The future of social care has been a matter of concern for politicians and policy makers for some time. Indeed it was a question that the Blair and Brown governments wrestled with but never quite answered. It was a question that the coalition government attempted to answer and one that will continue to cause rancour under Theresa May’s premiership.
Put simply, the problem is this: the number of people who require social care is increasing, while the money available to fund social care is becoming scarcer. Unlike the NHS, social care is not free at the point of use; it is rigorously means and needs tested by local authorities and it is almost entirely provided by the independent or voluntary sector.
Facing a lack of resource and rising demand, many local authorities chose to limit access to services by raising their local eligibility criteria. This meant that people with comparatively lower needs had to either privately fund their care, rely on family or friends for support, or simply manage without. It also led to people having to turn to acute NHS services at times of crisis.
This system was not cost-effective, not in the best interests of people’s health and wellbeing, and often led people with care and support needs to face catastrophic debt or to sell their assets in order to fund care. Faced with this reality, the coalition government chose to introduce the Care Act.
The Care Act
Rarely does a piece of legislation gain the level of cross-party support and breadth of support from the sector that the Care Act enjoyed. It focussed on wellbeing, advocacy and integration with the NHS. It promoted personalised care, and guaranteed access to specialist assessments for people who are deafblind. The Care Act laid down a strong framework for adult social care and delivered many much needed reforms.
However, 18 months on many people feel that some of the aspirations of the Care Act have not come to pass. There are concerns that many councils are not providing specialist assessments for people who are deafblind and that appropriate advocacy services are not in place. There is also concern that, in spite of national eligibility criteria being introduced to end the postcode lottery of assessments and to allow more people access to services, fewer people are in fact receiving services that they require.
The Association of Directors of Adult Social Services (ADASS) reported that in 2015/16 there was a real terms decrease in the number of older people receiving services, while 24% of councils reported that they were making savings by cutting services or personal budgets. Worryingly, 82% of councils reported that savings were impacting on the quality of commissioned services.
Even the integration agenda seems to be falling short. One of the key measures used to assess the success or failure of integration is the scale of delay in transfer of care (where a person experiences a delay in their discharge date because they are waiting on a package of social care to be arranged). By this measure, integration is not happening. Between April 2015 and March 2016 the number of days lost per month to delays like this increased by 23%.
The problem is a lack of money
ADASS report that between 2010/11 and 2014/15 council adult social care budgets reduced by £4.6 billion in real terms. This puts considerable pressure on commissioners of care to make savings, usually resulting in reductions in services and reduced expenditure on existing services. As detailed above, this impacts upon the quality and quantity of care services available and has a knock on effect on the NHS.
The government have shown some recognition of the poor state of social care funding. They have committed an additional £1.5 billion to the Better Care Fund (a pooled sum of money designed to incentivise the integration of the NHS and social care) and awarded councils new tax raising powers to fund local social care provision, which could raise as much as £2 billion per year by 2020.
But critics note that this is a short term solution and is not sufficient to plug the actual funding gap in social care. A long term, sustainable funding settlement for social care is required as a matter of urgency.
As well as money, we need to keep developing new and innovative models of care, to ensure that – as demand continues to grow – everyone can access high quality, person-centred care when they need it.
Sense will continue to work and campaign with our partners to keep this on the government’s agenda and to ensure that people who are deafblind and those with complex needs are listened to.