There is not a crisis in adult social care, says Nadra Ahmed, chair of the National Care Association. “We are now beyond the crisis point. We really are at the edge of the cliff now.”
Residential care homes are closing at an unprecedented rate, hospitals are logjammed with elderly patients with nowhere to go; in the community, local authority cuts are leaving more than a million people desperately in need of more assistance in their homes.
Steep rises to council tax bills are now being pencilled in for 2017-2018 to help plug the hole in care funding, after Theresa May reportedly dropped her opposition to increases.
A 2% “precept” added to most council tax bills this financial year, approved by George Osborne in the 2015 autumn statement to pay for social care, has already added an extra £22.39 to the council tax bill for the average band D home in England, but critics say it is not enough.
The Local Government Association, which represents local authorities, estimates that the gap in social care funding will be at least £2.6bn unless the government acts urgently to inject more cash into the sector.
Izzi Seccombe of the LGA’s community wellbeing board says: “Extra council tax-raising powers are not the answer as they will not bring in enough money to alleviate the pressure on social care. The only solution is genuinely new money.”
A cocktail of factors have pushed adult social care into financial crisis.
Falling government spending
Net expenditure on social care has dropped in real terms from £8.1bn in 2005-06 to £6.3bn in 2014-15, a drop of more than one-fifth, according to figures from Age UK. The King’s Fund thinktank has said that without a change of policy, spending per capita is on course to reach its lowest level since the mid-1990s, following billions in cuts to local authority spending since the financial crisis.
A spokeswoman for trade union Unison, which has members in the social care industry, said: “The Association of Directors of Adult Social Services has estimated that £4.6bn has been cut from social care budgets between 2010 and 2015. As councils have had their funding cut, they try to commission care on cheap and at hourly rates they know it is impossible to provide care at. Councils are meant to ensure all the companies they contract care out to are paying their staff a legal wage. Most don’t and turn a blind eye.”
Rising need
The number of over-85s increased by one-third between 2006 and 2016 – and will increase by 100% over the next 20 years, according to Stephen Lowe of charity Age UK. “There has been a combination of falling spend at a time of increasing demand. There has been an actual fall in the number of people getting care over the past 10 years. We calculate there are 1.2 million people who need help with the activities of daily living who are not getting it.”
Fees paid by local authorities to homecare and residential home providers
The UK Home Care Association says the minimum needed to finance all the costs of a care worker visiting people in their homes to allow them to continue living independently is £16.70 an hour, yet the average paid by councils is £14.58. It said seven authorities paid less than £12 an hour or less than the direct cost of staff.
Care homes receive between £550 to £750 a week for each patient sent to them by local councils, yet about £750 is the bare minimum needed, says Ahmed of the NCA, which represents thousands of smaller care homes. The number of care homes overall in England has fallen from 18,068 in September 2010 to 16,614 in July this year at a time of growing need linked to the ageing population, according to figures released by the Care Quality Commission.
The minimum wage
The social care industry workforce is dominated by low-wage earners and the rise in the minimum wage this year alone is adding £600m to the total wage bill. The new national living wage of £7.20 an hour (for over-25s) came into force earlier this year, but planned rises will take it to £9 an hour by 2020 – affecting as many as 1 million workers in social care. The Resolution Foundation thinktank calculates this will cost employers in the social care sector £2.3bn a year by 2020.
Social care in residential homes also requires more highly skilled staff than in the past. “We have a recruitment crisis and are unable to get the staff needed to deliver care,” said Ahmed. “We need many more specialist nursing staff today to look after the greater number of people who have high levels of dementia and challenging behaviour.”
Bias against the poorest areas of the UK and the ‘postcode lottery’ of care
Care home closures have been most severe in the poorest parts of the UK, says Age UK’s Lowe. “Poor areas where residents do not have homes to sell and where care homes are almost entirely financed by local authorities have seen the most closures.” In south-east England, there is a higher proportion of self-funders in care homes, many of whom are cross-subsidising residents placed by local authorities. The result, Lowe says, is that care homes are targeting self-funders and avoiding local authority-paid residents.
Government officials admit that there is a huge variation in how well councils manage social care services. Half of all delayed transfers of care (where older patients are discharged from hospitals) happen in just 10% of councils, with Reading named as among the worst and Sunderland among the best.
GP referrals
Too many elderly patients seen by GPs are going directly to hospital, says Ahmed, when they should be going into a care home. “We need GP surgeries to work better with us. People shouldn’t be going straight into hospital when what might be better is to stay in a specialised nursing home for a few weeks.”
Blame Beveridge, the architect of the NHS
Former pensions minister Ros Altmann says the problem goes back to the initial design of the NHS by William Beveridge in the 1940s. “The NHS would give healthcare to all, free at the point of need, funded by taxpayers. However, it did not factor in social care, which was left untouched and still the responsibility of local councils.
“In the 1940s, the concept of millions of chronically ill older people needing a little help with their daily lives on a long-term basis was unthinkable. Either their families or local communities would look after them, or they would not live very long. Life in the 21st century is totally different, but our social care system is stuck in the past.”
Government response
The government says a combination of the higher funding, the additional 2% on council tax and the Better Care Fund will help alleviate the sector’s crisis.
A Department of Health spokesperson said: “This government is committed to ensuring those in old age get affordable and dignified care. We have given local areas access to up to £3.5bn extra by 2020, Many areas are providing high quality services within existing budgets and the CQC has rated the majority of adult social care good or outstanding.
“The Better Care Fund, which brings together health and social care provision locally for the first time ever, will get an additional £105m funding in the next few months to raise standards further. This rises to £1.5bn by 2019-20.”
The total number of care and nursing beds has remained constant over the past five years, says the government, despite individual care home closures. It expects the existing 2% council tax precept to raise nearly £2bn a year by 2019-20, or enough to support 50,000 older people in care homes or about 190,000 in their own homes.
Social care: why are we "beyond the crisis point"?
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