Social care finances have been permitted to get to such a dire state that the quality and capacity of the sector has been undermined. There is no easy solution, but Sense has developed five key principles which should inform the Government’s decisions.
Adult social care is in a state of crisis. This is a crisis of finances; between 2010 and 2015 a total of £4.6 billion has been taken from council social care budgets.
At the same time demand for vital social care services has increased, as has the cost of providing these services. This has meant fewer people with support needs have had access to social care. It has also meant that more people have been stuck in hospital because no home support was available.
This is why Sense welcomed the news in the recent Spring Budget that the sector would receive a much needed cash boost in the short-term and that the Government would conduct a review of the sustainability of social care in the long term.
The process of review will be lengthy, the issues facing the sector are so entrenched that there is no quick fix solution. As a starting point, Sense has developed five key principles which we believe should inform the Government’s decisions as it progresses its review of adult social care.
1. The sector must be financially sustainable
This must be the first priority of the Government as we move towards a meaningful reform of social care.
At present social care is not sustainable. As costs and demand continue to grow, the sector will require ever growing sums of money from the Government, which will have to grow in cash terms and also as a proportion of GDP.
The Government must set out a series of options for how society can fund social care in the long-term, guaranteeing financial sustainability and consistency for the sector.
The sector, for its part, must demonstrate value for money and quality of service provision.
2. The Government must recognise that social care is about much more than care for the elderly and supporting the NHS
When the Chancellor of the Exchequer delivered his Spring Budget statement to Parliament, he stated that the investment he had committed to social care would “enable elderly patients to be discharged when they are ready, freeing up precious NHS beds, and ensuring that elderly people are receiving the care they need.”
In saying this, the Chancellor displayed a misunderstanding of what social care is and the value it has – a misunderstanding that is shared by much of the media and many other commentators.
Social care is not exclusively care for older people, and the growing demands on the sector are not exclusively driven by the rate of ageing in our society.
At present almost 33% of people who use long-term social care services are working age adults. Nearly 50% of total expenditure on social care services is on working age adults. Social care supports people at any stage of life to achieve the outcomes they want. This includes adults with learning disabilities and complex needs.
The number of adults with learning disabilities is due to increase by 11% to over 1.1 million by 2030.
The Government must recognise the huge variety of social care provision that exists and the wide range of people it benefits. To say that social care is care for the elderly is reductive and wrong.
3. Unmet need for social care services has grown, this must be addressed
Over recent years the number of people with care and support needs who receive no support whatsoever has increased.
At Sense we have calculated that there are over 108,000 adults with learning disabilities who have moderate or severe care needs who receive no social care. Age UK has reported that 1.2 million people aged 65 years or over do not receive the social care they need.
This is a symptom of the fact that eligibility for social care services has been tightened and people with less acute needs are denied the care they need.
When people are denied the social care they need, it impacts upon their wellbeing and means a likely deterioration of their condition.
We are calling on the Government to address the growing issue of unmet need and ensure that everyone with care and support needs receives social care in a timely fashion, at the point of need rather than at the point of crisis.
4. The sector must be supported to deliver high quality, person centered services
The Care Act 2014 set out a legislative framework for the sector to deliver personalised care and support. Sense was active in shaping the legislation and we strongly support its intentions and spirit.
All social care should be commissioned and delivered with a focus on people’s desired outcomes. It should also focus on supporting and developing people’s independence, taking an asset based approach to care planning.
The Government’s plans should include provisions to support commissioners and providers to work together to develop new and innovative models of community-based care. As opposed to more traditional models of care, that can sometimes have a ‘time and task’ focus rather than an outcomes focus.
5. Social care must be integrated with the NHS and care should be more focused on community settings rather than acute hospitals
For social care to be effective, it must work in partnership with the NHS.
This can improve people’s experience of health and social care, particularly if they have to transfer between the two sectors. However, integration remains the holy grail of the sectors.
The NHS is working with local authorities to develop Sustainability and Transformation Plans (STPs) which should offer a route to meaningful integration. It is vital that social care is not forgotten in these plans, and is included as an equal partner with the NHS.
A key part of this should be recognition that care outside of hospital, in community settings, is often more beneficial to an individual’s health and wellbeing and often more cost-effective.
The social care sector can, and indeed should, help deliver this transfer of care settings from hospital to the community.
It is in the interests of everyone that this process of reform and review is a success. We hope to work closely with the Government and across the sector to make sure it is.
This will be the thirteenth review of social care since 1998, and of those reviews none have been of great consequence; we can’t let this opportunity to reform and find a sustainable future for social care slip away.
Let’s just hope it’s thirteenth time lucky.