I’ve been in the House of Commons today talking to a newly-established All-Party Group on Social Care. There can be no doubt that consistent under-funding of social care is leading us to a crisis where councils will have to turn people away that we know desperately need help. The Adult Social Care Green paper which was promised in July 2017 is, as yet, unwritten. Until it is councils the NHS, families, communities and individuals will be unable to plan for the future.
Here are some of the key facts that show just how desperate the situation is:
- Councils have worked hard to protect adult social care spending. We estimate that between 2010 and 2020, English councils will have managed reductions to their core funding from national Government totalling £16 billion. By comparison, over the same period from 2010 to 2020 we estimate that NHS spending will have increased by just over £20 billion.
- Councils spend over £15 billion on social care every year. ‘Core pressures’ of demography, inflation and National Living Wage means that the gap in adult social care funding will be £3.56 billion by 2025 just to continue provision at its current rate. This is more than five times the amount spent annually on councils’ park services and close to the cost of councils’ waste management spending for a year (£3.6 billion).
- By 2019/20 councils could be spending as much as 38 pence out of every £1 of council tax on adult social care. This is up from just over 28 pence in 2010/11. As councils spend more on social care, less money is available to keep other valued local services running, such as libraries, community centres, parks and playgrounds. These are valued and vital in their own right, but they also play an important role in supporting the wider wellbeing agenda.
- Adult social care providers are under impossible pressure. In more than 100 council areas, residential care home and home care providers have ceased trading, or handed back their contracts to councils, affecting more than 5,300 people in the last six months. This is a direct result of funding pressures.
- Carers UK research shows that 72 per cent of carers in England have suffered mental ill-health as a result of caring and 61 per cent had suffered physical ill health. Our health and care system could not survive without the vital help from unpaid carers.
- Age UK estimates that there are 1.4 million older people who do not receive the help they need. That includes 164,217 people who need help with three or more essential daily activities like washing, dressing and going to the toilet but receive no help at all from either paid services or family and friends.
- Of those living in care homes, 45 per cent pay for their place themselves, with 11 per cent paying a top-up, and 35 per cent of places being state-funded. The remaining 9 per cent of places are funded by the NHS.
- Between 2008 and 2039, 74 per cent of projected household growth will be made up of households with someone aged 65 or older.
Adult social care and support is a vital service in its own right. It helps people of all ages to live the life they want to lead. It binds our communities, helps sustain the NHS and provides essential economic value to our country.
After years of underfunding going back to the 70s the adult social care and support sector is at breaking point. First and foremost, it is impacting on the quality of life of people who have care and support needs. It is also creating a fragile provider market, putting workforce and unpaid family carers under further strain, and impacting on social care’s ability to help mitigate demand pressures on the NHS.
A sustainable NHS is not possible without a sustainable social care sector. If the NHS is going to thrive over the next 70 years, we need to make sure our social care services are properly funded and sustainable. To do this we need cross-party cooperation on the debate about the future of adult social care – in particular, how it is funded.
Councils have protected social care relative to other services. But the service still faces a shortfall of £3.6 billion by 2025. This is needed simply to keep on providing existing support at current levels and would not meet the cost of changing the current model of provision, or include the funding needed to tackle under met and unmet need.
Whilst I welcome recent cash injections for social care, to help tackle winter pressures amongst other things, we are clear that pressures are year-round and short-term bailouts are not the answer. The Government needs to find a long-term funding solution for adult social care and support. Short-term pressures cannot be managed through the social care precept and it is vital that the Government uses the Spending Review and its forthcoming green paper to deliver sustainable funding for social care for the long-term.
In the absence of the Government’s green paper, the LGA produced its own. ‘The lives we want to lead: the LGA green paper for adult social care and wellbeing’ was published in July 2018 and posed a series of thirty questions covering social care, public health, health and wider wellbeing. The response to our consultation published in November 2018, set out key findings, implications and recommendations, including on how to fund social care.
Councils’ have seized new opportunities to make health everyone’s business since taking on responsibilities for public health. In the past six years, 80 per cent of the 112 indicators in the public health outcomes framework have been level or improving. This has been achieved despite cuts to public health budgets of £700 million by the end of 2020.
The publication of the NHS Long Term Plan is welcome and we are pleased it sets out an ambition to build a new service model for the 21st century with health bodies working in partnership with local government. However, the ambition can only be fully realised if adult social care and public health services in councils are also properly funded.
The problems of lack of availability of quality social care hits hard not only at the elderly but at all adults with acute physical and mental health problems. It hits hard at their families and friends and the communities in which they live. In short, they affect all of us and they don’t do so now they will do in the near future.
We need to discuss these issues; plan for them and deliver a strategy that deals with them. I bet you won’t hear a peep from Tory Leadership contenders about this vital and urgent issue.