The chancellor’s autumn statement was met with incredulity and dismay by many in health and social care. Incredulity because the unusually extensive analysis and briefing on the state of the NHS and social services was so brazenly ignored, and this when the NHS is top of the list of issues the public holds dear. Dismay because of the likely consequences for the very groups in society that, ironically, the PM has pledged to help. Why did this happen?
Politicians of all stripes, patient and community groups, thinktanks, local authority leaders and many more express disbelief at the outcome. Does “project fact” no longer work? Are we in a “post-truth” world? Or is this short-termism by the government writ large?
Let’s look again at a few facts. Social care is at a tipping point. So says the Care Quality Commission, which should know, given it inspects all 17,000 social care providers in England.
Spending by local authorities on older people’s care has fallen by almost 10% in the first half of this decade. The number of older people receiving care has fallen by more than 400,000 – one in four fewer people getting help with basic needs. Family, neighbours and friends pick up the pieces and some older people pay privately. But increasing numbers of the poorest have no one to turn to. This growing gap has a human cost, but it’s also affecting the NHS.
Anyone using or working in the NHS can see that hospitals are full, operating at unsustainable capacity levels. There is a growing number of older people in hospital, medically fit to leave but unable to because of a lack of care in the community. The number of patients waiting in hospital for care packages to be put in place has risen by more than 40% in the past year alone. Other older people are in hospital when their condition could have been prevented by better support.
If the NHS was awash with money, this might be inefficient but manageable, but it isn’t. The NHS is receiving almost no increase in funding for 2018/19 and 19/20, despite growing demand and widespread deficits in hospitals. Increasing waiting times for care are the predictable result.
Meanwhile, the government continues to claim that the NHS is receiving an extra £10bn between 2014/15 and 2020/21, despite a direct challenge from the chair of the health select committee and a warning from the UK Statistics Authority. It makes this inflated claim based on a definition of “NHS” different to that used by all previous governments.
Extra funds were promised for social care from last year’s spending review, but too little and too late. Many working in social care are on the lowest wages. The national living wage will rise to £7.50 from April 2017 – welcome for the workforce, but a further cost pressure. This, coupled with rising demand from an ageing population, means social services across England face a £2.4bn funding gap next year.
Local authorities are running out of options – they have cut providers’ margins to the bone and many are walking away from contracts. Almost everyone currently receiving local authority-funded social care has been assessed as high need, so withdrawing services will bite especially hard. Who will hurt most? The poorest. The “just about managing” will “just not manage”.
With lower growth forecasts, extent of debt and the disruptive uncertainty of the vote for Brexit, room for extra public sector funding is limited. One option is to look again at the triple lock that ensures that state pensions increase by inflation, average earnings or a minimum of 2.5% a year. The triple lock has helped reduce pensioner poverty. Since 2008, the average income of those over retirement age has risen by 11% and the number of pensioners in poverty has fallen. But money alone doesn’t guarantee a dignified old age. For the most vulnerable old people, cuts to social care have left them without help with basic needs. There is scope for the chancellor to reform the triple lock before the 2017 budget to redistribute funds by boosting social care.
The referendum has shown that the active ingredient to prompting the political class to address a thorny issue is less about forensic analysis – “project fact” – than the mobilisation of public rage. It is worth pondering why this hasn’t yet materialised for the old and vulnerable.
So much for “a country that works for everyone”. This looks more like short-termist business as usual.
Dr Jennifer Dixon is chief executive, the Health Foundation. Anita Charlesworth is director of research and economics, the Health Foundation
Shamefully, the autumn statement said nothing about social care | Jennifer Dixon and Anita Charlesworth
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