providing adequate training and ongoing support for staff is essential in ensuring they are equipped to manage complex patient needs effectively. The report advocates for continuous professional development to bolster the skills required in challenging situations.
3. Collaborative Approaches: The report stresses the importance of collaboration between various stakeholders—including healthcare providers, families, and patients - to foster a safer and more supportive environment for those receiving care.
4. Commitment to Continuous Improvement: The report calls for a dedication to learning from past incidents, encouraging services to cultivate a culture of continuous improvement in mental health care.

We encourage all our readers to explore these findings and consider their implications for mental health services, particularly in rural areas where access to care can be more limited. For a comprehensive understanding of the investigation and its recommendations, please read the full report by HSIB here.

Government’s First Steps to Strengthen NHS Foundations

The government has announced a series of steps aimed at addressing long-standing challenges facing the National Health Service (NHS) and improving service delivery. This announcement, which marks the start of a phased approach to strengthen the healthcare system, highlights the government's focus on structural reforms to improve accessibility and outcomes for patients across the country.

The Rural Services Network (RSN) cautiously welcomes these initial moves, particularly given the unique and persistent challenges that rural healthcare services face. While these changes have the potential to benefit rural communities, our network remains committed to ensuring that the specific needs of rural areas are considered in any systemic overhaul.

Overview of Government's Proposed Actions

The government’s announcement centres on key measures such as:

• Improving primary care and emergency response systems to reduce waiting times and streamline patient flow.
• Expanding workforce recruitment and retention initiatives to alleviate staffing pressures, particularly in underserved areas.
• Modernizing healthcare infrastructure with an emphasis on digitalization, which could significantly impact how rural patients access services remotely.

These proposed changes, if executed successfully, could help strengthen the NHS’s foundations and enhance healthcare access and delivery for rural populations, which often face barriers like longer travel distances, limited healthcare facilities, and staffing shortages.

RSN’s Perspective on the Impact for Rural Communities

The RSN appreciates that rural health inequalities have been brought into focus through these announcements. The need for a robust rural healthcare workforce, reliable emergency response times, and digital healthcare solutions is particularly pressing in remote areas, where residents can face significant logistical challenges in accessing timely and effective care.

However, we also urge caution, as these reforms will require sustained funding, targeted planning, and a rural-specific approach to make a meaningful impact. The complexities of rural healthcare - such as lower population density, transportation difficulties, and the need for flexible service models - must be factored into any plan. Without this, there is a risk that rural areas may not fully benefit from the proposed changes.

Next Steps

As the government moves forward with these initial steps, the RSN will be closely monitoring how these reforms are implemented. We remain committed to advocating for rural communities to ensure that they are not overlooked in the broader strategy to enhance the NHS. We anticipate that the government will provide further clarity on how these changes will be tailored to support rural healthcare and address the unique challenges these communities face.

Learn more about our Delivering for Rural Campaign HERE.

For further information on the government’s recent announcement, you can access the full details HERE.

Government Confirms £50 Million Investment in Medicines Manufacturing

The Government has announced a substantial £50 million investment to create a new facility dedicated to the manufacturing of lifesaving medicines, which will serve the National Health Service (NHS) and bolster the country’s health security. Chancellor Rachel Reeves made the announcement during a visit to Accord Healthcare's site in Newcastle.

This funding aims to enhance the production of critical medicines, particularly those used in oncology and autoimmune treatments. The investment is expected to generate more than 50 skilled jobs in the region and is part of a wider initiative following the Chancellor's recent Budget, which committed £100 billion to support capital investments aimed at revitalising infrastructure and attracting private sector investments.

The new facility will utilise cutting-edge automation technology, enhancing the UK's capability to produce essential medicines domestically. This move is seen as vital for maintaining a reliable supply chain for critical healthcare products, particularly in light of lessons learned from past health emergencies and the need for preparedness against future pandemics.

Chancellor Reeves emphasised the importance of this investment for economic growth, asserting that fostering a stable environment for business investment is a priority for the government. The initiative is central to the government's Growth Mission, which aims to bolster investment in high-potential sectors of the economy.

Science and Technology Secretary Peter Kyle noted that partnerships between the government and the pharmaceutical industry are essential for innovation and the successful transition of new treatments from research to patient care. He stressed that this investment will help ensure the manufacturing of advanced medicines, enhancing the UK's capacity to respond to public health challenges.

Paul Tredwell, Executive Vice President of Accord Healthcare, expressed appreciation for the government’s support, highlighting that this funding will enable the company to expand its production capabilities and contribute to alleviating medicine shortages in the UK.

This funding announcement follows a significant commitment of £63 billion in private investment made during the government’s recent International Investment Summit, which is expected to create approximately 38,000 jobs across various sectors, including infrastructure and life sciences.

The life sciences sector is a crucial part of the UK economy, employing around 304,000 individuals across nearly 7,000 businesses and generating over £108.1 billion in turnover in the fiscal year 2021/22. The government's investment is anticipated to strengthen the sector’s resilience and foster continued growth.

For additional information, the official press release is available HERE.

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RURAL SERVICES NETWORK

Up to date news on Health and Care
The Rural Services Network provides a useful source of themed news content and data. Check out the latest news on Health & Wellbeing and Vulnerability, where you’ll find articles on a diverse range of rural issues affecting rural communities. You might also find this research on Over 65 Population Projections useful too.

Latest from RSN Member Insights
RSN Member Insights is the place to discover the statistics that define communities within our membership.  It is regularly updated with new analyses, and these will be highlighted in the 'What's New' section of the RSN's Weekly Rural Bulletin. The Rural Bulletin also provides a selection of the most rurally topical news items, so do subscribe and encourage your colleagues to subscribe to what is an invaluable weekly periodical.

The Rural Health & Care Alliance is a membership organisation administered by the Rural Services Network on behalf of the National Centre for Rural Health & Care.  Explore the RHCA service below: