The most dramatic demographic trend of the past century has been the marked increase in human lifespans. The ultimate prize for advances in medical science, there is much to celebrate in longer lives. But there is a darker reality: longer spells of good health will, for many of us, end with longer spells in poor health.
Caring for older people experiencing end-of-life decline seems to come much lower down the pecking order of priorities than investing in expanding our lifespans. Last week the Care Quality Commission made a highly significant intervention when it warned that funding cuts have placed adult social care services at a “tipping point”. It follows similar warnings from independent organisations such as the King’s Fund.
It is no exaggeration to say that care services for older people in England are in crisis. Funding for adult social care looked unsustainable before 2010; since then cuts to their central government grants have forced councils to cut funding by 11% on average – in some areas by as much as 30%. At the same time, demand has risen as the population ages, and the cost of delivering care has increased due to higher regulatory standards and the introduction of the national living wage.
Little wonder, then, that the number of people getting state support for the cost of their care has fallen by at least 25% in the last five years. Older people currently face two tests to determine whether they are eligible for state support: a nationally set financial means test, with people holding assets of more than £23,250 expected to fund their own care; and a locally set test of their care needs. Falling numbers of people getting support suggests things need to be worse before councils will step in.
Politicians have long known the existing system is unsustainable. England is one of the few major advanced countries that has not reformed the way it funds care in recent decades. Since 1997 there have been no fewer than four independent commissions, and five government papers on social care funding.
But our political leaders have failed to implement a solution. The coalition government came closest in 2013 with a proposal to cap an individual’s care costs at £72,000. Yet it was riddled with problems. Most devastatingly, there was no long-term funding guaranteed to local authorities to help meet the costs of paying the bills once the cap had been reached. This made it little more than a complicated and expensive smoke and mirrors trick: without more money going into the system, councils would have been forced to find ways of limiting support. Ultimately, this reform proved a distraction from a truth: we need to spend more on older care, whether that comes from general taxation, compulsory insurance or private contributions. The proposal remains in the long grass, where it was kicked before the last election.
The government would argue it is providing at least a short-term salve. From this year, local authorities can charge an extra 2% on council tax to pay for care services. But the most deprived areas, with the highest level of need for state-funded care, are those least able to raise extra cash in this way. The government has also promised some additional funding by 2019. But it is all a case of too little, too late: even factoring all this in, the King’s Fund estimates the funding gap between needs and resources will be up to £3.5bn by 2019.
It is not just adult care under immense strain. A similar dynamic is playing out in children’s services, which also fall under councils’ remits. The National Audit Office last week highlighted that – shockingly – fewer than a quarter of child protection services have been rated as good or outstanding by Ofsted. As with adult social care, councils are increasingly being expected to fund children’s services through business rates and council tax; yet the least affluent areas, with the highest level of need, will find it most difficult to do so.
This is the painful reality of austerity: not fewer libraries, but the slashing away of the safety net that exists to protect the most vulnerable. The dreadful human cost falls under the radar. Age UK estimates there are more than a million older people who struggle with tasks such as washing and eating, but who get no professional help. We don’t look them in the eye until they end up in hospital after suffering preventable falls or from malnutrition.
The system is no less senseless in financial terms. It is vastly more expensive to treat a broken hip than to prevent it through assistance with washing and dressing. Too many older people languish on hospital wards because there is nowhere to discharge them to, at an annual cost of £820m.
More funding will go a long way to improve older care. But as critical as it is, the system does not just suffer from a lack of cash, but a lack of love. Too often, the starting point for care services is managing physical and mental decline while minimising risk, rather than supporting people to live fulfilling, dignified lives to the end. Caring as a professional activity is undervalued, often perceived as a series of low-skilled tasks rather than relationship-focused work. This has to change.
Politicians must accept much responsibility for the failings of the care system. As with pensions reform, change will require some degree of political consensus, yet cross-party talks broke down before the 2010 election. No government has been brave enough to have an honest conversation with the public about how much a properly funded system would cost. With Brexit negotiations looking set to absorb any available political capital over the next decade, it is hard to envisage politicians investing sufficient time and energy into social care reform.
But we cannot blame our political leaders to the exclusion of reflecting on our collective attitudes towards ageing. To reduce care reform solely to a question of funding is to shy away from more fundamental questions about why the way we care for older people is so inadequate.
What does it say about us as a society that we invest billions in medical science to stretch our lifespans but are increasingly abandoning vulnerable older people to cruelly insufficient levels of support as they face physical and mental decline? Unless we can honestly answer that question, social care reform seems a distant prospect.
