The King’s Fund and the Nuffield Trust have recently worked in close collaboration to better understand the impact of changes in local authority spending on social care for older people, through an analysis of national data and qualitative research with a number of health and care organisations in addition to users of social care services.
This joint submission draws on this analysis and our recent joint response (with the Health Foundation) to the Health Select Committee’s inquiry into the impact of the 2015 Spending Review on health and social care.
- After six years of unprecedented budget reductions, the adult social care system in England is not sustainable in its current form, and the human and financial costs to older people and their carers are mounting.
- The government’s response does not address the scale of the challenge facing the system as a result of the ageing population. The changes announced in the 2015 Spending Review will have some positive impact on social care funding but are insufficient to meet current or future needs.
- The introduction of the National Living Wage is good news for a poorly paid workforce, but it will increase financial pressures across the system. Overall, we estimate there will be a social care funding gap of at least £2.8 billion by 2019/20, with public spending on adult social care set to fall to less than 1 per cent of GDP.
- Local authorities have adopted different strategies to make efficiency savings, but our research found that there is very limited scope to find more savings. Many will find it increasingly difficult to meet their basic statutory duties.
- At the very minimum, the forthcoming Autumn Statement must recognise the scale of the immediate funding pressures facing the sector by bringing forward the additional Better Care Fund money due by 2019/20.
- The Care Act 2014 introduced welcome new rights for individuals and carers but created new demands for local government. Unpaid carers are the cornerstone of the social care system, but, despite the new rights granted under the Act, many feel unsupported.
- With many providers turning away from local authority funding, concentrating instead on self-funders and alternative income streams from the NHS, a two-tier system is emerging in which access to care depends not on needs but on whether people have their own private funds or live in areas with more social care providers.
- We welcome the government’s ambition to integrate health and social care by 2020, but effective integration takes time and it will be important to build on progress being made locally. The move to further localise funding for social care risks deepening the divide between the two systems.
- The Barker Commission outlined a new settlement for health and social care based on a single, ring-fenced budget, a single commissioner for local services and more generous entitlements for social care, with most of the additional funding needed coming from the public purse. It is time for the government to meet the challenge it set out.