There are 9.9m disabled people living in England. This includes adults with mental health issues, or those who have learning or physical disabilities or conditions related to older age. Ahead of the spending review and in an unprecedented move, providers and commissioners of adult social care have joined forces to demand that the Treasury is more transparent about the cost of, and funding for, sustainable and decent quality social care. Both parties face a perfect storm because a chasm is widening between the costs of delivering services and what care commissioners are prepared to pay.
The adult social care market in England alone is worth over £20bn. The market comprises of thousands of local services, from nursing homes to community supporting adults with complex physical disabilities to live independently. If the market is to function well, it needs a strong supply of innovative, high quality providers so people using its services can exercise choice and control. However, the joint campaign from providers and commissioners warns that people will only have very basic care needs met because their eligibility for social are is reduced. Sector leaders, and the social care regulator, warn of fragility in the market; the risk is that the market, supporting millions of people, is failing, and could collapse. We have seen the market fail before, with the collapse of a large care home provider Southern Cross, and the risk is that a failure of this scale could be repeated.
Pressing concerns
How have we got to this position? The stark reality is that unmet need is on the rise, and this will be further exacerbated by welfare reform changes .
Within the context of unremitting demographic change, funding to support disabled and older people has been significantly reduced. Over the last five years, social care funding cuts have totaled £4.6bn (a 31% reduction in real term net budgets). This year directors of adult social services in England plan on making very significant cuts:
- Physically disabled and people with learning disabilities using residential and home care -£53m.
- Older people supported through home care or in residential care -£67m.
- People using mental health services -£14m.
By the end of the decade the Local Government Association and Association of Directors of Adult Social Services estimate a £4.3bn funding gap in adult social care. The ongoing lack of investment in social care is leading to fewer and fewer disabled and older people being entitled to state funded services. The number of people aged between 65 and 89 years who have unmet needs is estimated to be 900,000.
The continued squeeze on fees for social care services is leading to an ever-widening gulf between the real costs of delivering high quality support and the actual amount commissioners are prepared, or able, to pay. As a result, providers fail to tender for services because they know they cannot deliver quality care at the lowest price. In some cases, they have had to hand back contracts to local authority commissioners, shut down services, and exit the market altogether.
The cuts to care services have fallen in different ways. Parts of the North East and the North West have experienced the largest average cuts to spending per person, which in turn has squeezed the fees paid to care providers. Local authorities are struggling to manage markets locally and, the risk is, that parts of the North East and North West, where the lowest fees for services are paid, could be the markets that collapse first.
The NHS faces financial pressures of its own, and a loss of social care support will pile further pressure onto healthcare. This includes an increase in accident and emergency admissions and delayed discharges of people from hospital to being supported at home. Such delayed transfers of care have increased over the last year, suggesting an erosion of community-based services .
The way in which services are being cut does not make sense. Providing people with access to good quality social care can reduce inequality and injustice, and save public money over the long term. Providers and commissioners of social care are jointly arguing for a sustainable funding solution - something that the chancellor has an opportunity to address in his forthcoming autumn statement. Without it, the current outlook for social care is bleak.