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What’s gone wrong with social care

October 20, 2017

 

Ministers in England have said they are looking for a solution to the problems in social care. That has raised hope that next month's Budget could include measures to tackle what many describe as the crisis facing the sector.

But what exactly has gone wrong? And who's affected?

 

Social care - organised by councils - is a broad term that covers everything from children's social workers and fostering through to services for disabled adults and the care provided to people in their old age. But some have been affected more than others.

 

1. Social care spending has stopped rising

Over the years, more and more has been spent on services. The growth in the population, the fact people are living longer and those with disabilities are more likely to survive to an older age are all contributory factors. But this upward trend in funding has tailed off in England over the past decade.

 

You do not have to look far to find the cause of this. Central government funding for councils was cut by a third during the last parliament.

 

2. Councils are prioritising care

Councils have tried to protect social care. The proportion of their budget being spent on these services has increased over the years and now well over half of their spending goes on care services.

 

But that, of course, has meant deeper cuts elsewhere - in libraries, leisure centres and refuse collection.

 

3. The NHS is propping up care

What's more, if you delve further into the figures you can see even this level of spending has been maintained only with a little help from elsewhere.  A third of last year's £24bn budget went on children.

 

That left just over £16bn for adults. But nearly £2bn of that was thanks to a transfer of money from the NHS into care services, ordered by the government.

 

4. No care means patients get stranded

If people are not given the support they need in the community, they can end up in hospital.

 

And if it's not available when they are then ready to be discharged, they can end up stranded on wards - doctors will release frail patients only if they know there are care packages in place in the community.  The number of delays of this sort has nearly doubled in five years.

 

Not all of these delays are down to a lack of social care, but it is the fastest growing reason for them.  And when beds are occupied by patients who cannot leave, it gets more difficult to admit new patients.

 

That's one of the reasons why we have heard so much about lengthening trolley waits and worsening waiting times in accident and emergency departments in recent months.

 

5. Councils are looking after fewer older people

This situation is understandable. To make savings, councils have started to ration care, particularly to the elderly, rather than younger adults with disabilities.

 

The number of older people getting care from councils has fallen by over a quarter between 2008-09 and 2013-14.

 

We don't know what has happened since 2014, as the way the data is collected has changed. Although, it's pretty clear there hasn't been a huge turnaround.

 

Councils agreed to help less than half the older people who approached them for help last year.

 

What about elsewhere in the UK? Whereas all adult council care in England is means-tested - those with assets of over £23,250 pay the full costs of their care - Wales, Northern Ireland and Scotland have slightly different systems.

 

In Wales, the cost of help in the home for daily tasks such as washing and dressing is capped at £60 a week, in Northern Ireland it is provided free to the over-75s, and in Scotland personal care is free whether the individual is in their own home or a care home.

 

Many argue these systems are more generous. That may be so. But all have had to ration services in recent years by restricting access to only the people with the most severe needs.

 

6. People are being left to fend for themselves

The result of this is that people make their own arrangements. Four in 10 people in care homes pay for themselves.

 

Others rely on family and friends to look after them. But growing numbers are being left to struggle on with no or little help.

 

The charity Age UK has been charting this. It estimates the number of those falling into this group has risen by nearly 50% since 2010, to 1.2 million.

 

These are people who have pretty substantial needs. They cannot wash or dress themselves. They may struggle to go to the toilet. The stories they tell are heart-breaking.

 

7.  The population is ageing

So what does the future hold? The population is growing older.

 

And their needs are getting ever more complex. At the age of 65, one in six people has trouble with daily living - washing, dressing or eating. By 85, half do.

 

8. Council tax bills are rising to help councils cope

Ministers have already taken steps to relieve the pressure.

 

The health service and councils are being encouraged to work together on joint projects. They have also given councils permission to increase council tax to pay for social care.

 

But there is a limit to how much this will bring in. This year, councils have been allowed to increase household bills by 2%.

 

Most have done so, but it is raising less than 3% of what councils plan to spend on adult social care from their own funds, once NHS money has been deducted.

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