Media Briefing Social Care White Paper and Draft Bill

1.0 Summary

 
• The social care system is chronically under-funded and unfit for purpose, betraying some of the most vulnerable older and disabled people in society.  It leaves nearly 800,000 older people who need help with everyday tasks with no formal support. Nearly 20,000 people each year are forced to sell their homes and use up nearly all their savings to pay for their care.

• The forthcoming Social Care White Paper and Draft Bill present a once in a generation opportunity to reform social care, so that it is fairly  and sustainably funded within a simplified legal framework, effectively integrated with health care services.

• Social care legislation is outdated, confused and contradictory. There are currently over 40 different statutes relating to social care, many of which conflict, some of which are based on the principles of the Tudor and Victorian Poor Law. The result is an unfair, post-code lottery that fails to support vulnerable people.

 
• Age UK is calling on the Government to reform the legal framework, to adopt the Dilnot Commission's proposals to cap the life time costs of care, and to raise the means tested threshold for paying for care to £100,000.  This will help stabilise the whole social care sector, drive up standards, and enable families to financially plan for their future care needs.

• Analysis by Age UK shows there is a £500 million shortfall in local authority funded social care in the year 2011/2012 (1)

1.1  What is social care?

 
Social care is the name given to the range of care and support services that help frail and disabled people remain independent, active and safe, for example helping with getting out of bed, bathing and preparing meals.

 
Support services can be provided in someone's home, in a community centre or in a care home.  There are 1.2 million older people who use social care services in England.  Social care includes services people arrange and pay for themselves, as well as support organised by local authorities, either in the form of specific services or payments that enable people to make their own care and support arrangements.

1.2   What is wrong with the current system of social care?

The current system is confusing, unsustainable and in crisis.

Vulnerable adults needing social care support are legally entitled to be assessed by their local authority. This assessment will rate their level of need against the four bands of eligibility criteria: low, moderate, substantial or critical.

However, someone assessed as having moderate needs could receive support in one local authority area, but nothing in a neighbouring authority area.  As budgets are squeezed, many councils have raised their eligibility thresholds so fewer individuals are eligible for state arranged support.

Provision of care is more restricted than ever.  In 2005 half of councils provided support to people assessed as having ‘moderate' needs, but in 2011 the figure fell to only 18 per cent. (2)

 
Social care support is means-tested, which means that someone with eligible needs will receive a financial assessment.  Income and capital is taken into account in a means test for home care services. Income and capital, including the value of a property, are  taken into account if the person needs residential care.  The financial threshold above which no financial support from the council is provided is £23,250.  The amount charged for services varies according to local area.  Some councils subsidise services and users are asked to make a contribution towards the cost.  Others charge the full cost to the older person.

Chronic under-funding has impacted on the quality of care that vulnerable people receive in their own homes.  Many difficulties with rushed care visits are a consequence of the way domiciliary care is commissioned (often in 15-minute time slots) and the low price paid by many local authority contracts.

 
Such pressures to beat the clock have resulted in widespread instances of neglectful care, where vulnerable and isolated people have been denied the basic dignity of being adequately helped to wash, eat go the toilet and maintain friendships outside the home. It is a particular issue for those affected by dementia who can find such task focused care provision distressing and confusing.

Evidence submitted to the 2011 Commission for Equality and Human Right's Inquiry into Home Care (3) included instances where people were left abandoned on the toilet and examples of where clients with dementia were left hungry after meals were  ‘hidden' in fridges.

At present, there is no structured way to support families plan for their future care. Some people currently face catastrophic care costs when they move into residential or nursing care.  One in two people can expect to pay around £20,000 and one in ten people face costs of more than £100,000 in care costs.

The crisis is deepening as cuts to local authority budgets make an impact.  There is currently a severe £500 million funding shortfall.  Age UK is calling for budgets to increase in line with the growing demand for care and support from an ageing population.

