public health and social care

‘No more burning injustice’ than failing elderly care system

Care for elderly people is failing to meet their needs because of cuts to local government spending, the King’s Fund and Nuffield Trust have said in a scathing new report.

Central government funding to councils has been cut by 37% in real terms in 2010-16, and spending on older people has fallen by 9%.

The researchers found that 26% fewer older people are receiving any help at all, leaving them increasingly reliant on private care or care by family members.

Richard Humphries, assistant director of policy at The King’s Fund, said: “The failure of successive governments to reform social care has resulted in a failing system that leaves older people, their families and carers to pick up the pieces.

“Putting this right will be a key test of the Prime Minister’s promise of a more equal country that works for everyone – there is no more burning injustice in Britain today than older people being denied the care they need to live with independence and dignity.”

‘Not if but when’ for provider failures

The report argued that the quality of care older people receive is increasingly dependent on where they live or what they can afford, not on need.

In addition, social care providers are increasingly under pressure because of reduced fees from councils, workforce shortages, increased regulation and the introduction of the National Living Wage.

“The possibility of large-scale provider failures is no longer of question of ‘if ’ but ‘when’”, the report warned.

The report also said that councils and NHS providers and commissioners must work more closely together to tackle the problem of delayed discharges of elderly patients.

Ruth Thorlby, deputy director of policy at the Nuffield Trust, added: “No one can predict whether they will have care needs later in life. But if they do find they need help with the basics – eating, washing, going to the toilet – most will discover that unlike a health problem where care is free, they somehow have to manage themselves.

“Our research found that local authorities have done their best to make savings while protecting funding for the poorest, but care providers are struggling on the low fees councils can afford. Shortages of home care staff and affordable care home places mean older people are often stuck in hospital, putting both their lives and vital NHS processes on hold.

“The number of older people needing care is increasing and yet we are continuing to put less money in. Unmet need is rising, providers are threatening to pull out of contracts, the wellbeing of carers is deteriorating, access to care is getting worse.

“A government that wants to create ‘a country which works for everyone’ should not tolerate the oldest and most vulnerable falling into a social care system riddled with holes.”

£3.5bn shortfall by 2020

The report predicted a bleak future for elderly people’s care. New measures from the government such as the Better Care Fund and the social care precept will not be sufficient to address the funding shortfall, and the precept will benefit already wealthy areas more than poorer ones.

Overall, spending on social care is due to fall by a slower rate over the next five years, but will still face a deficit of £2.8bn to £3.5bn by 2020.

Furthermore, the report’s authors warned that the UK’s withdrawal from the European Union has thrown elderly care into uncertainty.

It could be “sidelined” as the government focuses on negotiations with the EU, suffer a further downturn in public spending if there is an economic downturn, and lose the 5.2% of adult social care workers who come from EU countries.

The Nuffield Trust and the King’s Fund today urged the government to use the upcoming Autumn Statement to bring forward the additional Better Care Fund money, something it has previously refused to do.

In addition, it said more must be done to achieve a pooled health and social care budget for every local authority by 2020, and to develop a workforce strategy.

‘Unpalatable’ options for future of social care

The report warned that if the government is “unwilling to provide adequate funding”, social care may face the “unpalatable future” of admitting that individuals and their families now have chief responsibility for funding their own care.

Developing a policy framework making this explicit would motivate people to plan ahead for their care needs.

The Care Act 2014 should also be revisited to ensure that its expectations realistically reflect what national and local government can provide. A recent survey from the Carers Trust warned that the Care Act is being held back by funding pressures in the care system.

In the longer term, the report recommended a “frank and open debate” to develop a sustainable system of funding to cope with the needs of an ageing population.

Commenting on the findings, Cllr Izzi Seccombe, chair of the LGA community wellbeing board, said: “This report confirms what councils have been saying all along about the urgent need for government to properly fund adult social care, and we very much support calls for a fresh debate around how best to support future social care.

“Councils will continue to do all they can to maintain the services that older and vulnerable people rely on but there is little scope left for further efficiencies to be made.”

But a Department of Health spokesperson argued: “We understand the social care system is under pressure, and this government is committed to ensuring those in old age throughout the country can get affordable and dignified care.

“That’s why we have introduced landmark reforms to ensure no-one should have to sell their home to pay for care in their lifetime, and why we’re significantly increasing the amount of money local authorities have access to for social care, by up to £3.5bn by 2020.

“Our Care Act gave new rights to carers and we will be publishing a new carers strategy shortly.”

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