The future of social care

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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.


christine may

transition worker,
Comment date
16 May 2017
PH the challenge is indeed a great one, but I want for one moment to focus on patient participation. I am not sure If i am a lone voice - in the current wave of patient participation. There is a danger that those in charge are moving the gate keeping to the patient and by default the responsibility for the outcome. We use to have GP's who treated effectively but now the fear of litigation - your referral to the specialist is a given simply by request and effective gate keeping is lost. So not only the unwell but the worried well block the system. Which in turn produces more complaints and what appear less successful outcomes. While some involvement is good there are dangers in shifting the focus to the patient - what do you want and how do you want it - with little evidence of need. Then the failure is not down to the Dr's but the patient . This government sell of openness because 'we are listening to you' - is not what I believe the profession or the patient want - and those really fail and unwell people just want the Dr treat based on their on skill and expert knowledge.

george coxon

various inc Devon Care Kite Mark Chair,
Comment date
23 June 2016
Really excellent to have you now fully installed and active at the KF. A vital part of the H&SC integration plan is extending the 'reach' into SC away from the dominant health agenda as you mention - you and I have had several conversations over time and exchanged positive links including you coming down to Devon on 2 separate occasions in recent months in your previous role at SCIE - this, by its self, is a testimony to your commitment to engagement.

Amongst my wide H&SC portfolio (as I refer to it) is the role I have as Co Chair and care home representative at our Pan Devon H&SC Collaborative with its excellent representation of likeminded commissioners and providers, CQC seniors and a varying list of planners, policy leads and presentations about Prevention, Assisted Technologies and Innovation - This week's meeting alone heard about an award winning impactful programme of addressing care home upskilling addressing the numbers of people admitted to acute care. You mention how difficult it is to be optimistic - which I partly agree with - but you know me well enough to know I am a determined enthusiast for 'can do' not 'yes but' and despite being a self confessed 'Disruptive Innovator' I will continue to make a lot of much 'positive noise' about collective working sharing risk and seeking to forge ever greater alliances across the great H&SC divide. I will be saying a few things at the NEW FUTURE FOR SOCIAL CARE event on the 12th July (thanks for the invitation by the way) about genuine CREDIBLE LEADERSHIP, RECEPTIVE FOLLOWERSHIP, INCLUSIVE OWNERSHIP and RESPECTFUL PARTNERSHIPS

I really like your term Reimagine Social Care - I will certainly be using that expression locally and as far as Shirley and the elephant in the room goes we can deal with this with the right energy and spirit - with a genuine 'in it together' culture and ethos - bit size chunks they say - we've made good progress in our Devon Care Kitemark but as we still say - its a journey and we're not there yet. I hope the STPs, the BCF progress plans and NHS Vanguard initiatives can serve us better into the future and perhaps set the scene, as you have alluded to, for a 'FYFV for Social Care' with more of what the KF are advocating including sustainability as a key component!

Pearl Baker

Mental Health Advocate and Advisor/carer,
Comment date
23 June 2016
I have been concentrating on those vulnerable adults placed into 'supported unregulated accommodation' many who should be in residential care (LA would pay) are now being placed in the accommodation I am investigating.

'Supported unregulated accommodation' attracts large rents, mostly paid by Housing Benefit, but not ALL.

I have discovered a £43 a week increase in rent this year, with nothing in return, and NEVER challenged by the LA Housing Benefit Department.

The LA like it 'unchallenged'. I am informed much of this increase can be RECLAIMED by the LA from the DWP in the form of a 'subsidy' annually.

The challenge will be: if the service charges on the Rental Agreement is actually funded by the LA it is NOT permissible in LAW.

The LA would be 'raking' in large subsidies each year at the expense of the vulnerable who should NOT be expected to pay this enormous rent increase.

