Attempts to shore up NHS at risk without adequate funding for social care

Four leading research organisations say that the failure of successive governments to adequately fund and reform social care has left many people without the care and support they need and could undermine attempts to improve the NHS.

New analysis produced by The Health Foundation, Institute for Fiscal Studies, The King’s Fund and Nuffield Trust, highlight that more people in need of care will fall through the cracks of the social care system if a plan for substantial reform and sustainable funding is not outlined in the forthcoming social care green paper.

With the Prime Minister’s recent NHS funding announcement indicating that decisions about social care funding will be taken in the Spending Review and the green paper delayed till the Autumn, the four independent research organisations say that pressures on social care are projected to rise at an annual rate of 3.9%, leading to a funding shortfall of £18 billion by 2030/31.

Tackling the challenge of social care reform will require decisive political action and cross-party agreement to deliver a new funding settlement. Unless this happens, the inadequacies of the system will continue to undermine the NHS and leave many people without the care they need.

While the need for reform to social care is clear, there are no easy or cheap solutions. Despite the attempts to reform social care funding over the past 20 years, including 12 consultations, green and white papers and five independent commissions, none has delivered major change.

The new analysis published for the BBC as part of their programming for the NHS’s 70th birthday, highlights how social care services are under huge strain from an ageing population. It also outlines increasing pressures on services from younger adults with disabilities living for longer – something the forthcoming green paper will not address, with a ‘parallel process’ set up to look at this issue. Without reform, more people and their families will face a significant financial burden to cover the cost of their care and more people will be left without access to publicly-funded services.

Despite rises in spending between 2014-15 and 2017-18, spending on adult social care spending remains below its 2009-10 level. About 400,000 fewer adults received publicly funded social care services in 2013/14 than in 2009/10, as local authorities have increasingly had to prioritise funding for people with the most severe care needs. And there is a risk that the longer-term pattern of protecting NHS spending at the expense of social care spending will be continued.

The briefing, titled “What’s the problem with social care, and why do we need to do better?” also highlights instability in the care home market. Services at 303 locations were classified as inadequate, which the Care Quality Commission estimates affects as many as 16,000 people.

The researchers state that the means-tested social care system remains ‘a fundamental source of inequity and unfairness’ and that the 70th anniversary of the 1948 National Assistance Act will pass ‘largely unnoticed’, in comparison to the 70th anniversary of the NHS. New polling, commissioned by the Health Foundation and released today also shows that 44% of the public believe the current system of means testing is unfair*. In addition, 56% stated that it was unacceptable for people to have to use their housing assets to pay for care.

The impact on the NHS of the failure to adequately fund social care is seen in increased emergency attendances, and patients having to stay in hospital longer than they need to.

Jennifer Dixon, Chief Executive of the Health Foundation, said:

‘Successive governments have ducked the issue of social care reform. Last week’s announcement of additional funding for the NHS was welcome, but we are yet to see any similar commitment on social care. Despite the obvious urgency, the long-awaited green paper is now been delayed till the Autumn.

‘The NHS was founded 70 years ago to replace fear with security, so that people did not face bills they couldn’t pay in time of illness. But that security is just not there for many of those who need social care today. Many people assume social care is free of charge like the NHS, and it is a huge shock when they find out it isn’t and the bills mount up. As local authority budgets are squeezed, more people are having to go without, pay themselves or rely on unpaid care from friends and families. The situation is unfair, stressful and inefficient and is long overdue for reform.’

Media contact

Peter Stilwell

peter.stilwell@health.org.uk

020 7664 4647