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SOCIAL CARE

Later Life Ambitions Policy Positions

Many of us will require some level of care when we get older. Whilst life expectancy is increasing, there are also a growing number of people spending their later lives unwell, and by 2030 the number of older disabled people is expected to double.

As the population aged over 65 grows from 8.5 million in 2010 to nearly 13 million by 2030, the need for better care in later life will become increasingly acute.

At the same time, social care is facing a crisis. The Local Government Association estimates that adult social care faces a funding gap of £2.6 billion by the end of the decade.

The difficulties faced by the care sector are often increased due to the gaps between health and social care, and closer working will support the NHS to operate more efficiently. However, the service also requires the Government to commit to increased levels of funding over the short, medium and long term.

NHS sustainability

Good, efficient social care services will help to reduce the current financial pressures on the NHS by reducing the length of a person’s stay in hospital. Keeping older people in hospital longer than necessary increases bed shortages and diverts resources from patients requiring acute care.  Longer stays in hospital can also have a negative impact on older patients’ health as they quickly lose mobility and become at risk of social isolation.

The National Audit Office, Parliamentary Health Service Ombudsman and the Public Accounts Select Committee have all reported on the substantial cost of delayed discharges to the health service. The NAO estimated that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.

Workforce capacity issues in health and social care organisations are making it difficult to discharge older patients from hospital effectively. In addition, while hospitals are financially incentivised to reduce discharge delays, there is no similar incentive for community health and local authorities to speed up receiving patients discharged from hospital.

Health and social care services should work more closely to relieve the financial burden on the NHS and ensure that patients receive the most appropriate care. In addition, social care services must be properly funded in order to increase places and reduce the number of older people kept in hospital unnecessarily.

We welcome the re-branding of the Department for Health as the Department for Health and Social Care and hope that this signals are more joined-up approach between the two areas.

 

Uncertainty

Millions of older people are uncertain or unaware as to how they will be cared for in old age. Almost one in four (24%) people in England are unaware that the Government does not fully fund social care for older people. The reality is that:

  • 45% of people pay entirely for their own social care and support
  • 48% pay for nursing home placements
  • 20% are paying in full for home care support

With such a complex system, it is welcome that the Government is now developing a Social Care Green Paper to set out plans for how to improve care and support for older people. Although the Green Paper is expected to be published in the summer, it will be a number of years before resulting legislation is passed. Later Life Ambitions is therefore calling for the immediate introduction of the Dilnot recommendations and the implementation of the care cap.

We also call for the creation of a cross-party working group to take the politics out of social care. The group should set out a strategy for funding social care, reporting to the Care Minister, Caroline Dinenage.

Care Act 2014

The Care Act 2014 has replaced nearly all the old legislation.

It sets out how people’s care and support needs should be met and introduces the right to an assessment for anyone, including carers and self-funders, in need of support.

The ambition of the Act is to enable people to have more control over their own lives. The Government (correctly) believes that support should be less about firefighting and more about prevention, with the ultimate goal of helping people stay independent.

Most of it came into force in England from April 2015. However in July 2015, the government decided not to introduce its signature proposal to “introduce a cap on the costs that people will have to pay for care in their lifetime” until 2020.

The Chancellor’s commitment in the Spring Budget 2017 to provide an additional £2bn for social care over the next three years is welcome, but falls short of the amount required to close the social care funding gap. We agree with the Communities and Local Government Select Committee that expenditure on adult social care needs to rise as a proportion of total public expenditure.

 

Local authority precepts

In 2015, councils with responsibility for social care were given the power to add a precept to council tax bills to cover the rising cost of social care. Councils are allowed to increase council tax by up to 3% in 2017/18 and 2018/19, on top of any rise in council tax that would happen anyway.

However, even this opportunity for future revenue falls short of what is needed. The policy also favours wealthier areas (where income from council tax bills tends to be higher and demand for social care is lower) and therefore leads to a postcode lottery of care provision.

Whilst we want to see additional funding streams for social care this should not be solely the responsibility of the taxpayer.

Should the Government decide to raise revenues to fund social care, LLA would want public assurances that this money would be ring-fenced, like the social care precept for local authorities. Such an approach is vital to ensuring public support for such an increase in taxation.

 

The private care market

There are serious issues with the private care market. In March 2017 BBC Panorama reported that 69 home care companies had closed in just three months (between December 2016 and March 2017), and found that one in four of the UK’s 2,500 home care companies is currently at risk of insolvency. The Government needs to urgently set out provisions to deal with demand should care home companies continue to close at this rate. In addition, more care firms are cancelling contracts with councils, citing the reason as an inability to deliver the necessary level of care for the councils’ fee.

There are also concerns about the high cost that self-funders pay in care homes and how this is used to cross-subsidise those who rely on the local authority to cover the cost of their care. For example, a typical self-funding resident in a care home in England is charged £754 a week while their local council pays only £511 for exactly the same provision.

 

Impact of Brexit on social care

Many health and social care professionals currently working in the UK come from other EU countries. This includes 55,000 of the NHS’s 1.3 million workforce and 80,000 of the 1.3 million workers in the adult social care sector. About 90% do not have British citizenship and while Brexit negotiations continue, their future immigration status remains uncertain.

As such, Later Life Ambitions is delighted that the Government has pledged to allow the 3 million EU nationals living in the UK to stay permanently, with many of the rights that they currently enjoy.

Furthermore, Later Life Ambitions is concerned that a system already suffering due to high demand and a funding shortfall may collapse entirely if it is suddenly hit by a worker retention and recruitment crisis.

Contact

If you would like any more information about the LLA policy positions, please contact Tristan Westgate at laterlife@connectpa.co.uk or call him on 020 7592 9592.

LLA is calling for

  • The establishment of a cross party consensus to agree a long-term sustainable plan for social care.
  • Closer working between health and social care services to relieve pressure on the NHS and improve hospital discharge rates.
  • Immediate introduction of the Dilnot recommendations in addition to urgent interim funding while the Government consults on a long-term sustainable solution for social care.
  • Government expenditure on adult social care should rise as a proportion of total public expenditure, with an urgent review of how to fund social care in the long term.
  • Assurances that any revenue raised to fund social care will be ring-fenced.
  • Government assurances over the ability of EU nationals working in adult social care to remain working in the UK post-Brexit.
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