Spending review means challenge to caring for elderly and vulnerable
300,000 more elderly will need care in next four years – and so will 70,000 more people of working age
James Cooper embodies the often remarkable progress made in recent years in the care of disabled people. A quadriplegic with cerebral palsy, partial sight and no verbal communication, he has nevertheless moved out of his family’s home into his own bungalow where he lives independently with round-the-clock help from a team of support workers.
“The best thing for me is that they really put themselves out to make sure he is happy, that he is doing things and that he has a really good life,” said the 27-year-old’s mother, Tina Cooper, who has been liberated from the responsibilities of full-time, intensive caring.
Care packages like James Cooper’s are not cheap. The near-£100,000 annual cost of his support, which is bought with a personal budget, is met jointly by the NHS and social services authorities for his home district of Droitwich, Hereford and Worcester, together with a contribution of much of his disability benefits and some £400 a week, recently reduced, from the government’s Independent Living Fund.
Today’s review casts a long shadow over the future of elaborate support of this type: the ILF has already stopped issuing new grants and its future is under review. But the review equally calls into question the ability of councils to deliver simpler and relatively inexpensive interventions – a grab rail in a bathroom, for instance – that can make the difference between an elderly person continuing to live independently or falling and ending up in a care home.
The £14.4bn allocated by government for adult social care spending by English councils is right in the firing line for cuts. As local authorities’ single biggest controllable budget, now most education spending is devolved to schools, it is bound to take a significant hit.
Ministers have briefed that there should be no need for big cuts in services, and hint of an “extra” £1bn a year by 2015, but the demographic challenge is such that even that – were it true – would amount to a real-terms reduction. According to the Association of Directors of Adult Social Services (Adass), the ageing population and growing numbers of people with learning disabilities mean that spending needs a 4% boost annually, over and above inflation, just to keep pace with demand.
For elderly people, the figures are well rehearsed: a doubling of the number of over-85s by 2026, with 300,000 more needing care over the next four years alone. Less well known is the sharp rise in the number of younger people with care needs: thanks largely to the increasing longevity of learning-disabled adults, 70,000 more people of working age will need care by 2014.
“A reduction of 25% in our budgets over three years [the rule-of-thumb for unprotected spending areas] would come at a time when we know we are likely to see 370,000 more people needing care and support – an effective growth in demand of some 4% a year, creating a potential challenge of up to 40% for many councils,” said Richard Jones, Adass president.
“We know further efficiencies can be made and we have a track record, along with local government, of delivering 3% efficiency savings annually. But at best this gets us close to a sixth of the way towards what we might have to find.”
What will councils do to make savings? The two most obvious levers to pull would raise the threshold for eligibility for services and raise the charges levied on those able to contribute to the cost. But the scope for each is limited.
Three in four councils already limit service eligibility to elderly and disabled people deemed in “substantial” or “critical” need. Factors indicative of the former include “an inability to carry out the majority of personal care or domestic routines”; factors indicative of the latter include that “life is, or will be, threatened”. It is generally assumed that almost all councils will move to one or other of these thresholds.
On the level of charges, average means-tested rates for home care are already of the order of £8-£10 an hour. Some councils are contemplating increases of as much as 50% in the hourly rate and/or the maximum weekly payment. But the hard truth is that a 40% cut in funding would be almost £6bn: at present, social care charges of all kinds bring in a total £2.2bn.
Welfare charities acknowledge that local authorities are in a bind. “We recognise that councils are between a rock and a hard place,” said Stephen Burke, chief executive of Counsel and Care, which specialises in information and advice for elderly people and their carers. “But cutting access to care and supporting fewer older people will only cost more in the long run. Older people will be left to struggle on their own and more will end up being admitted to expensive and often inappropriate hospital and residential care.”
This will be the key. With up to 40% of elderly people in hospital beds placed there unnecessarily, and as many as 70% staying too long, there is a huge incentive for the NHS to use its supposedly protected funds to help out social care in its hour of need.
Sir David Nicholson, NHS chief executive, has been clear that this must happen. And there are signs that ministers get the message too. Earlier this month, health secretary Andrew Lansley committed £70m from savings in central Department of Health budgets to an immediate boost to “re-ablement” support for people in the six weeks after leaving hospital. About 35,000 people are expected to benefit before next April.
Next month, a focus on joint working with the NHS is expected to form a main plank of a new “vision” for adult social care to be unveiled by Lansley and Paul Burstow, the Liberal Democrat care services minister.
Further on the horizon is the commission on care funding, appointed by the coalition and due to report next summer. Led by economist Andrew Dilnot, the commission is charged with producing a workable settlement of the vexed issue of how social care costs, not least care home fees now typically in excess of £500 a week, should be reapportioned between the state and the citizen.
Ministers have pledged to legislate on a new settlement before the next general election. But cynics, reviewing the bloody record of past attempts to broker a new deal and noting that legislation would likely come in the runup to that election, are not betting heavily on the probability.
The blunt reality is that people in need of social care will in future get less state help. Individuals will have to do more for themselves and, very much in the spirit of David Cameron’s “big society”, also for others.