Social care for older people: Home truths

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Part of The sustainability of social care services

This report, published jointly with the Nuffield Trust, looks at the current state of social care services for older people in England, through a combination of national data and interviews with local authorities, NHS and private providers, Healthwatch and other groups. It considers the impact of cuts in local authority spending on social care providers and on older people, their families and carers. Alongside this work, we were commissioned by the Richmond Group of Charities to interview older people about their experiences of social care.

The picture that emerges is of social care providers under pressure, struggling to retain staff, maintain quality and stay in business; local authorities making unenviable choices about where to make reductions; a complex set of causes of delays in discharging older people from hospital; and the voluntary sector keeping services going even when funding was curtailed.

Key findings

  • Social care for older people is under massive pressure; increasing numbers of people are not receiving the help they need, which in turn puts a strain on carers.
  • Access to care depends increasingly on what people can afford – and where they live – rather than on what they need.
  • Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care The Care Act 2014 has created new demands and expectations but funding has not kept pace. Local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties.

Policy implications

Based on the evidence in the report, the authors recommend that policy-makers need to address three major challenges in shaping the development of social care over the next five years, focusing on how to:

  • achieve more with fewer resources – for example, through better commissioning and integrated care – recognising that these initiatives will not be enough to close the funding gap
  • establish a more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and families
  • reform the long-term funding of social care because reliance on additional private funding is unlikely to be sufficient or equitable.

Comments

Alisoun Milne

Position
Professor of Social Work and Social Gerontology,
Organisation
University of Kent
Comment date
15 September 2016
This report addresses a number of v important issues regarding the deplorable, fragmented and frankly scandalous state of care for older people in the UK. The govt are quite simply lying or not bothered or both. This is a huge political issue and is not being treated as one by our political leaders(?). We need honestly and transparency as the Kings Fund suggests, and reform of the care system including long term care funding which hits the most vulnerable when they are down. I feel ashamed and angry about how we treat older people in need. Thanks for your excellent work Kings Fund.

Elaine HIckling

Position
Business Improvement Manager,
Organisation
Hertfordshire County Council
Comment date
15 September 2016
I found this article very helpful and would like to be sent further updates.

Mark Coup

Position
Owner,
Organisation
Welcome Independent Living
Comment date
15 September 2016
The article is very interesting - if we applied the same policy approach to children there would be a national outcry. There is a real danger that social entrepreneurs like ourselves will walk away from this sector. The risks are too great (every day is a Daily Mail headline waiting to happen) and the rewards are too slim. Our Local Authority (Calderdale) and the CCG are innovative, creative and support local providers but year on year central government cuts are significantly impacting on your loved ones.

awaters

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
15 September 2016
Hi Elaine, glad to hear you found the report helpful. You can sign up for updates here: http://www.kingsfund.org.uk/about-us/get-latest-news-kings-fund. You can indicate your interest in social care by selecting the box under 'Your interest areas' to receive updates about our work in this area.

Adrian Adams

Position
Area Coordinator,
Organisation
Citizens Rights for Older People
Comment date
15 September 2016
This report mirrors the experiences of the volunteer advocates at Citizens Rights for Older People, a charity that provides advocacy, information and advice to older people.
We see on a daily basis older people struggling to survive in an increasingly complex and inadequate system that in spite of the rhetoric often leaves vulnerable people neglected and at risk.

Cherril Cliff

Position
Deputy Chair,
Organisation
Leeds Older People's Forum
Comment date
15 September 2016
I intend to read the full report. In a sense, it confirms what many of us already know; tens of thousands of older people not receiving the care they need and deserve and carers' at breaking point.

It surely is the responsibility of Government to support the most vulnerable in society and not to farm it out to private providers, who are often not employing people with the right skills because they are paying such low wages/terms of conditions. Also what happened to preventative care?

Then there are the older people stuck in hospital because there isn't a care package to get them discharged. This impacts hugely on older people themselves and the NHS; who are also teetering on a precipice.

Moira jenkins

Position
Law lecturer to social care students,
Organisation
Cork Institute of Technology and NUI Galway
Comment date
15 September 2016
Telling that older people, including those who self -identify as disabled, arent seen as having the same claim to personal budgets and advocacy. Enough of this. Ask what older people want and then respect and implement their decision.

David Stevens

Position
Chief Executive,
Organisation
Dementia Care
Comment date
16 September 2016
As a specialist dementia care provider, the report absolutely captures the issues that we face on a daily basis. Whilst the report focuses on older people generally, the issues are even more acutely felt by people with dementia and their families, who do not receive the support of the NHS despite being diagnosed with a long-term medical condition.

As a provider in the North East, one clear fault in the system identified in the report is the complete illogicality of basing a funding system for social care, not on need, but on house values and business rates. Social care is a people-business and we all have to pay at least the same National Minimum Wage, so how can we have such huge variations in the amounts that we are paid as care providers.

I would call on the government to fund social care at a national level (with local management to maintain quality), with national rates for care. This will start to move us away from the two tier system identified in the report.

