Social care for older people: Home truths

We consider a joint study by The Kings Fund and the Nuffield Trust on the impact of spending cuts on elder care.

The Kings Fund and the Nuffield Trust has published a joint study Social Care for Older People: Home Truths looking at the impact of spending cuts on the provision of and access to care for older people. The study collected evidence based on an assessment of the national data and conducting in-depth interviews with four unnamed local authorities representing different part of England.  

Comment 
Austin Thornton, solicitor at Wrigleys summarises the report "the Care Act 2014 imposes a legal duty on local authorities to promote diversity and quality in the provision of services. It is arguable that some local authorities may already be breaching that duty where cost pressures have reduced social care providers and drastically curtailed choice." 

Report Details
The Care Act 2014 came into force on the 1 April 2015. The Act created new duties for local authorities and rights for individuals in adult social care. It heralded a major shift away from the resource led model of social care provision towards a needs led model, incorporating changes consistent with the personalisation agenda.  In a time of austerity making the aspirations behind the Care Act a reality was always going to be significant challenge for local authorities. Nationally, central Government has reduced its funding to local government by 37%. Gross spending by local authorities on social care for older people has falls by 9% in real terms between 2009/10 and 2014/14. Without income from charges and money transferred from the NHS the reduction would have been 25%. The study confirms the enormity of the challenge.

The study comes to the following conclusions:

• In the last six years austerity has brought huge pressures on the social care market. With central government grant reductions to local authorities been passed on to care providers in the form of reduced or below inflation increases in funding. Allied to pressures on social care providers in the form of shortages of nurses and care workers, higher regulatory standards and the introduction of the National Living Wage many social care providers are under unprecedented pressure.
• Social care providers are increasingly reliant on people who can fund their own care which helps cross subsidise local authority funded residents. Those providers solely reliant on local authority contracts are in difficulty.
• Home care services face particularly acute workface shortages and are in a critical condition in England that threatens to undermine the policies to support people at home.
• The possibility of large scale provider failure along the lines of Southern Cross is more likely than not and such failure would jeopardise continuity of care on which older people depend.
• Local authorities have sought to protect the most vulnerable older people with the highest needs, whilst at the same time encouraging others to be independent, drawing on the resources of their families and communities and reduce their dependence on the state. There will be increased pressure on the army of unpaid carers.
• Access to care depends increasingly on what people can afford and where they live rather than what they need. This favours the relatively well off and well informed.
• The rapid growth in delayed discharges is a manifestation of the funding challenges in the NHS.

The study identifies 3 strategic challenges facing policy-makers in shaping how the adult social care system could develop in the next five years.

• Achieving more with less – The authors conclude that policies such as personalisation, better commissioning and integrated care will not in themselves be sufficient to meet immediate needs. They argue that the forthcoming Autumn Statement must recognise the scale of the immediate funding pressures and that progress towards establishing a single pooled budget for health and social care in all areas by 2020 should be accelerated.
• A different order – if the government is unwilling and unable to provide adequate funding to support the current system it must be honest with the public about what they can expect from publicly funded services. This would involve revisiting some of the rights and duties created by the Care Act 2014 so that expectations are more aligned realistically with what the government is prepared to fund and local authorities can afford.       
• Long term reform – England remains one of the few major advanced countries that have failed to reform the way it funds long-term care in response to the needs of an ageing population. A frank and open debate is required now on how to fund health and social care on a sustainable basis  in the future that secures a cross party consensus.