The UK’s social care crisis – and why we should all be worried

Do you know how the UK’s social care system is funded?

If you’re not sure, you’re not alone. Results from the British Social Attitudes Survey show that 34% of the UK public believes the government pays for social care – that is, services such as care homes and at-home support for the elderly.

It doesn’t. Anyone with more than ￡23,250 in assets or savings, excluding their home in certain circumstances, must pay for their own social care. Those with less can expect their needs to be partly or fully funded by their local council.

But with growing demand and rising funding pressures, what does this mean for the future of a system we may all need one day?

Challenge #1: Our ageing population

We’re living longer than ever. In 2017, the Office for National Statistics data revealed that there are almost 600,000 people aged 90 or over living in the UK. Our increasing longevity is a testament to medical advances, but it also brings a rise in dementia and other debilitating, incurable diseases.

According to the Alzheimer’s Society, there are 850,000 people with dementia in the UK – a figure that will more than double to two million by 2051. As dementia can impact virtually all aspects of a person’s daily functioning, ongoing expert care from trained professionals is crucial.

But the care homes desperately needed are falling in number. In the first half of 2018 alone, 267 nursing homes closed in the UK – resulting in a loss of 6,000 much-needed beds.

Why social care matters

This loss of care homes is impacting on hospitals, with up to 25% of all hospital beds now being occupied by dementia patients for far longer than clinically necessary, purely because there are no spaces for them in care homes.

If beds continue to be taken up by people who need social rather than clinical care, patients who need urgent medical care will struggle to have their needs met. This is a worrying situation that will impact on us all.

Reviving our social care system is the obvious way to turn things around. But this all starts with funding.

Challenge #2: Progressively reduced funding

While the NHS is financed from central government budgets, social care is funded by local authorities. However, repeated budget cuts have driven many local authorities to use up to 70% of their budgets to fund social care for the elderly and vulnerable. 

However, repeated budget cuts have driven many local authorities to use up to 70% of their budgets to fund social care for the elderly and vulnerable.

Despite this, there is still a huge shortfall. According to national charity the Health Foundation, spending by councils on social care fell by 11% per adult between 2009/10 and 2015/16, and the number of people receiving publicly funded social care services fell by 26%. This is not due to reduced demand but the fact that thresholds for eligibility have not increased in line with inflation, meaning fewer people are entitled to social care services.

It’s a problem that councils are trying to offset by cutting the cost of delivering social care, but this means that salaries of healthcare professionals and carers are under pressure, with many carers on either minimum or living wage. This amounts to around ￡275 per week after taxes for carers over 25.

This is counterproductive in the long term – unsustainably low wages are deterring more and more people from working in social care.

Why social care matters

According to a recent report by the Health Foundation and the King’s Fund, maintaining the current social care system will create a funding gap of ￡1.5bn by 2020/21 and ￡6bn by 2030/31.

The real-life consequences are huge. Without intervention, the system could collapse, leading to total privatisation.

The real-life consequences are huge. Without intervention, the system could collapse, leading to total privatisation.

Average weekly fees for a residential care home are around ￡600 to ￡800 but this varies widely according to region. This would add up to an average annual cost of around ￡31,000 to ￡42,000, but would be much higher in some parts of the country. Most people don’t have the savings or assets to cover this for long.

While community care, where carers visit up to several times a day, is more affordable, it is impractical or unaffordable for many people. The cost averages at ￡15 per hour, however depending on how many hours are needed, this could be prohibitive for many people.

With local authorities consistently under pressure and their social care budgets rising to unsustainable levels, people may become more dependent on care from relatives, who are forced to give up employment in order to provide it, impacting on the economy.

A more viable approach could be to better integrate the NHS and social care system while looking at new funding solutions to make up the shortfall.

Challenge #3: An overloaded NHS

The social care system is already fully stretched yet it continues to pick up overspill from the NHS without gaining additional funding for doing so.

The social care system is already fully stretched yet it continues to pick up overspill from the NHS without gaining additional funding for doing so.

NHS hospitals across the nation are struggling to hit care targets. Ever-rising GP and outpatient waiting times are clear evidence of the pressure the NHS is under.

The social care system currently alleviates some burden by providing services, such as rehabilitation for patients who are medically, but not functionally, fit to go home after an illness or surgery.

Similarly, by organising home adaptations and personal alarms, the social care system minimises the risk of falls and other emergencies that could lead to hospital admissions for disabled patients.

Why social care matters

If the social care system as we know it were to collapse, the repercussions would be vast. The NHS would have to absorb responsibilities such as rehabilitation and at-home care. Alternatively, they would face a surge in health problems arising from falls, malnourishment and hypothermia that occur when vulnerable people have no social support.

Given its struggle to cope with current demand, any rise in patient numbers could impair the NHS beyond a point of no return.

The way forward

As the Health Foundation and the King’s Fund’s report A Fork in The Road suggests, changes to the current model are essential. Suggestions for improvements include creating a better means-tested system, providing free personal care – help with washing, dressing, meals and nursing – or capping lifetime costs.

But first funds must first be found.

Community Integrated Care is a national social care charity which provides care and support to thousands of people across England and Scotland. To learn more, please visit www.c-i-c.co.uk.