New Age UK report: “We are living on borrowed time in saving social care for older people from complete collapse”

A new report from Age UK concludes that we are living on borrowed time in saving social care for older people from complete collapse.

The report, ‘The Health and Care of Older People in England 2017' draws on official statistics as well as new Age UK analysis. It builds on Age UK's previous work and highlights the immense challenges facing older people who need care, the numbers of whom increase every day, and the impact of the failure to provide it on their health and wellbeing, as well as on the NHS.

Download the report (2 MB)

Worryingly, the report suggests that however tough things are now they threaten to get a lot worse over the next few years for a number of reasons which the report details. The report also examines the Government's strategy for keeping the social care system from totally falling apart and concludes that it is not up to the job and is failing. Unless something changes the Charity says there is a genuine risk of social care completely collapsing in the worst affected areas this year or next.

The Charity is calling on Government to recognise the imminent danger which social care is now in and commit to an urgent injection of funds in the Spring Budget. It also calls on the Government to lead a process for developing a long term solution to the care crisis that incorporates the views of older and disabled people and all parts of the health and care sector, and that engages the public in the important question of how we pay for a decent care system we can all rely on when we need it. 

Key findings in the report include:

• Age UK's analysis shows there are now nearly 1.2 million people (1,183,900) aged 65+ who don't receive the care support they need with essential daily living activities [i].

• This represents a 17.9 per cent increase on last year and a 48 per cent increase since 2010.
• It means that nearly 1 in 8 of the entire older population now lives with some level of unmet need.

• The percentage of the older population receiving social care support fell from 15.3 per cent in 2005/06 to 9.2 per cent in 2013/14[ii].

• There has now been a £160 million cut in total public spending in real terms on older people's social care in the five years to 2015/16, during a period of rapidly rising demand because of our ageing population[iii].

• By 2020/21 public spending on social care would need to increase by a minimum of £1.65 billion to £9.99 billion in order to manage the impact of future demographic and unit cost pressures alone (i.e. to stop things getting even worse than they are today)[iv]^,[v],[vi].

• The minimum amount now allocated to local areas through the Better Care Fund will rise from £3.86 billion in 2016/17 to £5.33 billion in 2019/20. However, this extra investment is heavily ‘back loaded' with the full £1.4 billion only becoming available in 2019/20, meaning the extra funding will have little or no impact this year or next[vii].

• The Government hoped the social care precept would raise £1.8 billion (£1.67 billion in 2015/16 prices) a year by 2019/20 but actual amounts are falling slightly short and the impact varies a great deal by area[viii]^{,[ix],[x],[xi]}.

• Cash transferred from the NHS to social care has grown from two per cent of the total public spend on older people's social care in 2006/07 to 16 per cent in 2015/16[xii].

• The proportion of people who provide unpaid care for family and friends has been slowly tracking upwards, rising from 16.6 per cent of the population in 2011 to 17.8 per cent in 2015. New Age UK analysis shows that people are caring at greater levels of intensity than in the past and meeting increasingly complex needs[xiii]^,[xiv].

• Although overall numbers of carers are rising, there has not been a substantial increase in the proportion of the population providing care. New Age UK analysis suggests that the provision of informal care has not been able to expand significantly enough to fill the gap left by declining provision of formal care services.

• There are now over two million carers aged 65 and over, 417,000 of whom are aged 80 and over. Age UK analysis finds that 37 per cent of these carers aged 80 and over are providing 20 hours or more of care a week, and 34 per cent are providing 35 hours or more[xv].

• Yet nearly two thirds of older carers themselves have a health condition or disability, while 72 per cent report feeling pain or discomfort, rising to 76 per cent for those who provide 20 or more hours of care a week.

• In 2015/16 48 councils reported dealing with at least one home care provider who had ceased trading; 59 councils reported at least one provider ‘handing back' a contract, meaning they had elected to stop providing services to council clients; and two of the largest national home care providers also left the council market[xvi]^,[xvii].

• 77 councils reported dealing with at least one care home which had ceased trading in their area in 2015/16, and 31 councils reported at least one provider ‘handing back' a contract over the same period[xviii].

• Since 2010 there has been a steady decline in the number of residential home beds but huge variation across the country, with the reduction ranging from 18 per cent in London to two per cent in the East of England[xix].

• In 2015/16 the overall staff vacancy rate in the social care sector was 6.8 per cent (up from 4.5 per cent in 2012/13), rising to 11.4 per cent for home care staff. Turnover rates rose from 22.7 per cent to 27.3 per cent per annum over this period[xx].

• Between August 2010 and July 2016, the number of days of delay in being discharged from hospital because of waits for home care had increased by 181.7 per cent, from 12,777 delayed days to 35,994. Waits for residential care placements increased 40 per cent, from 13,459 to 18,973[xxi].

