The Norfolk and Norwich Hospital has 1,237 beds, but a fifth of them are occupied by people who are fit for discharge. They cannot leave because they need social care support, and the places don’t exist. Some have been waiting for months.
Meanwhile, the A&E department has a queue of people waiting for those beds. Outside, ambulances queue with patients in need of A&E. In homes, workplaces and on the streets people wait for ambulances which don’t come, because they are parked outside the hospital. Many of those people get worse while they wait. Some of them die.
Politicians have ducked the issue
For years, there has been no plan to fund social care adequately, to increase the number of places in care homes, to recruit enough care workers, or to pay them properly. As the proportion of the population over 85 doubles over 20 years and demand for social care rises, governments have repeatedly ducked the issue.
Because most people don’t want to think about it, and most believe (wrongly) that the costs will be met by the state, it has been an easy issue to ignore politically. The only people who care much about it are those in need and their relatives, who are often shocked to discover how inadequate provision is.
Meanwhile, Local Authorities received over 1.9 million new requests for care in 2020-21. And, in East Anglia, which has a high proportion of older people, Essex and Norfolk are among the top five Local Authorities in the number of new applications for care.
How is social care provided now?
Since the 1970s, when most social care was provided by the state, there has been mass privatisation.
Local Authorities now spend £21 million a year on social care, mainly buying places from private care companies, which provide for four out of five residents. Individuals are means tested, and make a contribution to the costs until their savings fall below a threshold. And since 2010, central government funding to Local Authorities has fallen by 37 percent, squeezing social care budgets and forcing most care homes to cross-subsidise, on average charging self-funding residents 40% more than Local Authority funded ones, in the same homes.
Care work is skilled, complex and demanding, but poorly paid. One and a half million people work in the sector, but there was already a shortage of staff before Covid and Brexit led to people leaving. Skills for Care reports over 100,000 vacant posts. So the number of care places shrinks.
The Coalition government plan
In 2010 the Coalition government commissioned Sir Andrew Dilnot to investigate. His report recommended:
- A more generous means testing threshold
- A cap of £35,000 on lifetime care costs.
- A national threshold for eligibility for funded care to remove the “postcode lottery”
Although the total cost of these proposals, at £1.7 billion in the first year, was only 0.25% of GDP, it was judged unachievable.
The Johnson plan
When he was elected, Boris Johnson promised that he had a plan ready to solve the problem. When a decision was finally announced (quietly) in 2021 it fell far short of Dilnot’s recommendations. It proposed a new “Health and Social Care Levy” funded by an increase in National Insurance charges. This was to raise about £11.4 billion for specific improvements, but not to increase the basic funding of the provision. Initially most was to be spent by the NHS on Covid recovery.
Now the Coffey plan
The latest Conservative government has now published a new, fairly sketchy, plan. They have abandoned the planned National Insurance charge, and propose to find the £13 billion from general taxation.
Their plan has four elements:
- Improving discharge from hospital into social care. A £500 million fund to enable health and local authorities to recruit and retain staff. This represents a little under 2% of current Local Authority expenditure on social care
- Supporting more people to work in care. Work to improve qualifications and recruitment, including £15 million to increase overseas recruitment, which might equate to around 400 more staff against the current post Brexit shortfall of 100,000.
- Freeing-up time to allow carers to care by using IT to reduce bureaucracy. Unspecified “support” to free up carer time.
- Delivering the “cap” reforms announced in 2021, which will restrict total lifetime expenditure on personal care (not food, rent or energy costs) to £86,000. Andrew Dilnot pointed out that the only people who would benefit from this were those with savings of over £186,000.
The elephant in the room
Adult social care is in crisis, as anyone who has experienced an elderly relative in need of care, or who works in the service, knows.
The government’s plan will make some improvement for some individuals. But it is silent on the biggest issue: that Local Authorities do not have enough money to pay a proper price to the care providers, who in turn cannot afford to pay staff properly. A 2% increase in the budget will barely scratch the surface of the problems.
So people who need care do not get it, or only get minimal care. Overloaded staff are unable to provide the quality of service that they know their clients need. The Care Quality Commission reports high numbers of unsatisfactory providers. Providers struggle to keep their businesses afloat, and are cutting bed numbers. Meanwhile, the NHS, already struggling to cope with demand, is unable to discharge patients because there are no care places for them to go to. To pay for social care, Local Authorities close libraries and swimming pools, and cut back on road repairs.
The latest plan, like the previous one, goes nowhere near solving the problem. And as people live longer, with more complex health needs, the demand on the service is bound to grow.
All of us get old in the end, and most of us will find we need some of these services. It still doesn’t look as if we can be sure they will be there.