Changes in the patterns of social care provision in England:

2005/6 to 2012/13

The Care and Support Alliance

The Care and Support Alliance was set up in July 2009. It is a consortium of over 70 organisations that represent and support older and disabled people, including disabled children, those with long term conditions and their families.

We campaign to keep adult care funding and reform on the political agenda.

Background

The care and support system in England is in crisis.

Services that are designed to help older and disabled people and their carers to live well and independently are letting them down. Too often we hear from people who are unable to access the services they need, or are forced to put up with reduced or poor quality services that fail to treat older and disabled people with the dignity they deserve.

The system is struggling to cope with a rapidly ageing population and people living longer with illness and disability. There is a huge public appetite for reform.

The Government’s introduction of the Care Bill is extremely welcome, and the Care and Support Alliance is very supportive of the Bill. The Bill contains many important reforms, including placing the ‘well-being’ of an individual receiving care at its heart.

However, the Bill will not improve the lives of older and disabled people or their families unless it is matched with long term, sustainable funding. It is clear that squeezed local authority budgets are having a huge impact on the social care that older people, disabled people and their carers receive.

The Care and Support Alliance has commissioned new research from the Political and Social Sciences Research Unit (PSSRU) at the London School of Economics (LSE) to quantify the changes in numbers of older and disabled people receiving social care that have taken place since 2005.

Outline of research

Previous work by the PSSRU has explored the nature of the criteria used for determining social care eligibility in England, the differences in how these thresholds are implemented and the changes in minimum eligibility thresholds in local authorities across the country.

This latest research builds on this work, and aims to quantify the changes in levels of social care service provision that have taken place since 2005. The report focuses on two indicators:

• the number of adults receiving local authority brokered social care support;
• the levels of net local authority adult social care expenditure.

Importantly, this research takes into account the significant demographic change that has taken place over this period.

Key findings

• The number of people receiving social care has fallen five years in a row – by a total of 347,000 since 2008.
• When considering demographic change during this period, this means that almost half a million[1] older and disabled people who would have received social care five years ago, now receive no support.
• Just to keep pace with demographic changes, spending on social care would have needed to rise by £1.6 billion.

Declining number of social care recipients

The number of people receiving social care has fallen for five years in a row – by a total of 347,000 since 2008 (see Figure 1).

Figure 1: Change in reported number of social care recipients (000s)

This includes:

• 250,000 fewer older people aged 65 and over
• 97,000 fewer disabled people aged 18-64

However, these figures do not take account of the social and demographic changes that have occurred in England over the selected time period. Changes such as population growth and ageing mean that several thousand more adults needed care in 2012 compared with 2007.

Taking this into account, the LSE research suggests that 483,000 people lost their right to care within five years.

The PSSRU research indicates that over the past five years, a significant reduction in the levels of service provision has taken place for both older and working age disabled people.

The extent of these reductions in service provision varies significantly, but only those with the highest level of need are now receiving support.  Typically, this means that those people with care needs who live in the community have seen a reduction in support. These reductions are particularly significant when consideration is taken of inflation and of increases in the levels of need linked to, amongst other things, demographic patterns.

Expenditure is not keeping up with demographic change[2]

Government expenditure on social care remained fairly static over the same five-year period.  However, there has been a real terms decrease in funding of social care by £210m.  The new research shows that Government spending on social care would have had to rise by £1.61 billion, just to keep pace with demographic pressures (see Figure 2).[3]

Figure 2: Modelled change in expenditure on social care recipients (£ billion)

Recommendations

This research paints a stark picture of the social care funding crisis.

The past five years has seen a dramatic reduction in the number of adults receiving social care.  We now know that there are half a million older and disabled people who would have been eligible for social care in 2008, but who now go without social care support.

The Care Bill, in its current form, will not address this crisis.  The current underfunding of care is forcing the Government to set the new ‘national eligibility threshold’ too high, at the equivalent of ‘substantial’ FACS.

This means those adults who ‘are or will be unable to carry out several personal care tasks’[4] (currently defined as ‘Moderate’ in the FACS criteria) will not be eligible for social care.

This will continue to exclude the 500,000 thousand older and disabled people identified in this report from receiving social care.  Furthermore, it means that over 300,000 older people with care needs will continue to pay for their own social care without this counting towards the new ‘cap’ on care costs, as introduced by the Bill.

In order to solve this care crisis, the Care and Support Alliance is urging the Government to invest in a ‘national eligibility threshold’, which will ensure that those older and disabled people who need care are eligible to receive it. 

We believe that a ‘national eligibility threshold’ that properly captures those with significant care needs will ensure that the Government’s ‘well-being principle’ at the heart of the Care Bill is upheld.  Should the threshold be set at the level currently suggested, there is a real risk that the ‘well-being principle’ will be undermined.

Ensuring that those older and disabled people who need social care support receive it, would give the Care Bill a truly enduring legacy.

References

Personal Social Services Research Unit (2013) Changes in the patterns of social care provision in England: 2005/6 to 2012/13, London: London School of Economics.

Available online at: http://www.pssru.ac.uk/archive/pdf/dp2867.pdf