22 September 2016: The King’s Fund assistant director of policy Richard Humphries is not given to wild exaggeration, so when he uses these terms to describe the state of our older people being denied the care they need to live with independence and dignity, a new prime minister whose first promise was a more equal country that works for everyone must we hope take notice.
The joint report by the King’s Fund and the Nuffield Trust on “Social care for older people: Home truths” (15 Sep 2016: Mr Humphries was a lead co-author) is all the more devastating for the measured way it exposes the failures of successive governments to grasp the nettle of social care, resulting in
“a failing system that leaves older people, their families and carers to pick up the pieces.”
The report also pointed to the rapid growth in delayed discharges from hospital, which are at the highest level in history, as a symptom of issues with social care.
As R&RA members will be only too well aware, the basic reason for this growing scandal is not hard to identify: the well-worn tactic of governments to put responsibilities on local authorities but deny the funding to meet them.
Councils’ adult social services budgets were cut by £4.6 billion, or 31 per cent, over the last 5 years (ADASS, 22 Mar 2016). And the elderly have borne the brunt of the cuts. Figures show a 26% reduction in the number of older people receiving care funded by local authorities, from more than 1.1 million in 2009 to 853,615 in 2013-14 (Kings Fund/ Nuffield Trust report).
The huge unintended cost of delayed discharges, and unnecessary hospital admissions when older people could be better looked after by funding primary care or at home, was also emphasised by the assistant director of policy at the NHS Confederation:
“Insufficient social care funding is now the most urgent threat to the NHS and the wider health and care system. Shortages of home care staff and affordable care home places mean older people are often stuck in hospital, putting both their lives and vital NHS processes on hold. The number of older people needing care is increasing and yet we are continuing to put less money in.”
Nor have governments been anything like frank enough about what recent tax and spending priorities have actually meant. The reality can come as an unpleasant shock to a generation brought up to expect their basic health and care needs in old age will be covered by the contributions and taxes paid during their working lives.
“No one can predict whether they will have care needs later in life. But … most will discover that, unlike a health problem, where care is free, they somehow have to manage themselves.”
– (Ruth Thorlby, deputy director of policy at the Nuffield Trust and a co-author of the report).
The report also makes clear the blame cannot be shifted on to councils or care providers:
“Our research found that local authorities have done their best to make savings, while protecting funding for the poorest, but care providers are struggling on the low fees councils can afford.”
And these conclusions were supported by parliamentary and health service ombudsman Julie Mellor:
“Our investigations have uncovered that older patients often fall through the cracks between health and social care when discharged from hospital, causing them and their families untold distress and suffering.
The issues of funding and lack of integration between health and social care need to be addressed so that older people get the support they so desperately need.”
Is it too much to hope that with so many respected voices emphasising what R&RA’s experience already tells us, the government and public will understand the need for urgent action and a real increase in public funding for the care of our older people?
In the sober (and sobering) wording of the report:
Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care. The Care Act 2014 has created new demands and expectations but funding has not kept pace. Local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties.
Or in the more graphic quotation from the voluntary and community sector that heads its chapter on “The future of social care over the next five years”: