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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
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.
It is interesting that the "shortage of carers" is cited so frequently. All it takes is slightly different thinking. My local Social Work Department was surprised when I told them I was not looking for carers to support my mother to live at home. I was looking for Personal Assistants. Carers are task orientated, and will only do certain things. Quality of life can only be gained through personal assistance, where empathy is hooked, and you become a part of the individual's life.
I agree with the last comment on the need to value those working in social care and to place a higher priority on caring for the vulnerable people in our society. I notice the policy implications include intention to place primary responsibility for funding with individuals and families. This is simply not fair or equitable that care will depend on how much money someone has to buy a service. Are we living in the USA with mainly privatised health and social care services? How long will it be before this is suggested for the NHS?
I really find it difficult to start my response: firstly we all pay National Insurance, based on our earning, those not in employment have their State Pension protected, however their are many 'working poor' who cannot survive' without visiting 'food banks' and 'handouts' from friends and family: to actually have a further 'compulsory' deduction from your already low wage, will have serious consequences. The United Nations are to Investigate the Increase in Poverty in the UK in November 2018, we should be ashamed.
I have recently attended a FOCUS group regarding CHC, commissioned by the NHS England, where this 'fits into this latest idea' is NOT clear.
Dementia is a HEALTH issue so where is the CHC.
It is clear' Care' needs to be provided closer to the COMMUNITY, smaller units, where family and friends could be part of their caring process (if they choose).
'ICS' should receive Government funding to allow the COMMISSIONING of these NEW smaller Residential/Nursing/Care UNITS, closer to the COMMUNITY. This should be included in ICS discussions re: 'integration'.
The LA should take over the STAFF recruitment and management of these HOMES.
There are many individuals who can't wait to help others for FREE.
The idea that these Nursing Homes are actually providing 'value' for money is a 'myth' £1495 a WEEK for sitting in a CHAIR with twenty other residents with the TV on is a disgrace, 'hard earned' SAVINGS gone in a 'wink'.
The current system is open to 'abuse' Financially and 'Physically' extra COMPULSORY payments by those left with hardly anything left to live on will have 'dire' consequences. Depression, Suicides will increase, and their younger family members will be the next generation to access the Mental Health System.
My idea is the only 'viable' one, it creates a better 'environment' closer access for family and friends (who can be included in the caring programme) lets be realistic, many CARERS and Friends visit as often as possible, why are they paying a Nursing Home £1495 a week, when they are there for hours, but 'charged' for the 'privilege'!
Residential Care is a BUSINESS and nothing more, STOP the 'GRAVY TRAIN' and bring it back 'in house'.
Some vulnerable adults may require complex needs and as a result, it will be culpable if they are neglected because of the cost of securing care home support. However, It would be better to seek the opinion of the service users and their families wishes and feelings to promote individual best interest before professionals make their decision.
Comments
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.
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.
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.
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.
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.
It is interesting that the "shortage of carers" is cited so frequently. All it takes is slightly different thinking. My local Social Work Department was surprised when I told them I was not looking for carers to support my mother to live at home. I was looking for Personal Assistants. Carers are task orientated, and will only do certain things. Quality of life can only be gained through personal assistance, where empathy is hooked, and you become a part of the individual's life.
I agree with the last comment on the need to value those working in social care and to place a higher priority on caring for the vulnerable people in our society. I notice the policy implications include intention to place primary responsibility for funding with individuals and families. This is simply not fair or equitable that care will depend on how much money someone has to buy a service. Are we living in the USA with mainly privatised health and social care services? How long will it be before this is suggested for the NHS?
I really find it difficult to start my response: firstly we all pay National Insurance, based on our earning, those not in employment have their State Pension protected, however their are many 'working poor' who cannot survive' without visiting 'food banks' and 'handouts' from friends and family: to actually have a further 'compulsory' deduction from your already low wage, will have serious consequences. The United Nations are to Investigate the Increase in Poverty in the UK in November 2018, we should be ashamed.
I have recently attended a FOCUS group regarding CHC, commissioned by the NHS England, where this 'fits into this latest idea' is NOT clear.
Dementia is a HEALTH issue so where is the CHC.
It is clear' Care' needs to be provided closer to the COMMUNITY, smaller units, where family and friends could be part of their caring process (if they choose).
'ICS' should receive Government funding to allow the COMMISSIONING of these NEW smaller Residential/Nursing/Care UNITS, closer to the COMMUNITY. This should be included in ICS discussions re: 'integration'.
The LA should take over the STAFF recruitment and management of these HOMES.
There are many individuals who can't wait to help others for FREE.
The idea that these Nursing Homes are actually providing 'value' for money is a 'myth' £1495 a WEEK for sitting in a CHAIR with twenty other residents with the TV on is a disgrace, 'hard earned' SAVINGS gone in a 'wink'.
The current system is open to 'abuse' Financially and 'Physically' extra COMPULSORY payments by those left with hardly anything left to live on will have 'dire' consequences. Depression, Suicides will increase, and their younger family members will be the next generation to access the Mental Health System.
My idea is the only 'viable' one, it creates a better 'environment' closer access for family and friends (who can be included in the caring programme) lets be realistic, many CARERS and Friends visit as often as possible, why are they paying a Nursing Home £1495 a week, when they are there for hours, but 'charged' for the 'privilege'!
Residential Care is a BUSINESS and nothing more, STOP the 'GRAVY TRAIN' and bring it back 'in house'.
Some vulnerable adults may require complex needs and as a result, it will be culpable if they are neglected because of the cost of securing care home support. However, It would be better to seek the opinion of the service users and their families wishes and feelings to promote individual best interest before professionals make their decision.
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