An unmet need for care

Caroline Abrahams is Charity Director at Age UK and Chair of the Care and Support Alliance (CSA), a group of over 80 charities calling for improved social care for older people, disabled people, and their carers. We spoke to her about the importance of a well-funded social care system and what the priorities should be going forward. 

Why is social care so important?

For the people who need social care, it’s not just a nice to have, it’s an essential part of their lives, making the basic things we take for granted possible, like washing, dressing, eating and managing in the home. 

But we’re in the midst of a real care crisis. There are at least 1.2 million people in this country with an unmet need for social care. That’s almost doubled since 2010, and over a million of those are older people. And the gap is growing. The number of older people needing care has gone up, while the number actually receiving care has gone down. We’re not keeping up with the demographics, we’re going in the opposite direction.

What does the current funding situation mean for people of all ages in need of social care?

In reality an unmet need for care means a young person with a disability unable to access a job or training because there’s no one to help them get ready in the morning. It means a lady in her 80s having to make difficult choices about how to use the support she does have: should she ask the carer to wash her or to get her something to eat? 

The CSA recently spoke to nearly 4,000 people who need care or look after someone who does, and the results show just how much social care is struggling. Over a quarter of the people we spoke to said that because of a lack of care they’d been unable to maintain basics like washing, dressing, or visiting the toilet. 1 in 5 said they’d gone without meals and felt unsafe moving around their own home, and 4 in 10 said they’re unable to leave the house. These are the things that most of us just take for granted. It shows that the system is really not fit for purpose.

What do people think about how social care could be better funded? 

People who use social care recognise why a quality service is so important. They want better trained staff and enough of them, who can provide decent, reliable care and who aren’t in a rush all the time and cutting visits short. To do that we have to pay people properly. As long as you can make the same money stacking shelves as caring for vulnerable people, things won’t get better. 

People know that better care costs, and the consensus seems to be that they are willing to help pay for it – potentially through taxation and/or a small levy on people’s estates after they’ve died. As older people don’t pay tax, some argue it’s unfair to shift the burden onto the younger generations, but it’s important to recognise just how much older people and their families are already paying for social care. 

The reality is we’re so far off the amount of money we need to be investing in care and health that, right across society, we’re all going to have to contribute in various ways.

If we keep spending at current levels for the next five years what do you think might happen?

Underfunding of social care is already causing collateral damage to the NHS, and this is only going to get worse. Older people who aren’t well cared for at home are much more likely to become unwell and need hospital treatment. And delayed discharge from hospital due to a lack of adequate social care to go home to has an impact too. Asking the NHS to pick up the cost of care is completely inefficient (a hospital bed costs £2,800 a week compared to £600 for personal care in a care home and less still for care at home). 

I think there’ll also be more people quietly dying who could and should have lived longer. It’s a hidden problem at the moment, but it’s going to become more obvious. And people will become increasingly aware and unhappy about the situation, particularly as more and more family members have to step in and provide care for elderly relatives. If the government doesn’t find a solution I think we might see a backlash at the ballot box next time around.

What are the priorities for social care funding going forward?

Politicians on all sides of the debate say ‘if only we could get the public to understand social care it would be so much better’. But the truth is that most people don’t want to think about their future social care needs because it’s associated with decline. So the idea that there’s some way of raising awareness to get people to start planning for their own care needs is pretty unlikely. 

But we will be in a better position if we create a care system which allows us all to share the risk that we might need care. We must be clear about what sort of care system we want and deserve as a society and then be honest about how much that will cost and how we can pay for it. And then we need to present those arguments to the public. It’s a mistake to try and shy away from the difficult issues or hope that the problem is going to go away. It’s time to spell out a more ambitious vision and try to build some consensus around it. Let’s hope the forthcoming Green Paper will actually do that.