Home truths: are older people paying the price for social care cuts?

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Part of The sustainability of social care services

The problems of the NHS do not exist in a vacuum. Older people are getting caught between the cogs of a complex and under-resourced system that is struggling to offer the right care, in the right place and at the right time.

Hospitals are in the headlines again. NHS Providers, the body that represents NHS acute, ambulance, community and mental health services has warned that the NHS faces a deepening financial crisis. Indeed, our most recent Quarterly Monitoring Report found that NHS finances remain very fragile and that it would be premature to suggest that the financial pressures that have engulfed the NHS have eased.

The problems don’t stop there. For each month so far in 2016/17 there has been the equivalent of an additional 54,000 attendances at A&E and 14,200 admissions from A&E compared to the previous year. Key targets are being missed and the scale of these performance issues cannot be shrugged off as poor management. This is a systemic problem.

Many of these additional emergency admissions are older people. They are also more likely to be stuck in hospital when they are ready to go home – a ‘delayed discharge’ in policy parlance. Why? Many people point the finger at social care ‘supply’. Of course, the truth isn’t quite as simple as that. The system of assessing needs and putting care packages in place can be complex, slow and cumbersome. What is clear is the growth in unnecessary waits for health or care packages in individual’s own home have increased over and beyond delays for any other reason.

Our new report with the Nuffield Trust, Social care for older people: home truths, follows on from our recent work on primary care and district nursing in highlighting the growing divide between the policy rhetoric of ‘care closer to home’ and the reality of a fragmented system. Our assessment of national data and in-depth interviews in four unnamed local authority areas found that the past six years have brought huge pressures on the social care market. Reductions in central government grants to local authorities have been passed on to care providers in the form of reduced fees, or below inflation increases, squeezing their incomes so much that some are now stepping back from providing care to people funded by councils.

The pressure is greatest on home care providers but the highest price – human as well as financial – is being paid by older people, their families and unpaid carers. Access to social care increasingly depends on what people can afford — and where they live — rather than on what they need. This favours the relatively well off and well informed at the expense of the poorest people who are reliant on an increasingly threadbare local authority safety net.

The combination of under-investment in primary care and district nursing, as well as social care, means older people are more likely to end up in hospital and get stuck there if the right community support is not available.

Politicians and policy-makers have two choices. They must either be honest about what the current system can deliver in a context of ever-increasing demand and shrinking resources (revising both the legislative and policy basis of the health and care systems). Or they should face up to the fact that, as a matter of national importance, we must undertake long-term reform to funding for health and care. This means acknowledging the reality of the costs of good care and where the money comes from to pay for it, accompanied by real investment to scale up emerging better, more community-focused models of care. Otherwise, our aspirations of keeping people well in their own communities will remain just that. It is time for some home truths.



Comment date
26 September 2016
Where is it possible to give feedback on care of elderly relatives that could contribute to policy changes?


My Landlord
Comment date
20 September 2016
It is ridiculous how all of us (including older people) are constantly paying our taxes and are only witnessing their vanishing. Where are all the money? Why do people in need have to face cuts in social care? Where do all the money go at the end of the day? Not all of us need care 24/7, actually, most people don't, so why do people in need face this type of hardship?

The Tenant

George Coxon

Various inc care home owner,
Comment date
19 September 2016
I'm going to say no to this although I fear the answer is yes really in many ways and many parts of the system and country. I say no because I want to speak up for those direct service givers who believe in what they are doing for older, do it well with pride and never leave an older person wanting or feeling short changed from the person supporting them. There are plenty of us out here. I said at the July King's Fund event I was invited to that "no one likes a whinger" so I am determined not to whinge and mostly manage this maintaining positive enthusiasm. there is a balance needed however in speaking out and telling truth to power about the strain many of us feel in social care maintaining quality, goodwill, trust in others and optimism that things will ge better.


Chair of Trustees,
Reading Mencap
Comment date
16 September 2016
Although the elderly are the biggest group of vulnerable people as Chris says the learning disabled and those with mental health problems are also experiencing the same hardships when it comes to needing care. Adults with LD living on their own in the community with little support are multipally disadvantaged by their innability to help themselves, their poor incomes, lack of employment, vulnerability to hate crime, poor housing and the increased chance of an early death from neglect and a health care system they often cannot access because it makes no allowences for their difficulties. But this always was a sector of society that people prefer to ignor. Well done Kings Fund for speaking up at last even if it does only focus on the elderly.

Chris Sterry

Comment date
15 September 2016
Yes, older people are at risk due to cuts, but this is not the only vulnerable group, for there are also substantial cuts in social care services for persons with Learning Disabilities and health care for persons with Mental Health issues.

All these have a bearing on care for vulnerable people both in social and health care, no one section of the community should be forgotten.

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