Key points
- England has an ageing population with increasing levels of disability and need – by 2026 the number of people aged over 85 is expected to have doubled; adults with a learning disability will increase by 30% over the next 20 years, and dementia numbers will double over the next 30 years (Securing good care for more people). The ratio of working-age people to retired people will fall from 4:1 to 3:1 by 2029.
- Social care funding has increased in real terms for the past decade, but has not kept pace with demographic trends. Over the last five years for example public spending on social care for older people has barely increased, yet the number of over 85s has risen by a quarter.
- There are wide geographical variations in funding – in part because spending on social care is handled by local councils, whose circumstances vary. Local social care services are funded in an entirely different and much more localised way than the NHS. This reflects the continuing legacy of the settlement after the second world war in which the NHS was established as a centrally directed service, largely free at the point of use, while personal social services were the responsibility of local councils and subject to means-testing. Some of the resulting variations in local services has given rise to concern about a ‘postcode lottery’ in care.
- Some of these differences in cost and performance across a number of measures – for example, emergency hospital admissions, delayed transfers – reflect different relationships between health and social care (Social care funding and the NHS: an impending crisis?) The government has pledged to facilitate closer integration so that people can receive a more joined-up service and proposes to give local councils the lead role in promoting integration through new Health and Wellbeing Boards.
- The widening gap between needs and resources has seen councils tighten their eligibility criteria so that over three-quarters restrict help to those with substantial or critical needs only. One estimate suggests that 800,000 people receive no formal support from public or private agencies (Age UK – Crisis in Care). The CQC has warned that access to publicly-funded care will become further restricted as a result of funding and demographic pressures. The growth of property ownership and pensions over the last 60 years has seen more people required to pay the full costs of their own residential care because their assets exceed the current limit of £23,250. This is has fuelled dissatisfaction with the current funding system and exposed how poorly it is understood (Caring Choices).
- There is universal agreement that along with rising expectations and wider social changes, the current means-tested system of social care is not sustainable. Previous attempts at reform have included the 1999 Royal Commission With Respect to Old Age and the 2009 White Paper Building the National Care Service.
- In response to growing concerns, the coalition government identified additional resources in 2010 – including £1b from the NHs budget – and to commission an independent Commission on the Funding of Care and Support led by Andrew Dilnot to report by the end of July 2011. The report will make recommendations on how to achieve an affordable and sustainable funding system for care and support, for all adults in England, both in the home and other settings.
- Following a major review the Law Commission has recommended radical reform of adult social care law which dates back to 1948 and consists of a complex and confusing patchwork of legislation. This would be replaced by a single, clearer, modern statute and code of practice that would pave the way for a coherent social care system. Under the reforms proposed in our report, older people, disabled people, those with mental health problems and carers will, for the first time, be clear about their legal rights to care and support services. Local councils across England and Wales will have clear and concise rules to govern when they must provide services.
- The coalition government has pledged to consider the recommendations of the Law Commission and the Dilnot Commission, alongside its previously published Vision for Adult Social Care. It intends to publish a White Paper on social care reform in December 2011 followed by legislation in the next parliamentary session.