Caroline Abrahams, Age UK's Charity Director said:

"Our new report makes for frightening reading because it shows just how fragile older people's social care now is. Even worse, unless something changes the crisis will certainly deepen this year and next, and we think there is now a real risk of a complete collapse in social care in the worst affected areas. If this happened it would be a disaster that would threaten the health and even the lives of the older people affected. It would also greatly intensify pressures on our hospitals."

"Some older people and their families are already telling us that they simply cannot find any carers where they live, and we are also hearing of vulnerable older people receiving council funded care whose help has been significantly reduced, leaving them to manage alone for many hours at a time."

"The Government has tried to prop up older people's social care in three ways: through financial transfers from the NHS, a social care precept in local areas, and by calling on families and friends to do more. Unfortunately our analysis shows there are problems with all three approaches, which in any event are not enough to make up for the chronic shortfall in public funds: the NHS is now under such financial pressure that it can't keep bailing out social care; the amount the social care precept can raise doesn't match the needs in an area - with the poorest places at great risk of losing out; and new Age UK analysis shows that the numbers of families and friends coming forward to care are not keeping pace with a rising ageing population."

"What's more, two million of those who care for a family member or friend in our country are themselves older people, often with their own health problems. And astonishingly, more than a hundred thousand people in their eighties and beyond are caring full-time. At Age UK we believe that we are asking too much of these wonderful older people who may well be jeopardising their own health through their dedication to the person they love - they need more support."

"This is an incredibly serious situation that demands an immediate Government response. We urge the Government to make an emergency injection of funds into social care in the Spring Budget to stave off the risk of complete collapse. But even that's not enough: the Government must also get on with developing a long term solution to the care crisis and listen to older and disabled people and all parts of the health and care sector about what is required. This process cannot happen behind closed doors in Whitehall: we must also engage the public in the important question of how we pay for a decent care system we can put our faith in if we or someone we love needs it."

- ENDS -

Notes to editors

[i]. Age UK analysis of Marmot, M., Oldfield, Z., Clemens, S., Blake, M., Phelps, A., Nazroo, J., Steptoe, A., Rogers, N., Banks, J., Oskala, A. (2016). English Longitudinal Study of Ageing: Waves 0-7, 1998-2015. [data collection]. 25th Edition. UK Data Service. SN: 5050, Source

[ii] NHS Digital (2014); "Community care statistics, social services activity, England - 2013-14, final release," - Source

[iii] NHS Digital (2016); "Personal social services: expenditure and unit costs, England - 2015-16," - Source

[iv] Age UK analysis of Marmot, M., Oldfield, Z., Clemens, S., Blake, M., Phelps, A., Nazroo, J., Steptoe, A., Rogers, N., Banks, J., Oskala, A. (2016). English Longitudinal Study of Ageing: Waves 0-7, 1998-2015. [data collection]. 25th Edition. UK Data Service. SN: 5050, Source    

[v] Age UK (2015); "How much would it cost to meet the unmet care needs of older people in England," - Source

[vi] Office for National Statistics (2015); "Principal projection - England population in age groups," - Source

[vii] Department of Health written evidence to the Health Select Committee Inquiry into the Spending Review impact on health and social care, CSR0042, February 2016 -  Source

[viii] Department of Health written evidence to the Health Select Committee Inquiry into the Spending Review impact on health and social care, CSR0042, February 2016 -  Source

[ix] Department for Communities and Local Government (2016); "Provisional local government finance settlement: England, 2017-18," - Source

[x] Department for Communities and Local Government (2016); "Dedicated adult social care funding forms key part of continued long-term funding certainty for councils," - Source

[xi] Association of Directors of Adult Social Services (2016); "Budget survey 2016/17," - Source

[xii] NHS Digital (2016); "Personal social services: expenditure and unit costs, England - 2015-16," - Source

[xiii] Office for National Statistics (2016); "Population estimates for UK, England and Wales, Scotland and Northern Ireland" - Source

[xiv] Age UK analysis of University of Essex. Institute for Social and Economic Research and NatCen Social Research, Understanding Society: Waves 1-5, 2009-2014 [computer file]. 7th Edition. Colchester, Essex: UK Data Archive [distributor], November 2015. SN: 6614, Source

[xv] Age UK analysis of University of Essex. Institute for Social and Economic Research and NatCen Social Research, Understanding Society: Waves 1-5, 2009-2014 [computer file]. 7th Edition. Colchester, Essex: UK Data Archive [distributor], November 2015. SN: 6614, Source

[xvi] Association of Directors of Adult Social Services (2016); "Budget survey 2016/17," - Source

[xvii] Laing and Buisson (2016); "Care of Older People: UK market report."

[xviii] Association of Directors of Adult Social Services (2016); "Budget survey 2016/17," - Source

[xix] Humphries R, Holder H, Thorley R, Hall P, Charles A; "Social Care for Older People: Home Truths," Kings Fund/ Nuffield Trust (2016) - Source

[xx] Skills for Care (2016); "The State of the Adult Social Care Sector and Workforce in England," - Source

[xxi] NHS England (2016); "Delayed transfers of care data,"- Source