This report, published jointly by the Nuffield Trust with The King's Fund, 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, the authors of the report 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.
- 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.
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.