In his sheltered accommodation on the edge of London, Harry Jackson is worrying about the future. The 82-year-old lives alone, is confined to a wheelchair and cannot use the toilet unaided. He pays £520 a month to cover rent and four visits a day from a company contracted by the local council to feed and dress him.
Mr Jackson (not his real name) is typical of pensioners being affected by the slow erosion of services for the elderly over the past decade. The council cancelled the bus that took him shopping twice a week, then it cut the number of people working in his building and stopped him using the communal room without paying. So now Mr Jackson seldom leaves his room except to go to church on Sunday. He pays for his care from the proceeds of the sale of his former flat, but that money has nearly run out.
His case is a small part of a quiet emergency going on around the country. While the crisis in funding for the National Health Service (NHS) grows, and every closed ward is greeted by a chorus of outrage, funding for social care—which includes the in-home care Mr Jackson gets and the old folks’ homes he may one day have to move to—has discreetly been cut to the bone.
Spending by local councils on social care for the elderly fell by 9% in real terms between 2010 and 2015. The number of elderly people receiving social care from their local authority declined by 26%. By 2019-20 the funding shortfall for social care will be at least £2.8 billion a year, says a report by the King’s Fund, a think-tank.
“If the same level of cuts were occurring in the NHS, it would be a national outrage,” says Tom Gentry of Age UK, a charity. More than 1m people who have difficulty with the basic activities of daily life now get no help at all. Even Simon Stevens, the head of the NHS, recently said: “There is a strong argument that, were extra funding to be available, frankly we should be arguing that it should be going to social care.”
Much of the problem lies in how social care is funded. Whereas NHS treatment is free at the point of delivery, social care is means-tested and provided by local authorities, whose grants from central government have been severely squeezed by austerity. Care for the elderly makes up 42% of local government spending on adult social care, or £7 billion in 2014-15.
The threshold to qualify for help is £23,250 in savings or assets. Anyone who has more than that must pay their own way. More than 40% of care-home funding is thus met by individuals. Care homes catering to wealthy pensioners are doing well. But some are refusing to look after government-funded clients altogether, because they say local authority funding does not cover the cost. Those costs will rise as the minimum wage, currently £6.70 per hour for over-21s, rises to £9 per hour for over-25s by 2020. Brexit could also push up staffing costs, since 7% of the industry’s workers are EU migrants.
Some 90% of social care is provided by 19,000 independent organisations, which are struggling to provide services for the price being offered by councils. Consequently, the number of beds in care homes fell by 3,000 last year, the first decline for a decade. In 2011 Southern Cross, a large provider, went bankrupt. Another, Four Seasons, has been on the edge for months. “The possibility of large-scale provider failures is no longer a question of ‘if’ but ‘when’,” says Richard Humphries of the King’s Fund. Some feel that would be the wake-up call the government needs.
Home care is in even deeper trouble. Community-based services like those that visit Mr Jackson have faced the biggest cuts from local authorities; their funding has fallen by 30% since 2009. Two of the largest home-care providers have recently withdrawn from the market and two others have made losses in their home-care divisions. Other services are also squeezed: the ratio of GPs (family doctors) to elderly people has fallen and the number of district nurses declined by 28% in 2009-14. All of this leads to more pressure on informal carers, usually family members.
Many admissions to hospital of elderly people could be avoided with more community services, says Mr Gentry. Delayed transfer of the elderly from hospital beds, when they are better and could leave, costs around £820m a year.
A recent reform has allowed local authorities to raise council tax, a levy on property, by up to 2% to help pay for care for the elderly and disabled. This will help a little. But those most in need will benefit least: areas where there is a low council tax base are often the ones with the highest need for publicly funded social care.
The siloed nature of health and social care does not help. Greater Manchester has been handed control of both in a devolution deal that will try to co-ordinate the two services better. Other cities may follow Manchester’s lead, although the new government of Theresa May seems less keen on devolution than its predecessor.
The thinning out of state-provided social care may force a cultural shift towards families and neighbours lending more support. The local council is constantly asking whether friends or relatives could do more to help him, says Mr Jackson. People will also need to budget better for the possibility of living in a care home in later life, just as they plan for their pension.
Local authorities’ vision of independent pensioners turning to the state for care only in extreme circumstances requires close family, a strong voluntary sector and health and care services able to support them in their own homes. That is all very well but, says the King’s Fund report, “We have not found evidence of these things being in place.”