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Adult social care ‘approaching a tipping point’, warns CQC

Social care in England risks reaching “a tipping point” as the market becomes increasingly unsustainable, the Care Quality Commission (CQC) has warned in its annual assessment of the health and social care sector.

According to the ‘State of Care’ report, the number of older people receiving local authority funded social care fell by 26% between 2009 and 2014, and 81% of local authorities have reduced their real-term spending on social care for older people over the last five years.

It quoted Age UK figures showing that over a million people who have difficulties with the basic activities of daily living now receive no help at all.

David Behan, chief executive of the CQC, said: “The good news is that, despite challenging circumstances, most people are still getting high-quality care and there are encouraging levels of improvement taking place. This is something to celebrate. However, there continues to be wide variation in quality, some providers are struggling to improve and there is emerging evidence of deterioration in quality.

“We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a ‘tipping point’. The combination of a growing, ageing population, more people with long-term conditions and a challenging financial climate means increased need but reduced access.

“The result is that some people are not getting the help they need – which in turn creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital.”

Further cuts on the way

The CQC report noted that this year’s Association of Directors of Adult Social Services (ADASS) survey found that 94 councils exceeded their adult social care budgets in 2015-16 by a total of £168m.

ADASS added that in the future the proportion of adult social care savings that can be funded through efficiency measures will fall from 75% to 55%, while the proportion that will need to be achieved through cuts has risen from 18% to 39%.

In its submission to the Autumn Statement, also published today, the LGA said that at least £1.3bn is needed to address pressures on social care now, and a further £1.3bn by 2020.

Between November 2015 and May 2016, 32 councils had residential and nursing home contracts handed back and 59 had home care contracts handed back.

Cllr Izzi Seccombe, chair of the LGA community wellbeing board, said: “There is a real danger that more providers either pull out of the publicly-funded care market, or go bust, placing vulnerable people at risk.”

The State of Care report warned that providers will increasingly struggle to cut costs without reducing staff numbers, which could “compromise the quality of care”.

The CQC is the latest body to highlight problems with adult social care after a joint report from the King’s Fund and the Nuffield Trust called it a “burning injustice” and warned that large-scale provider failures are a question of “when”, not “if”.

Inadequate ratings lower, but still a concern

As of July 2016, the CQC has rated 71% of the social care services it inspected as ‘good’, 26% as ‘requires improvement’, 2% as ‘inadequate’ and 1% as ‘outstanding’.

The CQC said the amount of social care services rated as ‘inadequate’ had decreased from 7% the previous year, but was still a concern. Around a quarter of ‘inadequate’ services and half of ‘requires improvement’ services did not improve their ratings following an inspection.

Peter Wyman, chair of the CQC, said: “We know that tough financial conditions are having an impact on providers. But the focus on the financial problems of the NHS has to some extent masked other issues – reduced access to adult social care and vacancies in primary medical services have led to increased demand in secondary care, which is often not in the best interests of people while generally being considerably more costly.”

A recent report by Carers UK found that 9% of carers have had to take their loved one to A&E or call 999 because of a lack of alternative care.

The CQC report warned that social care is likely to be increasingly difficult to fund because it will “not be easy” for councils to continue to add the social care precept to council tax, especially if there are changes of leadership following council elections.

In addition, the full impact of the Better Care Fund will not be felt until 2018-19, and the national living wage will put further pressure on services.

STPs an important opportunity

The CQC report said that the NHS-led sustainability and transformation plans (STPs), were “an important opportunity to determine the right balance between health and social care funding” that would involve “making hard choices about the right balance of investment”.

It added: “All local health and care leaders need to be having a conversation with their local populations about these choices and what they mean – conversations that need to happen now and that need to happen quickly.”

Behan said: “Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren’t meet, less improvement and more deterioration.”

Margaret Wilcox, vice-president of ADASS, said that her organisation has been arguing for some time now that adult social care needs to be given adequate recognition and resourcing.

“Services are being cut and the outlook for future care is bleak,” she said. “We are at a tipping point where social care is in jeopardy and unless the government addresses the underfunding of the sector, there will be worrying consequences for the care market, the NHS and, most importantly, for older and disabled people, their families and carers.”

Wilcox added that ADASS, in its submission to the Autumn Statement, had called on the government to be “a power for good” by increasing social care funding, as well as taking measures to address staff shortages in the sector.

A Department of Health spokesperson said: “The government is investing £10bn to fund its own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5bn extra by 2020.”

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Billy Davis Hft   14/10/2016 at 16:03

I am the Public Affairs & Policy manager for Hft. As a charity providing support for people with learning disabilities, we welcome this report as it highlights the precarious and unsustainable funding pressures blighting the adult social care sector. It also acknowledges learning disability care as a more expensive form of social care - an area that is often overlooked and widely underreported, despite being a significant part of the budget for the social care sector. We are pleased that the introduction of the new National Living Wage will mean some staff receive more financial acknowledgement of their specialist skills. However, coupled with the funding cuts our sector has absorbed in recent years, providers like us find ourselves in an unsustainable situation. Without additional funding the sector is under significant threat. We fear providers will fail and it will be the people who we are working so hard to support that will be most at risk.

Jackie Riis-Johannessen   19/10/2016 at 11:44

A huge number of us with learning disabled relatives at Botton Village are dismayed at the shortsightedness and poor judgement of Local Authorities in times of economical crisis. Botton in North Yorkshire was an autonomously and locally run Intentional Community for 130 learning disabled adults, practicing Social Therapy, through providing shared work, primarily shared family living, but also residential and supported living, hobby, cultural and spiritual activities and strong links to the wider community. The community was run by extremely competent and experienced Vocational Volunteer Coworkers, proven care providers for decades. The health statistics of the learning disabled adults was over 50% less than the national LDA population in terms of obesity, mental health and use of anti psychotic drugs and the care was the cheapest option for the LAs, knowing that many of the beneficiaries in shared family living would need far more funded care hours if they were in supported living. The estate was kept in trust by the Camphill Village Trust. Why then did the LAs acquiesce when the Camphill Village Trust decided to stop the shared living and shared community life style for one of employee based supported independent living and employee run supported workshops, with minimum wage care workers and layers of management, with a resulting doubling of the incidence of obesity, mental health disorders and use of anti psychotic drugs and huge cost increases to the charity which is now at risk of financial difficulties? No wonder the care sector is in a crisis. It is not a question of throwing more money at the LAs , but getting them to stop wasting money on bureaucracy, risk control and covering themselves, and rather to look at outcomes and to listen to their clients wishes, not their care providers.There is so much good will and initiative out there that is squashed by the machinations of charity and care industry. An example of how LAs waste money was the recent and highly questionable introduction in North Yorkshire of risk assessments being done on all parents when their LD children joined them for their holidays; apart from being a waste of resources, many found it extremely intrusive.

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