Social care is on the cusp of a crisis

Deep in the detail of a raft of new official adult social care statistics are the unmistakeable signs of a system in breakdown. Sector leaders have for months been warning that they cannot hold the line much longer in the face of real-terms budget cuts of 31% over five years, but hard evidence of crisis has been lacking. Now we have it.

When the Health and Social Care Information Centre last week published several data series on social care, attention focused on a finding that of more than 1.8m people whose requests for care and support were assessed by English councils in 2014-15, 59% received no direct services at all. While striking, this may not be as bad as it appears: a main thrust of the new Care Act is to encourage councils to do more to direct people to other sources of support, such as welfare benefits, charities and community groups, and to give more advice to those who have the funds to pay for their own services.

Three rather more worrying sets of numbers were lurking in the data dump, however. First, family carers’ reported quality of life and satisfaction with social services had both dropped since 2012-13, suggesting they were coming under growing pressure and receiving less back-up. Only 39% said they had as much social contact as they wanted.

Second, the proportion of older people being successfully supported at home by reablement services after hospital discharge had fallen after rising in previous years. Three months after discharge, 82% were still at home in 2014-15 but 18% were back in hospital, in residential care or deceased. The proportion of discharged patients receiving reablement services had also fallen.

And third, the number of hospital patients who had suffered a “delayed transfer of care” had risen in both 2013-14 and 2014-15. Not all of these cases, often referred to crudely as “bed-blockers”, were attributable to failings in social care – in fact, the numbers of those fell in the three years to 2013-14. In 2014-15, however, the average number of delays attributable to social care alone, or to social care and the NHS jointly, soared 19%.

Taken together, these figures indicate clearly that the social care system is starting to give way and the impact is being felt by the NHS. This is what sector leaders have been forecasting and why, as they gather in Bournemouth for this week’s annual National Children and Adult Services (NCAS) conference, all their hopes are pinned on getting some respite from a relentless diet of cuts when the outcome of the government spending review emerges next month.

In an unprecedented joint submissionahead of the review, commissioners, providers and users of social care services have warned: “As organisations that work in this area, we are clear that the sustainability of the sector has now reached a ‘crunch’. Unless decisions are made during the spending review to reverse this downward trend, we fear for the future of people who need social care, for the NHS and for our society.”

More than £5bn has been slashed from councils’ adult social care budgets since 2010, according to their own figures, and the gap between available resources and the demands of an ageing society is said to be widening by at least £700m annually. Companies providing care are warning that any further reductions in their fees they receive will drive them to the wall, not counting the costs of the new “national living wage” which will add upwards of £800m directly to pay bills by 2019-20 plus hundreds of millions more to maintain differentials in wage structures.

Hopes of some relief in the spending review rose in July when the government broke its manifesto promise of only two months previously and shelved a planned scheme to cap people’s liability for care costs. That would have cost as much as £6bn over five years and councils had asked for the cash to be used instead to bail out the care system.

Since then, however, ministerial silence has set sector nerves jangling. At last week’s Conservative party conference, health secretary Jeremy Hunt made only a passing mention of social care in his address and David Cameron used his speechto attack councils with poorly performing children’s services, saying the care system “shames our country” and reiterating a threat to “take over” council departments that failed to improve.

Both Hunt and education secretary Nicky Morgan, whose department funds children’s services, have declined invitations to attend the NCAS conference, fuelling concern that social care is once again being sidelined. Alistair Burt, minister for community and social care will attend and speak. Simon Stevens, NHS England’s chief executive, did remark in a speech last week that it was time to “get creative” about policy in respect of social care funding. But he, too, seemingly has other things to do rather than be in Bournemouth.

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