As the Lib-Con coalition announces the launch of a commission on long-term adult care funding, Vern Pitt reminds the government of the gaps and a social worker, a service user and a care home manager call for action
The funding of long-term care in England will be considered by a commission, reporting within a year, the coalition government announced last week.
The commission comes 11 years after a royal commission on the same issue recommended free personal care for older people but this idea was rejected by the Labour government.
Whatever it concludes, it will be up to health secretary Andrew Lansley to decide whether to proceed with reform.
Meanwhile, a host of problems plagues the current system.
Between now and 2026 an extra 1.7m adults are expected to need care and support in England – the result of population ageing and the medical advances that have increased the life expectancy of people with severe disabilities.
From 2007 to 2026, the cost of state care in England is expected to nearly double in real terms, from £12.7bn to £24.1bn (at 2005 prices), if current service patterns are maintained.
Given demographic pressures, maintaining the status quo will entail more service users going without the support they need and result in further pressure on family carers.
The strains are being felt already. In only a quarter of councils do service users with less than substantial needs receive publicly-funded care, forcing social workers to ration care away from people with lesser needs.
But the projected spending cuts from the new government is likely to present a big challenge to even maintaining the status quo.
Age UK has estimated that a £1.75bn gap would open up between annual spending on older people’s care and that required to keep pace with demand if projected cuts from 2011 to 2013 are implemented.
Besides tight eligibility criteria, means-testing excludes many thousands of other people from support and contributes to the perception that the system is unfair and penalises people who have saved for their retirement.
For many in the sector, service users and carers, reform cannot come soon enough.
It remains to be seen whether this fact will force political action from Lansley and his colleagues.
Adult services social worker, London
Service user-led initiatives such as personalisation are to be welcomed as a way of reforming the way care id delivered. But local authorities are asked to implement these at a time when there are going to be some savage cuts. Managers and frontline staff are being pulled in two directions.
In the borough where I work mental health services will see cuts of several million pounds over the next three years to stave off a projected budget deficit.
The primary care trust that commissions services is asking for cuts to community teams and there’s talk of closure of the assertive outreach team because it has a high staff-to-service user ratio.
You hear all the bosses dressing it up in fluffy terms, about services being “taken out of the system”, “disinvestment” and “efficiency savings”, but what they mean is cuts, cuts and more cuts to services.
Some of the cuts will drive up efficiency but, if there’s less money in the system, service users will eventually lose out. This will only further overburden an already straining system.
The only way to get more money into the system is wholesale reform of how care is paid for. Whether it is through insurance, taxation or some other contribution, this is the only way to stave off the loss of services for those who need them most.
The times of relative plenty are over, but there is still hope if we can agree a different system. These are uncertain times in social care.
Jan Southey, manager, Croft Lodge care home, Devon
When I became involved in the care industry, my driving passion was to manage a residential home for older people, to make a real difference to peoplee_SSRqs lives and encourage others to do the same.
Care homes have two strands running through them: the care ethic that drives us to do all we can for clients and staff; and the business requirement of making money to satisfy creditors and investors.
At face value these are not comfortable bedfellows but without them a home could not survive. High-quality care does not just materialise, it takes investment, time, planning and the vision to do it well but, without enough income, it will fail.
Current funding levels from councils bear no relation to the care that older people need. Even the highest fee band would prevent adequate service provision, and this year many councils have told providers there will be no increase in fees.
It is a terrible situation when privately-funded clients subsidise those funded by social services but this is how we have survived. It would be fantastic to provide more activities, more one-to-one and have time to listen but, unless funding issues improve, we will keep on firefighting.
Something has to give. Should it be poorer quality food or less staff training? Should we lower the heating, forget the activities or compromise safety? Absolutely not. We know our responsibilities and councils should know theirs.
In our area alone, 36 residential homes and three nursing homes have closed in the past 12 years. This leaves little choice for people looking for residential care and is an indicator of what poor funding levels do.
Who will be there to pick up the pieces? Not us: we will no longer exist.
Chris Davies, disabled service user
There needs to be reform to adult social care. Staff need to be trained to understand the problems an individual faces when they first approach them and there also needs to be more funding.
If I had more funding, I could manage my money better, eat properly, relax more and have a generally better standard of living.
Because of a lack of money and care facilities, I have not taken a holiday since 1995.
My benefits just about cover my normal bills, but because some are paid weekly, some fortnightly and others monthly, I can’t always pay things on time. I then have to juggle payment dates and amounts and that nearly always leads to missed payments and having to pay extra in late payment charges and interest. If it were possible to have all the benefits I’m entitled to paid once a month, all together, life would be so much easier.
One particular incident arose when I came to renew my bus pass. I am registered blind and need someone to accompany me on the bus. The first time I was issued with a free bus pass, both myself and a companion were included on the pass. However, when I came to renew it I was charged £75 by my local council for the companion to be included. I didn’t have £75 at the time so I was without a bus pass for about six months.
Only shear determination enables me to overcome these kind of problems. I’m always trying to find money from somewhere to pay for day-to-day essentials. Although I receive working tax credit and disability living allowance, being self-employed makes it difficult to make ends-meet.
I’ve been in debt for the past eight years and have quite severe arrears on all my utility bills and rent.
This article is published in the 27 May issue of Community Care magazine under the heading Why funding must be reformed