Age UK’s new report ‘Care in Crisis: causes and solutions’ opens six weeks of intense debate as we run-up to the publication of the Dilnot Report on the funding of care and support. The main purpose of our paper is to explain how and why older people’s care has reached financial breaking point. By re-analysing existing data from official and academic sources we have assembled a devastating critique of the care system for older people as it stands today.
High and rising levels of unmet need are the first signs that the system is failing. Already, out of 2 million older people in England with care-related needs, 800,000 receive no formal support from public or private sector agencies. As a result of spending cuts, combined with rising need, the figure is likely to pass one million between 2012 and 2014.
We have also exposed shocking underinvestment in public care provision. Since 2004, net spending on older people’s social care rose by just 0.1% per year in real terms, a total of £43 million (compared to real spending on the NHS rising by £25 billion). During this time the numbers with care needs increased rapidly, as did the costs of delivering care.
Now, spending cuts are projected to reduce spending on older peoples’ care by £300 million over 4 years (using optimistic assumptions). Real spending on older people’s care will therefore be £250 million lower in 2014 than in 2004. What makes this statistic almost beyond belief is the fact that the number of people over 85 will have risen by two-thirds (630,000 people) over the same decade.
The consequence of this spending famine is that the public care system has slashed the support it offers, even for those with lower incomes who are covered by the current means-tested arrangements. In 2005 half of councils provided support to people assessed as having ‘moderate’ needs, but in 2011 the figure has fallen to 18%. As a result the number of people receiving local authority funded care at home has been slashed from 489,000 in 2004 to 299,000 in 2009.
At the same time public sector commissioners are underpaying for older peoples’ care homes, with a cumulative shortfall of half a billion pounds. Age UK estimates that the average shortfall per resident is £60 per week, rising to £120 per week in South East England. As a result, many care homes are demanding that older people and their relatives ‘top up’ their care fees with additional private money, a real injustice as families are forced to subsidise the state’s statutory duties. Age discrimination is also rife, with this spending freeze on older people’s care not replicated on services for younger disabled adults. An independent review of age discrimination found that younger service users are allocated an average of £78 a week per person, compared to £53 a week per older person
Finally, our report uncovers huge geographic diversity in publicly delivered care. This is most visible with respect to variations in eligibility criteria and the problems people face when they move between localities. But huge local discrepancies in the quantity and quality of care for older people are also unmasked by spending data. The highest-spending local authority (Tower Hamlets) spends five times as much as much per older resident as the lowest spending (Cornwall).
Before the Dilnot Commission recommends anything else, it must press the Government to invest in today’s system so that it delivers what is intended for those who meet existing means-tested criteria. From 2015, once the deficit is closed, this will mean finding between two and three billion pounds extra for older people’s care. If we do not, we will cause misery and danger for hundreds of thousands of frail older people.