Care services are failing old people, concludes major The King's Fund inquiry

Services for older people who need care in London are failing, according to a major inquiry, The Business of Caring, published today. It concludes that the capital's care system is under-funded and under-staffed and offers little in the way of choice and quality. And it warns that unless urgent action is taken even more older people will suffer from poor care in 20 years' time.

The year-long investigation by The King's Fund into care services in the capital found major shortcomings, with older people and their carers experiencing:

  • restricted access to care and practical support
  • limited choice and control over care services
  • being put at risk from untrained and unqualified staff
  • hardship caused by inadequate funding and controversy about who pays for long-term care.

The inquiry concluded that at the root of these problems is a complex, care system that relies on a mixture of market forces and government policy to deliver the right quality and quantity of services. The Inquiry found that many older people were highly vulnerable consumers in this market as they often lack knowledge of what is available, opportunities to influence the quality of care on offer to them, and money to purchase what they need.

Inquiry chair Julia Unwin said:

'This Inquiry shows that care and support services for older people in London are in a sorry state. Many older people simply aren't getting what they need and steps to improve the situation are being hampered on several fronts. At the root of this is a poorly developed care market that is failing older people and their carers. The government is increasingly looking to empower older people through the use of direct payments and individual budgets, but this will not be successful unless there are sufficient services of the right kind that people want to buy.

'We believe that unless there is serious investment in developing the care market to offer the quality and diversity of services people rightly expect, then older people won't be able to exercise their consumer power to get the right care for them. The government has outlined its vision for the future of social care in its recent green paper, but we are not convinced that existing funding levels will deliver this ambitious agenda. We urge ministers to review the decision not to increase funding for adult social care and older people in the short term. With services for older people currently high on the political agenda, the time is now right to take concerted action.'

The King's Fund inquiry – led by an independent committee made up of people with experience and expertise in health, housing and social care – gathered evidence from several hundred older people and their carers, care staff and managers, regulators, and local authority and NHS commissioners, plus special research studies into the state of care services for older people in London. It examined many of the characteristics in London that create special challenges for the care of older people, including above average care home fees, more acute staff shortages; higher rates of mental illness and other social problems; and high land and property values. Among the major findings are:

  • Limited choice - whether older people can pay for their own care or not, they are less likely to be able to choose a care home near their own community than older people outside London. Older people have little say about their care and limited control over the kind of help that is offered in their own homes
  • Service shortages - a serious shortage of services for older people with mental health problems such as dementia, depression and anxiety, while there are not enough care services catering for people from black and minority ethnic communities
  • Staffing difficulties – London's care services continue to suffer from severe staff shortages, high turnover and a lack of trained staff
  • Funding – throughout London, councils are struggling to meet the needs of all but the most dependent older people. In some parts of the capital, resources for older people continue to be diverted to services for children and families as councils face reductions in grants and rising costs. High costs deter independent service providers from investing in extra care housing and nursing homes in the capital.

The Inquiry report, The Business of Caring, makes 30 recommendations for action to improve care services in the immediate and longer-term future. The recommendations relate to:

  • investing in the care market to strengthen consumer power, encourage the growth and diversity of services and to improve their overall quality
  • reforming policy so as to ensure equality of opportunity for older people and a culture that focuses on their rights as well as their needs
  • improving poor services for specific groups - in particular, tackling shortages in services for older people from black and minority ethnic communities and for older people with mental health problems
  • increasing overall levels of resources in older people's care.

The King's Fund chief executive Niall Dickson said:

'This substantial inquiry has relevance nationally - many of these findings are not peculiar to London. This is a story of a market that is failing and needs to be improved in many ways, it is the story of a neglected area of our national life with muddled policy and what looks like inadequate resources. If we got it right more older people could lead independent lives and exercise the choice and control we all desire.

'And of course funding remains at the heart of all these problems. It's an issue we can no longer avoid. That is why we have commissioned Sir Derek Wanless to carry out a fundamental review into the long-term demand for and supply of social care for older people in England and he will map out the likely costs over the next twenty years.'

Read the inquiry findings: The Business of Caring: King's Fund inquiry into care services for older people in London

Notes to editors: 

1. For further information, interviews or a copy of the report, please contact the King’s Fund media and public relations office on 020 7307 2585, or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.

2. The King’s Fund set up an independent committee, chaired by Julia Unwin OBE, to undertake the Inquiry during 2004, with support from a secretariat involving staff at the King’s Fund. Its secretary was Janice Robinson, senior adviser in health and social care, King’s Fund. She was assisted by Penny Banks, fellow in social care, King’s Fund, and Sarah Robinson, administrator, King’s Fund. The members of the inquiry were:

  • Ratna Dutt, Director, REU
  • Peter Fletcher, Director, Peter Fletcher Associates
  • Howard Glennerster, Professor Emeritus, London School of Economics
  • Tessa Harding, Head of Policy, Help the Aged
  • William Laing, Director, Laing & Buisson
  • Leslie Marks, Chair, Bromley Council on Ageing
  • Loraine Martins, Director of Diversity, Audit Commission
  • Jo Moriarty, Research Fellow, Social Care Workforce Research Unit, King’s College London
  • Peter Smallridge, Chair, Ashford Primary Care Trust
  • Peter Westland, Commissioner, Commission for Social Care Inspection
  • Peter Williams, Deputy Director, Council of Mortgage Lenders.

3. Download the Inquiry report, The Business of Caring: King's Fund inquiry into care services for older people in London from The King's Fund website.

4. New research - the Inquiry committee also commissioned four new research studies, and a briefing on housing and care issues, from researchers with extensive experience in this field. Their work provided the committee with a wealth of detailed information that helped it to drill down on some of the broad issues raised in other evidence presented to the committee. The research studies have been published as working papers to accompany the committee’s final report. They look at commissioning care services in London; social care expectations of the next generation; understanding public services and care markets; and trends in the London care market 1994–2024.

5. The King’s Fund commissioned former NatWest Group chief executive Sir Derek Wanless in January to carry out a fundamental review into the long term demand for and supply of social care for older people in England. This report will follow the two independent reviews Sir Derek conducted for the Government on future health care spending in the UK and on public health in England. Sir Derek will report back the findings of his review by the Spring of 2006.

6. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.