Social care: a system on the edge

Someone holding a woman's handThere is a consensus across health and social care that the system is in a dire state. Social care has now seen several years of budget cuts, while demand for services and the cost of providing services has steadily increased.

This consensus was echoed in a recent debate on social care in the House of Commons, in which speakers from all parties made clear their concerns about the state of social care funding and the need for a long-term, sustainable funding model. Opposition MPs called on the government to address these concerns urgently.

Sense too is calling on government to address the growing deficit in social care as a matter of urgency in the Autumn Statement, which the Chancellor Phillip Hammond will deliver on 23 November.

The current state of adult social care

Expenditure on adult social care services has decreased in real terms by 8% since 2010. While local government and providers have made some efficiency savings to make up the growing funding shortfall, the system is now beginning to creak under the pressure.

The Care Quality Commission (CQC, the independent regulator of health and social care in England) recently took the bold step of publically stating that adult social care was at a ‘tipping point’ and that greater funding was needed urgently. A group of independent health charities have forecast that the adult social care system will face a deficit of £1.9 billion next year, unless the government takes urgent action.

This is clearly unsustainable, and impacts on the health and wellbeing of those people with care and support needs who rely on services to maintain and develop their independence. Data shows that there has been a 26% decrease in the number of people receiving social care services since 2010.

People with sensory support needs have been particularly affected. Sense has reported that over the last year alone, there was an 11.4% decrease in the number of people receiving a sensory support service.

This has serious consequences for people with long-term care and support needs.

When social care is under-resourced, and fewer people are able to access services, it means that more people have unmet care needs. As a result they turn to NHS services like A&E at times of crisis. In this situation people with unmet needs will struggle to maintain their independence and access their community and, as a result, their health and wellbeing will suffer.

It also means that the NHS faces unnecessary demand for its services. Over the last decade the number of admissions to hospital each year has increased by over 28%. A more worrying statistic is that the number of bed days lost in NHS hospitals because people were waiting for social care hit a record high of 196,000 in September 2016. This is a figure we expect to rise over the winter months; it will be made all the worse if this winter is a bitter one.

What has the government done so far?

The government has acted in response to widespread concern about the future of social care and its relationship with the NHS.

Last year, in the Comprehensive Spending Review, the then Chancellor George Osborne announced two measures to address the funding deficit in social care.

Firstly, he announced that councils in England would be given powers to increase council tax by 2% – and that the money raised by this 2% precept would be used to fund adult social care services within that council.

The government stated that this could raise £2 billion per year by 2019/20. This year it has raised just £382 million. The £2 billion figure will only be reached if every council in England implements the 2% increase every year up until 2019/20.

The second announcement the Chancellor made was that the Better Care Fund would be ‘improved’, receiving an additional £1.5 billion by 2019/20. The Better Care Fund is a pot of money, designed to encourage the NHS and social care to integrate, the money does not necessarily go to front-line services. The main criticism of this announcement, however, was that the new money would be introduced in back loaded increments, meaning that social care would receive no new money in 2016/17 and little over £100 million in 2017/18.

This is problematic given the immediacy of the funding concerns that the sector is facing. So while the sector will always welcome funding injections from government, many criticised these two measures as providing too little, too late.

What needs to happen next?

There needs to be an immediate funding injection into the adult social care sector. If this does not happen we risk seeing the quality, quantity and sustainability of the sector undermined. We believe that this must be done in the Autumn Statement.

However, new funding will only provide temporary relief, as the pressures on the sector will continue to grow in line with demographic forecasts. In the long-term we need a sustainable funding settlement for an integrated health and social care sector. This must now become a priority for the government.

Providers and commissioners also need to look into innovative models of care and into developing person-centred services that enhance people’s independence and wellbeing.

For example, Sense offers supported living services to people with a range of complex needs. The supported living model can provide people with the support to live an independent life, participate in the community and support their long term health and wellbeing.

In short, Sense wants to see a well-funded, sustainable, integrated health and social care sector, that provides high-quality, personalised care. Every member of society who needs that support should be able to live a full and independent life.

Author: Jonathon Holmes

Policy Advisor (Health and Social Care) at Sense

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