Another find is Housing Benefits Claimants (NOT ALL) are given a Rental Agreement that identifies replacement of broken furniture, whit goods etc. A small charge is made each week, this amounts to thousands over the 'supported unregulated accommodation'. I cannot verify ALL Housing Associations are doing this, but evidence I have confirms a VERY large Housing Association, based in LONDON is doing exactly that.

I have set aside Thursday 23rd June, 2016 to put my evidence together to challenge this illegal practice.

Those individuals subject to section 117 of the 1983 MHA including others who are also subject to a COP Order are mostly effected.

'Robbing Peter to pay Paul' comes to mind, who is the loser? The Vulnerable adult to whom we owe respect, honesty, and integrity.

Esther clift

Consultant practitioner trainee,
Wessex Deanery
Comment date
21 June 2016
My observation that the crux of the inequality and financial squabbling lies in the continuing healthcare process. It is expensive and slow. Leading to delays and increases by private providers not based on need alone. This is where the Care Act needs reforming and it will save money.

Patrick Hall

The King's Fund
Comment date
20 June 2016
Thanks for your comments Elizabeth. I agree, the way we pay for care is inequitable, and needs to be addressed through real reform. That is why we were disappointed by the government's decision to delay, and possibly abandon, part 2 of the Care Act. Although these reforms were rather limited scope and there were legitimate concerns about their affordability, they at least would have offered some protection to people facing high costs and would have introduced more generous means-test thresholds and free care for disabled people entering adulthood with eligible care needs.

Stella Tsartsara

Consultant Integrated Care,
South East Europe Healthcare
Comment date
17 June 2016
Mrs Murgraff are you the same Shirley Murgraff carted off by police while protesting against NHS reforms?

Shirley Murgraff

Comment date
17 June 2016
Patrick Hall/King's Fund trying to face both ways? PH's third paragraph gets near the hard truth about the financial reality of govt policy and its dire impact across health & social care in general and on the poorest and most vulnerable in particular. But he goes on to lecture us - "no time to stick our heads in the sand" (it's WE who are doing that??!) and "we have to work together..." without mentioning the govt's numerous broken promises ("no more top-down imposed re-organisation", "nothing about me without me"etc. etc.) and lies (ditto, plus their steady privatisation programme while denying the clear facts of it non-stop (huge increase in private sector contracts). And of course no mention either that despite being the 6th (5th?) richest country in the world we have lower bed provision/lower (and declining) doctor-patient ratio, less gdp spend etc. etc. than many poorer countries; and his talk of US "reimagining" is insulting.
If, as seems most likely on this evidence, the "upcoming conference" continues to deny the existence of those huge elephants in the room, what credibility can we possibly give to PH's/KF's "look at the issues..."? And how dare they ask us to even contemplate giving it?

Elizabeth Guest

Comment date
17 June 2016
While I can appreciate the plight of people who need care as they get older, I am very concerned that a small group of disabled people who are very severely affected are getting forgotten about.

Few people realise that disabled people who need care, but work anyway, get their care for free until they retire. Once they are in receipt of a pension, the situation for them is dire: they are forced onto benefit level income for the rest of their lives unless they have managed to save enough pension to live on AND PAY FOR ALL THEIR CARE. In most cases this means a pension pot in excess of 1 million pounds.

The calcuation by the council goes like this
1) We give you the bare min to live on (depends on age)
2) If you are paying a mortgage you can keep enough to pay that, (or rent)
3) We will allow you some disability related expenditure as long as it is on our list
4) We take the rest.
This means that people who own their own homes will have insufficient income to be able to maintain. Leeds City Council attitude to tell people to sell up and rent. Presumably in the hope the person will die before the council has to pay rent and care.

This means that disabled people who need care should not
1) Pay into a pension because the council will benefit much more than you.
2) Buy your own home. This is probably not possible in many parts of the country because the council will take savings over a certain amount which will make saving for a suitable deposit almost impossible.

I think this amounts to state discrimination of disabled people. Can anyone tell me if anyone is campaigning against this so I can join them? If not does anyone know how to campaign against it?

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