Councils in England will struggle to meet basic statutory social care duties over the next five years, a report by the Kings Fund and the Nuffield Trust has warned.
The report said the funding outlook was “bleak” and government measures would not meet the widening gap between needs and resources, which is set to reach at least £2.8bn by 2019.
This means “the potential for most local authorities to achieve more within existing resources is very limited and they will struggle to meet basic statutory duties,” the report said.
The research, which looked at the impact of changes to local authority spending on social care for older people, found 26% fewer older people were receiving support from their council in 2013-14, compared to 2008-9.
Six consecutive years of budget cuts had created a social care system ‘increasingly unable’ to meet the needs of older people, the report said, and this was leaving rising numbers of older people who have difficulty completing living tasks with no support at all.
An “unacceptable burden” has also been placed on unpaid carers, it said.
The research also found that access to social care now increasingly depends on a person’s resources and where they live, rather than what support they need. This means poorer people lose out, with those living in areas where local authorities have been “least able” to sustain spending likely to be the worst affected, the report said.
The research confirmed the ‘unprecedented’ pressure on social care providers, citing reduced councils fees, below inflation increases, staff shortages, higher regulatory standards and the introduction of the national living wage in April 2016 as factors behind this.
Home care services were ‘in a critical condition everywhere’ due to workforce shortages, the report said, and this was threatening to undermine policies to support people at home. “The possibility of large-scale provider failures is no longer a question of ‘if’ but ‘when,’” it said.
The situation for older people has also been compounded by pressures in the NHS, the research found, with overstretched GPs, community nurses and an uneven distribution of intermediate care beds all cited as factors by interviewees.
The most obvious sign of pressures on health and care budgets was the ‘rapid growth’ in delayed discharges, the report said.
But the report’s authors warned that, despite the pressures, local authority and NHS commissioners had to work more effectively together to address the problem of delayed discharges, because it was taking an ‘unacceptable toll’ on older people and their carers.
The government has introduced measures to boost adult care spending from 2016 onwards, including allowing councils to increase council tax by 2% a year up to 2020 to raise money for the service and providing more funding through the Better Care Fund from 2017-18 onwards. However, the report said that, under the most optimistic scenario, spending would rise by 0.6% a year from 2016-20, against projected cost pressures of 4% a year.
The report concluded that there were three major strategic challenges for social care policy-makers: achieving more with less, a different offer, and long-term reform.
It recommended that commissioners could continue working within existing policies, such as personalisation and integration, but these efforts would not be sufficient in themselves.
“As a minimum, the forthcoming autumn statement must recognise the scale of immediate funding pressures facing the sector by bringing forward the additional Better Care Fund money planned from 2018-19,” the report said.
The report added that if the government was “unwilling to provide adequate funding” to support the current system, it must be honest with the public about what they can expect.
“This would mean establishing a fresh and more explicit policy framework, which makes it clear that the primary responsibility for funding care sits with individuals and families,” it said.
The report added: “This will be an unpalatable future but it is one that is already upon us.”
Finally, the report recommended that a longer-term strategy for reforming the social care system was needed, because reliance on private funding was not “sufficient or equitable”.
Vicky McDermott, chair of the Care and Support Alliance, said: “Social care is life support. It’s as basic as washing and dressing. Yet while more and more people need it, less get it because of chronic underfunding. It’s just staggering that 26% fewer people now get help than just 6 years ago.
“This is the latest bit of evidence that social care is in crisis. But there continues to be no political will to address the desperate need to properly fund our social care system. The autumn statement is a great opportunity for Theresa May to address the immediate needs of social care and demonstrate she is serious about creating ‘a society that works for everyone.’”
About the research
The researchers analysed national data and evidence, as well as taking a snapshot of four local areas, looking at the relationship between the NHS and social care services in meeting the needs of older people (aged 65 and over). The project had four key lines of inquiry:
- How local authorities are dealing with current pressures, the implications for their financial sustainability and their ability to meet statutory requirements.
- The implications for the social care market, including recruitment and retention issues, the impact of the national living wage and the risks of provider failure.
- The impact on the NHS, with a particular focus on primary care, community nursing and acute services and how changes in the availability of these services have affected care needs and local authorities’ ability to meet them.
- The implications for older people’s experience of social care and the quality of care they receive.