文章来源：《经济学人》Dec 1st 2022 期 BritAIn 栏目
Britain’s social-care sector is in even worse shape than its health service
英国社会关怀部门的状况甚至比医疗服务还要糟糕
Wear and care
That is awful for the old and the vulnerable
这对老年人和弱势群体来说是可怕的
Nov 28th 2022
The national health service (nhs) in England is under unprecedented strain. So it is baffling that more than one in ten of its beds are occupied by patients who do not need them. Some 13,600 inpatients are medically ready to be discharged yet remain in hospital—more than double the number five years ago. This is bad for them. It is even worse for the sick people waiting outside in ambulances, queuing in record numbers to get in.
英国国家医疗服务体系正面临着前所未有的压力。因此，医院超过十分之一的床位被不需要的病人占用，这令人费解。大约有13600名住院病人已经做好了出院的准备，但他们仍在医院里，这一数字是五年前的两倍多。这对他们不利。更糟糕的是，病人在外面的救护车上等待，排队的人数创下了记录。
Discharging a patient requires a dizzying amount of administrative work, much of it still done on paper. “It is easier to track a pizza than it is our patients across health and social care,” says John O’Connell, who is leading an nhs pilot scheme to digitise the process. One problem, however, cannot be solved by technology. Increasingly, when elderly patients are ready to leave, there are no carers to look after them.
让病人出院需要大量的行政工作，其中许多工作仍需在纸上完成。正在领导着NHS数字化试点计划的约翰•奥康纳表示:“追踪披萨比追踪医疗和社会保健领域的患者更容易。” 然而，有一个问题是技术无法解决的。越来越多的老年病人准备离开时，却没有护理人员照顾他们。
In 2021 the number of workers in adult social care fell by 50,000, the first decline in the decade that there have been records. There are 165,000 vacancies; one in 11 posts is unfilled. As the workforce dwindles, so does the quantity and quality of care on offer. The proportion of older people receiving state-supported long-term care is decreasing, but this does not seem to be because their needs are diminishing. Public satisfaction with social care fell from 29% three years ago to a dismal 15% in 2021.
2021年，成人社会关怀工作人员的数量减少了5万人，这是有记录以来的十年来的首次下降。现在有16.5万个职位空缺; 每11个职位中就有一个空缺。随着劳动力的减少，提供的医疗服务的数量和质量也在下降。接受国家支持的长期护理的老年人比例正在下降，但这似乎并不是因为他们的需求在减少。公众对社会关怀的满意度从三年前的29%下降到2021年的惨淡的15%。
Frustration stems in part from a complicated system. Long-term social care, consisting of both in-home care and care in nursing and residential homes, is supplied by thousands of mostly private providers. It is difficult to get publicly funded care. In order to qualify, a person must typically be deemed by their local authority to have both high needs and assets of less than £23,250 ($28,100). Separate funding streams hobble efforts to integrate the nhs and the social-care system: money for social care is still primarily funnelled to local authorities through the Department for Levelling Up, Housing and Communities, not the Department of Health.
不满意部分源于一个复杂的体系。长期的社会关怀（包括家庭护理和养老院护理）是由数千个提供者提供，其中大部分都是私人提供。很难得到公共资助的医疗服务。为了符合资格，一个人通常必须被当地政府认为有很高的需求，并且资产不超过23250英镑(28100美元)。独立的资金来源阻碍了NHS和社会关怀体系的整合: 社会关怀的资金主要还是通过“住房、社区及振兴地方”部门(而不是卫生部)流向地方政府。
More fundamentally, in the decade from 2010 the funding of local authorities fell by half in real terms. Some losses were made up by rises in local council tax and by the introduction of a special social-care “precept”, or levy. But in 2020-21 prices, social-care spending still dropped from £514 per adult citizen in 2010-11 to £478 per adult ten years later.
更为根本的是，从2010年开始的10年里，地方政府的实际资金减少了一半。一些损失是靠增加地方市政税和引入一项特别的社会关怀“规定”或税收来弥补的。但在2020-2021年的物价水平上，社会关怀支出仍然从2010-2011年的每位成年公民514英镑下降到10年后的每位成年人478英镑。
Josh Hawker of AbleCare Homes, which runs six care homes in the south-west, says his firm needs £800-1,000 per week to look after a client. That seems cheap given that it costs the nhs at least £2,500 per week to keep someone in hospital. But Mr Hawker says that Bristol city council pays £771 for each state-funded client, almost irrespective of their needs. The “council just aren’t paying what it costs to look after people”, he says. Self-funders, who make up the remaining third of residents, end up paying more to subsidise others.
AbleCare Homes的约翰·霍克在西南部经营着六家养老院，他说他的公司每周需要800-1000英镑来照顾一个客户。考虑到NHS每周至少要花费2500英镑让一个人住院，这看起来很便宜。但是霍克先生说，布里斯托市议会为每个政府资助的客户支付771英镑，几乎不去考虑他们的需求。他说:“ 议会根本没有支付照顾人们所需的费用。” 剩下的三分之一居民得自筹资金，他们最终会为补贴他人支付更多的钱。
The miserliness exerts downward pressure on wages. In March the median hourly wage of a care worker was £9.50, less than that for an easier job stacking supermarket shelves. One of Mr Hawker’s employees had been an “excellent” care worker for a decade. But when she quit for an entry-level job as an administrator in the nhs, she instantly received a pay bump of 30%. Some providers fill gaps with pricey agency workers. Others make do with fewer staff.
