Over the past month we have seen widespread celebrations for the 70th birthday of the NHS, with the Prime Minister announcing new funding for a service that is both highly respected and at the forefront of voters’ concerns according to Ipsos MORI research. But many people don’t realise that 2018 also marks the 70th anniversary […]
Posted on August 6, 2018 by James Beveridge
Over the past month we have seen widespread celebrations for the 70th birthday of the NHS, with the Prime Minister announcing new funding for a service that is both highly respected and at the forefront of voters’ concerns according to Ipsos MORI research. But many people don’t realise that 2018 also marks the 70th anniversary of the birth of the welfare state and social care as we know it, or – as our recent publications show – as we think we know it…
Recent findings from the National Centre for Social Research’s British Social Attitudes survey (PDF) reveal that many people are unsure about exactly what social care services are, and relatively few people have experience of using them. The survey also shows that the public has even less understanding of how social care is funded. Most people think it is funded in a similar way to the NHS – through tax revenues and free at the point of need (King’s Fund report, May 2018 – PDF). But publicly-funded care makes up only a minority of the total value of care and many people contribute their own money towards their care, as it is means tested.
Improvements in living standards and clinical treatments have changed the nature of the population’s health and care needs. More people are now living longer and often with multiple long-term medical conditions, which means it’s more important than ever that people can receive the most cost-effective care, when and where they need it.
Our recent publications, our overview Adult social care at a glance, and our ‘think-piece’ The health and social care interface summarise our most recent work on adult social care. They explain how the social care system operates, the pressures it is facing and, crucially, how it works alongside the NHS.
The value of adult social care
Most care is provided informally by unpaid family, friends and neighbours, who provide personal care, practical help and coordinate formal services. Estimates of the value of informal care are as high as £100 billion per year. By contrast, the total value of care arranged by local authorities in 2016-17 was £20.4 billion, a level of spending they have struggled to maintain.
While the NHS is a familiar public institution, free at the point of use, adult social care is a much less visible service, for which people need to meet national eligibility criteria to access, and, if the local authority charges for the required type of support, undergo means-testing. Over the period 2010-11 to 2017-18, local authorities experienced a real-terms reduction in spending power (government funding and council tax) of 28.6%. Between 2010-11 and 2016-17, local authorities reduced real-terms spending on adult social care by 5.3%. In contrast, between 2013-14 and 2018-19, NHS England’s budget increased by an average of 2.1% per year, although this was lower than the long-term average growth in health spending of 3.7% per year.
The impact of funding reductions is evident in both the social care market and workforce. There is evidence that the fees currently being paid by local authorities to care providers are not sufficient to sustain the current levels of care.
- The Competition and Markets Authority’s November 2017 report found that many care homes, particularly those that are most reliant on local authority-funded residents, are not currently in a sustainable position.
- In 2016-17, local authorities paid on average £15.52 to external providers for one hour of homecare. This is 16% below the £18.01 rate the United Kingdom Home Care Association has said is necessary for homecare providers to deliver sustainable services.
- Providers are having increasing difficulty recruiting and retaining workers, despite rising demand. In 2016-17, the annual turnover of all care staff was 27.8%. The proportion of vacancies in care rose from 5.5% in 2012-13 to a peak of 7.0% in 2015-16, falling slightly to 6.6% in 2016-17.
From the perspective of users, both the NHS and social care are made up of a complex range of organisations, professionals and services (click on diagram to see in detail). This can lead to uncoordinated and fragmented care, particularly for older people who are more likely to have multiple needs, and who are the biggest users of health and social care services.
All this leads us to the conclusion that further and faster progress is needed towards a joined-up health and care system that centres on the needs of individuals, meets the growing demand for care and delivers value for money to the taxpayer. However:
- Financial pressures on the NHS and local government make closer working between them difficult and can divert them from focusing on transformation.
- The NHS and local authorities operate in very different ways, and both sides can have a poor understanding of how the other side’s decisions are made.
- Problems with sharing data across health and social care can prevent an individual’s care from being coordinated smoothly.
- New job roles and new ways of working could help to support person-centred care, but it is difficult to develop these because of the divide between the health and social care workforces.
We look forward to the long-awaited social care green paper, now scheduled for autumn 2018, which the government has said (speech by the Secretary of State) will put forward proposals to reform social care, better integrate services and put social care on a long-term, sustainable footing.
As always, we would welcome your comments and invite you to contact us if you would like to discuss any of the issues raised in this post.
About the author: James Beveridge is a value-for-money study lead at the NAO. Since joining in 2012, James has led studies looking at the implementation of the Care Act, delayed discharges, health and social care integration and emergency hospital admissions. Previously James worked at the Audit Commission as an auditor of local authorities, clinical commissioning groups and NHS trusts.
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