Adult social care has become the poor cousin of the NHS. Those of us in the sector may not feel comfortable with this assessment, but few would disagree with it. While the NHS was the key issue in the general election campaigns, social care was pushed into the background. And while the health budget was ringfenced throughout the last parliament, social care funding fell by more than a third in some places.
This disparity in treatment is not only unfair, it is also unwise: a textbook case of robbing Peter to pay Paul. Social care supports people to live in their own homes for longer and enables them to be discharged from hospital sooner, freeing up beds and enabling people to live with more independence and dignity. Without an effective social care system the NHS could not function. But local councils are being asked to do more, for more people, with less money and fewer resources. This is untenable; the new government must act swiftly to arrest this decline or risk a crisis in both health and social care.
Figures from the King’s Fund show that spending on social care services for the over 65s has fallen by 17% since 2010. Yet in the borough I serve, Haringey, the proportion of people aged between 65-84 is expected to rise from 8 to nearly 12% by 2037. The number of people living for longer with long-term health conditions has also increased. This change in demographics necessitates a change in social care budgets that has so far failed to materialise. It is worrying that the NHS, created to deal with people’s acute health needs, is increasingly having to use its resources to cope with a very different set of health problems, many of which could be addressed by an efficient social care system. This is leading to a lower quality of life for millions of people, in both care and health settings.
The scale of this challenge is significant. The Local Government Association has predicted a funding “black hole” in adult social care of £4.3bn by 2020. Age UK estimates that there are currently 900,000 older people with unmet social care needs. The Care Act, which came into force in April, promises real progress in preventing and delaying people from needing acute forms of care. But as the cost of its implementation may prove unaffordable for some local authorities, there is a danger this opportunity will be missed.
In the face of these stark warnings there are, however, still some causes for optimism. Many councils remain innovative, working hard to maintain and improve the quality of services despite financial constraints.
In Haringey we’ve developed community-based provision with a greater emphasis on helping people to live independently at home. We welcome the opportunity to make this transformation, which is not only improving the quality of life of hundreds of adults, but also delivering vital savings. But there are limits to what councils can do on their own while the current system prevails.
Genuine integration of health and social care is needed, so that the services both sectors provide complement each other and are focussed on what individuals need, rather than what suits a particular institution. To make this happen central government must empower local government to take on a greater role. Councils’ increasing confidence in commissioning and their new public health responsibilities are seeing local authorities lead the way in intervening early to stop health problems escalating. In an era where hand-to-mouth budgeting has become commonplace in the NHS, local government has proved that it can deliver efficiency while increasing the public’s satisfaction with services.
Yet there is a danger that as we move towards integration, the government continues to treat social care as health’s junior partner. It’s hard to imagine another public service that could be cut so extensively without eliciting a national outcry. No doubt the ingenuity and dedication of social workers has helped to patch over the worst effects of underfunding – but as we enter a new parliament it’s clear we cannot afford five more years of the same. If the government fails to act decisively, allow effective integration and redress the imbalance in funding and profile between health and social care, then we risk the sector being brought to its knees.
