The chief executives of the Health Foundation, Nuffield Trust and King’s Fund call for the chancellor to provide funding to deal with immediate pressures in the sector
The annual clamour for extra public spending in the run-up to the chancellor’s autumn statement is predictable. But as our three organisations have highlighted, this year it is underpinned by some brutal facts which make a strong case for tackling the growing crisis in social care.
Six years of unprecedented cuts to local authority budgets have resulted in a reduction of more than a quarter in the number of older people who are eligible for council-funded care services. This means that more than 400,000 older people who need support with the basic activities of daily living – such as washing, dressing and getting out of bed – are no longer entitled to help.
It is the frailest and most disadvantaged older and disabled people who lose out. Many are at home, often alone, and suffering in silence
These people are left without the support they need, placing an unacceptable burden on the families and carers left to pick up the pieces. With eligibility having been progressively pared back, council-funded services are now only available to the poorest and neediest, leaving more families to foot the bill or without any support at all.
The Care Quality Commission reported last month that nearly a third of services don’t meet even basic standards, putting vulnerable people at risk. It is the frailest and most disadvantaged older and disabled people who lose out. Many are at home, often alone, and suffering in silence.
Councils have dealt with cuts in their budgets by holding down the fees they pay to care providers. Operators of major care homes have warned that up to 25 per cent of places may close because of the funding pressures they are under. This would remove as many places as there are beds in NHS general hospitals.
Providers are increasingly pulling out of providing care in people’s own homes because the fees they receive from councils don’t cover their costs. The regulatory burden placed on providers is simultaneously driving up their costs.
Some providers make ends meet through the higher fees charged to those not eligible for public funding but this option is not available everywhere. It also means that people who can afford to pay are cross-subsidising the costs of care for those who can’t. Income redistribution should be the role of the tax and benefits system, not a malfunctioning social care system.
Even if the vast majority of councils levy an additional 2 per cent precept on council tax to increase funding for social care as they did this year, our analysis finds that the publicly funded social care system faces a £1.9bn funding gap in 2017. The CQC, not an organisation known for hyperbole, has warned that the social care market is at “tipping point” – a view we endorse.
Growing pressures in social care may not translate into public discontent in the short run but they are having a direct and serious effect on the NHS. The two systems are inherently intertwined – we know that every £1 spent on social care saves 35p in the NHS.
There has been an inexorable growth in the number of patients waiting for discharge from hospital after treatment. Lack of social care provision is the fastest growing cause of delays. Bed days lost as a result of delays in discharging patients who are medically fit to leave increased by nearly 30 per cent in the year to August.
The social care system is clearly not working and this must be addressed as a matter of urgency
Patients waiting for discharge can become institutionalised, lose muscle tone and the delay can permanently damage their health. If beds can’t be released then emergency patients are kept waiting in A&E, on trolleys in hospital corridors, or in ambulances. Most hospitals are running with over 90 per cent of their beds occupied, posing a risk to patient safety and placing greater burdens on staff already working to their limits.
With increasing pressure on beds, some hospitals are taking matters into their own hands to reduce delays. For example, Oxford University Hospitals Trust has recruited 60 care workers to provide social care in people’s homes to help improve discharge from hospital. Other hospitals are giving serious consideration to setting up their own care homes. Better joint working between NHS and social care services is the key to addressing these problems but this is harder to achieve when services are stretched to the limit.
The social care system is clearly not working and this must be addressed as a matter of urgency. Anyone who believes there is a role for the state to help the most vulnerable and needy members of society cannot be comfortable with the large numbers of people now denied the opportunity to live with dignity.
The urgent priority for tomorrow’s Autumn Statement is to provide extra funding for social care to deal with immediate pressures. The simplest way of doing this would be to bring forward to next year additional funding already promised for the Better Care Fund in 2018 and subsequent years. Without it, thousands more older and disabled people will be denied the support they need.
Beyond this, the now long overdue fundamental reform of the social care system is essential to put it on a more sustainable footing for the future. Doing so would be a tangible expression of the prime minister’s stated commitment to a more equal country.
Dr Jennifer Dixon is chief executive of the Health Foundation, Nigel Edwards is chief executive of the Nuffield Trust, and Chris Ham is chief executive of The King’s Fund