Charity says a big cash injection at Wednesday’s Spending Review is imperative to avert the risk of collapse
A major new report from Age UK concludes that social care is in desperate need of a long term plan with the funding to match, as is already in place for the NHS, and in the meantime that Wednesday’s Spending Review must direct very substantial additional investment into care services in 2020/2021 to avert the risk of complete collapse in the worst affected districts.
The report, ‘The Health and Care of Older People in England 2019’, draws on many official statistics as well as new Age UK analysis to provide a comprehensive picture of how services are functioning today for older people across the NHS and social care. It builds on Age UK’s previous work and highlights the immense challenges facing older people who need social care, the numbers of whom are increasing every day, and the impact of the failure to provide it on their health and wellbeing, as well as on the NHS.
The analysis presents a tale of woe for social care, with every indicator showing that the system is under extreme duress and in no position to respond adequately to the demands being placed on it by growing numbers of older people and of sick and disabled adults.
System failures are having an adverse impact on the care market with a recent report concluding “the current model has broken down in some areas of the country and is no longer capable of delivering care to people in need”. The total amount of home care delivered has gone down by 3 million hours between 2015 and 2018 while the worst hit local authority lost a massive 58 per cent of its nursing home beds between 2016 and 2018. In 2018 alone Directors of Adult Social Services in 58 local authorities reported at least one care home closure, and nearly a third reported seeing home care providers cease trading. Similarly, the social care workforce is experiencing chronically high turnover, estimated at 30.7 percent each year.
Not surprisingly against this immensely difficult context, levels of unmet need for care have been going up. In 2016, nearly 1 in 8 people aged over 65 were estimated to be struggling without all the help they needed to carry out at least one essential Activity of Daily Living. By 2018 this had increased to 1 in 7 – or 1.4 million – older people, of whom 300,000 are estimated to need help with 3 or more activities – such as getting out of bed, washing and going to the toilet.
In 2017/18 total net expenditure on adult social care from local authority funds was £15.5 billion – an 8 per cent reduction since 2010/11. This fall has resulted in an increased reliance on money re-directed from the NHS as well as on greater means-tested contributions from older people and their families; the cross subsidy the public is paying to prop up the State funded care system is now huge and means that, on average, care home fees for an older person who is funding their own care are 41 per cent higher than their council has to find if they are paying for an older person’s placement.
Taking into account this additional funding from older people and the NHS, total spending on adult social care in 2017/18 stood at £21.7 billion, which still represents a real terms cut of more than half a billion pounds since 2010/11. Unless there is significantly more money for social care in Wednesday’s Spending Review Directors of Social Services are saying they will have to make even more cuts next year.
It is crucial to remember that over the last decade, and continuing, demand for care has been on a sharp upward trend because of our ageing population and because there are more disabled adults in need of support too. Overall, funding has not remotely kept pace as is shown by the fact that spending per head of the adult population actually fell by 17.5 per cent in real terms – approaching a fifth – between 2010/11 and 2017/18.
There were 1.32 million new requests for care from older people in 2017/18. Of these over half resulted in either no services being provided or in people being sign-posted elsewhere. While new requests for support and service provision have been broadly stable, the numbers of older people receiving long term services over the course of the year have declined by 5.7 per cent since 2015. Support for carers has also declined massively since 2015, with a fifth fewer carers now benefiting from access to respite care or from direct support for the person they care for compared to four years ago.
Caroline Abrahams, Charity Director at Age UK said:
“Our new report paints a frightening picture of where our social care system is heading unless the Government intervenes quickly and decisively to arrest its spiralling decline. When you strip out the complexity the story is really very simple: demand is going up but funding and supply are going down, leaving increasing numbers of older people to fend for themselves, rely on loved ones if that’s an option for them, or pay through the nose via a hefty stealth tax without which many care homes would not stay afloat.”
“Things are so bad in some places that it is becoming impossible to source care, however much money you have. Certainly, the idea that there will always be a care home or home care agency able to help you in your neighbourhood is increasingly out of date. Yet millions of older and disabled people depend on social care to stay safe and well and live their lives on their own terms, and when good care is available it makes a fantastic difference.
“There are genuine worries that as we look into next year we are seeing the prospect of total system collapse in the worst affected areas. Social Service Directors have been clear in saying they will have to make even more cuts if they’re to come in on budget in 2020/21, so this is why we are calling on the Chancellor to give local authorities a significant sum to invest in social care at the Spending Review next week. This is not a substitute for the long term plan and sustainable funding model social care badly needs but it is the essential first step that millions of older people simply cannot do without.”