Thank you Kings Fund for bringing the issues to the public attention. We all need to make sure that the politicians read it and do something about it before the system falls apart completely.

c james

Comment date
16 September 2016
I so agree, we should be ashamed and we should be fighting hard for both recognition and change before people die from neglect

Robert Arnott

Position
Community Worker,
Organisation
Ricoh Arena Community Space
Comment date
16 September 2016
There seems to be a state of denial by our politicians,despite all the
evidence by organisations like the Kings Fund that the provision of
healthcare in the UK is in need of urgent debate regarding its future.
I was born in the 1930s and I was privileged to grow up in a time when
people of vision created the NHS and Welfare State which have kept
the people of this country healthy for over 60 years,and I passionately
believe the NHS should remain an example of the best of public service
in the UK.The fact that a healthy population will live longer and in turn
place added demands on our services seems not to be taken seriously
by any political party,as we see by the present dire state of social care,
and unless this is addressed urgently,thing will only get worse.
The problems in our health service can be resolved,but only if the people
of the UK support the principle of a public service for all funded by the
taxpayer, and with politicians of all parties putting aside their idealogical
prejudice towards public services and bringing passion and vision to
the debate.

BRIAN GUMBLEY

Position
Director,
Organisation
MATM cic MH RECOVERY ORG
Comment date
20 September 2016
Can I stress to all -a home truth ------ fact that a lot of older folk have paid a lot of there hard earned income over the years into the health service believing that in older age they would be secure in the knowledge that there health care would be provided for by the state it seems they have been led up the garden path -----------today's earners and those on exceptional good retirement pensions should have no choice and more empathy with those who have done the lower paid jobs and pay extra into the tax system from now ---for the better off to say it doe's not effect them because they have the private sectre to care for them are kidding themselves and selfish ---even that group of people should be more understanding and caring for those less fortunate after all even the rich very often need the emergency services to help them at some time in there lives

BRIAN GUMBLEY

Position
Director,
Organisation
MATM cic MH RECOVERY ORG
Comment date
20 September 2016
in answer to Moira's letter which is correct and the needs of the disabled should be dealt with now ---because if we don't as a nation look after this group regarding there care ---we will all only bring more problems down the years with carers breaking down through anxiety and stress

Sue Hester

Position
Retired RGN,
Comment date
02 November 2016
I am a retired RGN aged 65with a husband aged68 unfortunate enough to have Parkinsons Disease. We have no children so are making informed choices now regarding our care for the future.
Whilst I agree totally that social care is in crisis I find it alarming that most of our friends and acquaintances think they will breeze through old age with the state or their family to look after them .
. Having all 4 of our parents spend their last years in a home (where my mother was the the subject of a care safety order ) we are determined this will not be our fate.
To end up with £23000 from the sale of their properties after paying to be the subject of a care safety order is scandalous.
Spending your final days apart because your loved one is too far away to visit is scandalous.
Living in one room the size of a shoebox with no en suite at £900 a week is scandalous
There is an alternative but unfortunately only available to the well off.
Retirement villages.
Home ownership with facilities available for help as needed ;nursing home facilities onsite so that loved ones can be visited every day especially at mealtimes so meals can be taken together.
Consistency in care with regular staff on site not 10-15 min visits by a different person every visit.
If there is going to be 6 million elderly by 2030 we need to be encouraging people to make their own informed choices to provide for their care in their old age.
Whilst there continues to be a limited choice in retirement properties ,most people will want to remain in their family homes.
Decent affordable retirement villages need to be incorporated in town planning,to encourage people to downsize.
Financially it makes sense.
Economically it makes sense.
It works in the USA,New Zealand ,so why not here.

Julie ellis

Position
Community carer,
Organisation
Caring forever
Comment date
21 November 2016
Being a home carer I can see this happening. As we are not allowed to do half the things we use to do when visiting a client. We are supposed to stick to our times. We'll sorry it doesn't happen with me being old school. So I can garentee by the end of my shift I will be over about an hour or so which I do not get paid for . The other point is yes I have now reached 60 and all through my working life (since age 15 ) I was told my ni contribution would look after me in my old age. We'll here I am told I got to work till I 67. Not being horrible but I could be dead by then. If I am still going I dread to think what the caring system will be like in another 10 years.

Tom McEwen

Position
Palliative care doctor,
Organisation
Local hospice
Comment date
10 January 2017
Because of a shortage of carers we cannot get patients looked after in their homes although funding is allocated to them. This is due to poor pay and a shortage of personnel, now worsened by the effects of Brexit. Care homes are also closing as funding is inadequate to pay staff wages and red tape has raised overheads. Patients in hospital are in the same "bed-blocking" quandary. This causes crises at the admission stage.

Shuaiba Ahammed

Position
CEO,
Organisation
http://www.yourcareandsupport.co.uk/
Comment date
26 August 2017
I agree with your opinion. The article is very helpful.

Irene N Hardie

Position
Volunteer, adult mental health auditor,,
Organisation
CRCC Rethink/Mind
Comment date
05 September 2017
I have been doing independent hospital visiting for CRCC, but funds finished last October. Rethink is now only funded on a yearly basis : we had to form an independent group because we thought that the paid workers had to leave in February. Their contract was renewed for 1 year but the room had to be changed to a smaller one for economic reasons & may close next February. It is disgusting as all people, old or young have an uncertain service & virtually no support at all.

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