National Care Association co-chairman Nadra Ahmed asks whether “throwing money” at our broken health and care system is really the solution, or whether deeper changes are needed.

While there is widespread agreement that health and social care are two sides of the same coin, it is only the sustainability of health which taxes the minds of politicians. The irony is that investment in one part of the system without the other renders it futile.

As we embark on yet another election_, no doubt we will hear much about care and health services. The question will be: how confident can we be that any incoming administration will create a more sustainable offer to the public than the one we have now?

We know that the current health service is creaking, with not a day passing without ‘trusts at risk’, ward closures or strikes. The optics of overflowing A&E departments will fill those who need urgent care with dread, potentially dissuading them from seeking medical advice. We hear about shortages of medical staff with those employed in these services under enormous and unsustainable pressure. While management structures within the NHS continue to grow, their evolutionary development has brought with it challenges of conflict between those watching the budgets and those trying to save lives.

There is no part of the health service which is not under pressure and the issues are well-documented, with solutions often cited at lack of sufficient funding. The question often asked is: is it poor funding that has the hospitals creaking, or is it the management of the structure created within it? I suspect there will be a division of thought around the question, but one thing is for certain: throwing money at a problem seldom solves it. The fact is that we expect services to be designed to respond to the needs of the population, and the projected demographics show that we have a growing ageing population with ever-evolving complexity of both physical and mental health needs.

It is widely accepted that without a strong, robust and sustainable social care sector the NHS will continue to falter. Politicians bring up the hallow rhetoric of “fixing social care” at every general election since the 1980s, however once they assume power there is little if any movement on half-baked plans. As we speak, we know that the two main parties will tell us much of the same, with glimmers of innovative ideas with limited budgeting attached rendering them unachievable.

Those currently in power will talk about the millions they have invested, and the opposition will talk about the plans they have, which are ready to hit the ground running – the detail seldom follows the promise. The millions of pounds talked about seldom hit the frontline where it is needed and is often a drop in the ocean when compared with the evidence that we need billions rather than millions to create sustainability, let alone inspire innovative ways of working.

We are so far behind in the range of investment required to support social care that catching up will be even harder going forward. The primary reason for this is that social care today is much more than it says on the tin. The care we deliver is no longer centred around able-bodied people who make the choice to come into care services because they are lonely or forgetful; today it is more about the fact that they cannot function independently in their own homes without care and support. In social care today we have people with complex health care needs for which the NHS receives funding, but we in social care have no access to that funding. We are supporting people at the end of their lives, or with conditions such as Parkinson’s, mental health, stroke, dementia and more.

To deliver these services providers have adapted their services, upskilled their workforce, innovated, adapted environments, created partnership for professional therapies and much more, but these are seldom recognised in the fees received from funders. It is important to note that the average fee for adult social care in an SME setting is between £700 and £900 per week, not the £1,000 often quoted by the media when people are in corporate or not-for-profit care services.

When we look at the litany of broken promises it is difficult to be optimistic about the solutions for social care and ensure it is fit for the future. We must be mindful of the precarious position local authorities find themselves in as we are going into a critical election, for the country as a whole and for social care and the NHS specifically. We have seen the creation of integrated care boards (ICBs), which now can also determine funding for social care in addition to the Continuing Care Fund held by the NHS; frankly, everyone is protecting their budgets at the expense of those for whom the money is intended – service-users who need care and support. It is especially challenging as we know that there are hundreds of thousands of people awaiting care assessments and being supported by the invisible army of unpaid carers across the country. Let us not forget that all these three funding organisations sit in precarious funding situations too.

We cannot go into this election without addressing the issue of unpaid carers who themselves can be frail in mind and body; one must never underestimate the impact on individuals who are supporting loved ones 24 hours a day, and the sacrifices they make toty their own wellbeing and personal lives to enable it. As a society, if we do not value and support them, we may well be creating problems for the future, as they may become a generation of people who will need care and support themselves. It is inconceivable that we are not valuing unpaid carers and providing support for them as they save the nation millions of pounds, many sacrifice their own careers and lives to do so.

I have deliberately not concentrated on the discussions around how much has been invested or needs to be invested to create the social care offer needed over the next 20 years, as there is evidence in the public domain. However, I will say, if this is not forthcoming under the next administration, we will see the current issues of the workforce shortages and the full cost of care spiral, resulting in the escalation of the challenges already faced by the NHS and social care. Let us address the funding gap and raise the image of social care and our workforce at the very least, to ensure that those who need care can access it.

Words by Nadra Ahmed.