The Health Foundation today says the new government must urgently act to stabilise and reform adult social care in England if it is to avoid growing numbers of older and disabled people being unable to access the care they need.
The warning comes as the health charity publishes new analysis setting out the priorities for reform and what it would cost to establish a fairer, more comprehensive system.
The analysis highlights that the social care system is failing on three fronts:
- First, the system is at risk of collapse because care providers are finding it increasingly difficult to provide services at the cost paid by English local authorities. The system also faces a staffing crisis: there are 110,000 job vacancies in adult social care – partly the result of low rates of pay – which is likely to be exacerbated in the wake of Brexit. This is because 8% of staff are of EU nationality and 90% of care workers earn below the proposed £30,000 salary threshold for immigrants to qualify for a work visa after the UK leaves the EU.
- Second, the system leaves large numbers of people struggling without the care they need. State funded care is only available to those with the highest needs and lowest means. As a result of cuts to funding and rising need, the number of older people receiving publicly funded care fell by 400,000 between 2009/10 and 2014/15 and is likely to have fallen further since.
- Third, the system leaves people fearful of the costs they may face in the future; those with the greatest needs – with dementia for instance – may end up paying hundreds of thousands of pounds. Under the current system, those with assets (including their own home) worth more than £23,250 must pay for their own social care. Around one in 10 people aged 65 face future lifetime care costs of over £100,000.
Meeting the prime minister's pledge to provide security for people in their old age and the government's 2018 commitment that social care will not impose additional pressure on the NHS requires investment and reform. The Health Foundation analysis shows it would cost the government an additional £7.5bn a year by 2023/24 to address the worst aspects of the crisis. This money comprises an additional £4.4bn to stabilise the current system, including growing staff pay in line with the NHS and meeting future demand pressures. A further £3.1bn is required to remove the fear of catastrophic care costs and the loss of people’s homes and other assets, by capping individuals’ costs at £46,000 over their lifetime. This is the central level of the cap recommended by the Dilnot Commission and a credible level for the cap under a reformed system.
However, the Health Foundation warns that £7.5bn in additional funding represents the ‘bare minimum’ and urges the government to go further and increase eligibility and access to social care. To restore levels of eligibility to 2010 levels would require additional funding of £8.1bn a year by 2023/24 (£15.6bn in total).
Charles Tallack, Assistant Director for Health and Social Care Sustainability and one of the authors, said:
'The current social care system in England is a shameful policy failure which is compounding the suffering of some of the most vulnerable people in our society. The number of people unable to get the care they need for things like washing and dressing is increasing; care providers are going out of business and, faced with the possibility of catastrophic costs, many people are fearful of the future.
'The new government must start addressing this systematic failure by stabilising the market, boosting staff pay and putting in place reforms that limit the costs for those most in need. This would be a welcome start but we urge the government to go further and expand access to state-funded care by reducing the threshold at which people are eligible for care.
'Successive governments have ducked the need for reform for too long, but a solution is within reach. An additional £7.5bn by 2023/24 is relatively affordable, representing less than one percent of total government spending. By taking advantage of policies already on the statute books, the government can act quickly and create a system that is fit for the future.'
The Health Foundation analysis sets out five priorities for the new government for social care:
- To stabilise the current social care system, which is at risk of collapse. The Health Foundation estimates this would cost £4.4bn by 2023/24. In 2020/21, this would cost £1bn.
- To protect individuals against unfair and catastrophic care costs. A range of approaches could be used here. The Health Foundation recommends a Dilnot-style model where the government can set the maximum amount individuals would be required to pay over their life time. An approach whereby the maximum cost was capped at £46,000 would cost government an additional £3.1bn per annum by 2023/24.
- To increase eligibility and access to social care. To reinstate levels of access to 2010 levels would cost an additional £8.1bn, according to Health Foundation analysis.
- To see the capped cost model as a flexible approach to reform. The principle of a cap on care costs was included in the 2014 Care Act and could be put in place without new legislation.
- To explore a range of options for raising revenue. After a decade of austerity in public finances, cutting other services to pay for social care is not feasible or desirable. Increases in tax revenue is likely to be needed, although borrowing could also play a part.
Notes to editors
- In 2018/19, the government spent £18bn on adult social care in England and £115bn on the NHS England budget.
- The figure of a £46,000 cap on lifetime costs is the middle of the range proposed by Dilnot in 2011, in today’s prices.
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