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The King’s Fund has a long history of analysis and comment on social care issues but has traditionally been a health-focused organisation, so in my new role as Fellow in Social Care Policy I’m keen to help expand our work in this area.
I hope that my appointment is representative not only of a broader commitment to the importance of social care for good health and wellbeing, but also a wider recognition that without good, personalised and sustainable social care, the NHS cannot remain the vital institution it has been and must continue to be.
Simon Stevens, Chief Executive of NHS England, recognised this in his five ‘NHS tests’ which included investment and funding protection for social care services which have faced unprecedented budget reductions in most parts of the country. And the latest NHS England figures for delayed transfers of care reinforce concerns about the impact of these financial pressures – not just on social care services but across the whole of the health and care system.
In an attempt to counter these financial pressures, the government has introduced a social care precept of up to 2 per cent on top of Council Tax, and the Spending Review also announced additional funding for social care from 2017/18 through the Better Care Fund. Nevertheless, once the National Living Wage is factored in we estimate a social care funding gap of £2.8–3.5 billion by the end of this parliament. In addition, the Council Tax mechanism chosen by the government will (in the short term at least) raise most for the councils that need it least and least for those that need it most. Add this to the commitment to abolish the central government grant for councils, doubt about whether the cap on care costs included in the Care Act but shelved after the General Election will ever see the light of day, and a forthcoming consultation on the future of Attendance Allowance, and it is hard to predict what the next five years will look like for social care in terms of funding.
The financial situation is complex and difficult to assess, but given the challenges of an ageing population with a variety of long-term conditions combined with a changing family, community and cultural structure, it is difficult to be optimistic. But now is no time to stick our heads in the sand – we have to work together to reimagine social care for those who will need care and support in the next decades and beyond. Fundamental questions need to be asked about sustainable models of practice, ownership and career development for care professionals.
We have been working with the Nuffield Trust to understand the impact of public spending reductions on social care services for older people over the past five years, taking account of changes in NHS spending and activity on related services such as community nursing. We've also been asking those involved for their opinion of what social care might look like in another five years. Our team of researchers has been travelling the country talking to care home operators and managers, commissioners in local government and the NHS, local acute trusts and the local voluntary and community sector to try and understand the strategies they have used to cope with these funding reductions, what is working well and ultimately what the impact has been on the lives of older people, their carers and the wider community.
We know there is huge variation across the country in the strategies employed by organisations to implement and deal with reductions in funding. Of course some of our findings give cause for concern, but we have also heard some positive stories of innovative care models and more open and honest relationships between local health and social care leaders. Local government, the NHS and the provider sector are beginning to think about how we can work towards ensuring better social care provision for future generations.
Access to adequate social care is literally a lifeline for many people – essential for maintaining health, independence and inclusion in society. With an increasing number of people living longer more of us are likely to require social care at some point, and the changing nature of society means that we need to reassess how best it can be delivered. Our upcoming conference on the future of social care will summarise some of our research findings and look at the issues now facing the sector. I hope we can begin to build a more innovative and sustainable future for social care.