这种吝啬给工资带来了下行压力。三月份，护工的时薪中值是9.5英镑，比一份更轻松的在超市摆货物上架工作的时薪还低。霍克先生的一名雇员是一名“优秀”的护工，工作了十年。但当她辞去NHS的初级管理工作时，她立即获得了30%的加薪。一些提供人用昂贵的专门机构人员填补空缺。其他公司则用更少的员工将就。
The losers are among society’s most vulnerable. Age uk, a charity, estimates that around 2.6m adults who need care are not receiving it. In the first quarter of 2022, 2.2m hours of home care could not be delivered because of staff shortages. Providers such as Right at Home, a home-care franchise, are focusing more on self-funding clients. “It means we can pay our workers more,” says Lucy Campbell, the ceo.
吃亏的还是社会上最弱势的群体。慈善机构Age uk估计，大约260万需要照顾的成年人没有得到照顾。在2022年第一季度，由于人手短缺，220万小时的家庭护理无法交付。像仁爱华这样的家庭护理特许经营企业的服务提供者更关注于自筹资金的客户。公司首席执行官露西•坎贝尔说，“这意味着我们可以给员工支付更多的工资。”
Care homes must contend with soaring energy costs, too. That means making tough choices. At best, carpets grow shabbier and walls aren’t repainted. At worst, clients with more complex (ie, costlier) needs are turned away. Profit margins are at their lowest since the Care Quality Commission, a regulator, began monitoring them in 2015. “You’d be mad to open a care home at the moment,” says Mr Hawker.
养老院也必须应对不断飙升的能源成本。这意味着要做出艰难的选择。最好的情况下，地毯会变得破旧不堪，墙壁也不会重新粉刷。在最坏的情况下，有更复杂(即更昂贵)需求的客户会被拒之门外。利润率处于自2015年监管机构护理质量委员会开始监控以来的最低水平。霍克先生说:“在这个时候开养老院，你一定是疯了。”
The autumn statement did bring some relief. Jeremy Hunt, the chancellor of the exchequer, pledged up to £7.5bn of extra money for social care over two years, a chunk of which will come from allowing local authorities to raise council tax. Around a third of the money is tied to hospital discharges, to be split with the nhs; some of the rest will probably go on wages.
秋季的声明确实带来了一些宽慰。英国财政大臣杰里米•亨特承诺在未来两年内为社会关怀投入至多75亿英镑的额外资金，其中很大一部分资金将来自允许地方政府提高市政税。大约三分之一的资金用于医院出院，与NHS分摊; 剩下的部分可能会变成工资。
Mr Hunt described the cash as “the biggest increase [in social-care funding] under any government of any colour in history”. But the money fell short of his own assessment of what was needed when he chaired the health and social-care select committee: in December 2021 he said that social care needed an extra £7bn a year.
亨特先生称这笔现金是“历史上任何党派政府(在社会关怀基金上)最大的增加”。但这笔钱没有达到他在担任卫生和社会关怀特别委员会主席时对所需资金的评估: 2021年12月，他说社会关怀每年需要额外的70亿英镑。
“These are tiny sums of money given the issues,” says Geoff Butcher, who runs Blackadder care homes in the West Midlands. “I honestly cannot see them addressing the problem.” Clive Lewis, the leader of Wokingham council, in the south-east, agrees. To save money for social care, he is still considering reducing the bin collection from weekly to fortnightly. He is already relocating council employees in order to rent out the top two floors of their offices.
在西米德兰兹郡经营黑蛇养老院的杰夫·波奇说:“ 考虑到这些问题，这些钱是很少的。说实话，我看不出他们在解决这个问题。”东南部沃金厄姆议会领袖克莱夫•刘易斯对此表示赞同。为了给社会关怀省点钱，他还在考虑把收垃圾的时间从每周减少到两周。他已经在重新安置议会雇员，以便出租他们办公室的顶层两层。
Some of the extra cash has been found by deferring a plan to cap the lifetime costs of personal care paid by individuals in England at £86,000. Councils say that the cap could never have been implemented by October 2023, as originally scheduled. Others (including the plan’s architect, Sir Andrew Dilnot) feel that delay is short-sighted: the introduction of a cap would bring peace of mind to many. Around one in seven over-65s face bills of more than £100,000 for their own care. The government is plugging holes in social care but “the public wants more than that,” says Simon Bottery of The King’s Fund, a think-tank. “They want a better, fairer system.” ■
一些额外的现金是通过推迟实施一项计划来获得的，该计划将英国个人终身护理费用限制在8.6万英镑。地方议会表示，按照原计划，2023年10月之前不可能实施这一限制。其他人(包括该计划的设计者安德鲁·迪尔洛特爵士)认为拖延是短视的: 引入上限会给许多人带来安心。在65岁以上的人群中，大约有七分之一的人需要支付超过10万英镑的医疗费用。政府正在填补社会关怀的漏洞，但“公众想要的不止这些，” 智库国王基金的西蒙·博特里说道。“他们想要一个更好、更公平的体系。”■
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