Our new assessment with the Nuffield Trust of the state of social care for older people has some important but mixed messages for local authorities. Their overall spending in real terms on adult social care has fallen over the last five years, by 10% in more than half of councils.
But over the same period 18% maintained or actually increased spending. There also remains wide service variations between councils – a six-fold difference in rates of people supported in care homes, eight-fold for home care.
To their credit many councils have used austerity to craft a different offer which in many cases produces better outcomes and reduces the need for formal services. User satisfaction levels have remained buoyant.
But our fieldwork revealed that many voluntary and community groups were sceptical about the impact on older people and their carers and we conclude that most councils do not know what has happened to growing numbers of people who no longer get help from them. Complaints upheld by the Ombudsman are rising. With the over-85 population set to nearly double over the next twenty years, the system in its current form is not sustainable.
The Care Act 2014, while widely welcomed, adds to the pressure on councils in trying to reconcile new statutory duties with soaring demand and diminishing budgets. The funding gap will not be closed by the precept or the £1.5b extra Better Care Fund promised by 2019.
As a minimum requirement, we call on the government to bring this forward to address some of the immediate pressures. If it is not prepared to fund the system adequately, it should be more honest with the public about what to expect. Though unpalatable, this might mean revisiting parts of the Care Act so that expectations are aligned more realistically with what local government is funded to deliver.
Finally, England is one of the few advanced countries that has not reformed the way it funds long term care. The need for a frank debate about what good health and care costs and where the money should come from has never been more urgent.
Richard Humphries, assistant director, policy, The King’s Fund