1.3   Age UK's key requirements for social care reform

• Implementation of the recommendations of the Dilnot Commission on Funding of Care and Support, which the Coalition Government itself established, including the £35,000 cap and £100,000 means-testing threshold for residential care

• A national threshold of eligibility for care and support

• Reform of the chaotic social care legal framework through full implementation of the Law Commission's recommendations

• Retention of the Law Commission's emphasis on upholding the rights of people who need care and support, especially those who lack capacity or who otherwise face barriers to arranging their own care. Assessment and care management functions must continue to be free;

 
• Implementation of the Law Commission's proposals for effective adult safeguarding legislation;

 
• A clear framework that has disabled and older people's choice and control at its heart;

 
• Portability of social care to secure continuity of care and support for people who move from one area to another;

 
• A mapped out path towards full integration of the health and social care systems; and

 
• Statutory duties on local authorities to inform people of their right to request assistance to arrange care.

1.4 Key facts on the crisis in social care

• There is serious under-spend on older people's social care.  Spend on older people's care since 2005 has stagnated and then decreased. Yet the number of people aged over 85, the age group who are most likely to need care, has increased by over 250,000 since 2004-05. (4)  As a result each year unmet need has increased as people are excluded from accessing services or see their care packages reduced.

• Currently nearly 800,000 people who need care receive no support from either public or private agencies.

• Councils have cut back on their service provision.  In 2009-10 the total hours of support purchased by local authorities for older people fell from 2 million to 1.85 million. (5)

 
• The financial demands on older people who receive care are increasing.  In real terms, charges were £150 per year more in 2010-11 than in 2009-10 for each older person using local authority care services and £360 more than in 2008-09.

•  Funding for frontline services has not been adequately protected.  Councils have reduced their spending on older people's social care by £671 million in real terms in the year between 2010-11 and 2011-12. (6) This is a decrease of over 8 per cent. (7)

 
•  Additional money from the NHS has not filled the gap.  Even after adding the £330 million transferred from PCTs for social care to the amount spent by local authorities, the overall effect is still a real decrease in spending on older people's social care of £341 million or around 4.5 per cent.

• In order to maintain the care system at the same level as in 2010 (before current spending cuts) expenditure on older people's social care should be £7.8 billion in 2011-12. But this year's total spending is £7.3 billion. Even making allowances for efficiency gains, this has left a total shortfall of £500 million.

1.5 Evidence of a system of social care at breaking point

• In January 2012, Age UK's Crisis in Care dossier set out the evidence and impact of the under funding of social care.  Read Age UK's Crisis in Care document here.  

 • In November 2011, the Equality and Human Right's Commission Inquiry into the Home Care System found: ‘disturbing evidence that the poor treatment of many older people is breaching their human rights.  Read the EHRC document here. 

 
 • In February 2012 The Health Select Committee Report on Social Care concluded that ‘older people are being let down by fragmented care services.'  Read The Health Select Committee Report on Social Care here.

 
• In March 2012, a Which? Undercover investigation into home care ‘exposed shocking examples of poor home care of vulnerable people, suggesting a system that is at breaking point' ' Read the Which? Undercover investigation here.  

1.6 The personal impact of the crisis in care

In May 2012, following the Queen's speech, David Cameron said, "We have rewarded responsibility in our society, backing people who work hard and do the right thing."

 
David: David is 76 years old and has a neurological disorder that severely restricts his mobility. He relies on carers four times a day to help him with getting up, dressing and eating.  They are hard pushed to fulfil their tasks in the allotted time.  He shares his home care costs with the local authority and his contribution recently went up from around £260 to £324 a month. He struggles with his payments from his pension and dwindling savings.  He is still only able to shower once a week because he is not provided with sufficient assistance.  David has worked hard for over 50 years and feels that he has more than paid his dues.  He left school at 17 to join the Royal Navy and then worked until he was 70.

Jenny:  Jenny is 63, and a  retired nurse, who cares for her husband, James (73), who developed Lewy Body Dementia almost overnight.  When the NHS said he had to go into a care home, she was determined that he should be looked after in his own home.  She is damning of the whole system.  Once they found out he was a self-funder they got no support and were completely cut loose from any care services support at all.  Jenny is stretched to breaking point.  She pays privately for a care at home package - a night-sitter 3 nights a week.  James visits a day centre twice a week.  Jenny pays for a week's respite care every 6 weeks.  She provides all care for her husband at all other times which works out at 121 hours a week.

Paula: Paula's husband, 66, was diagnosed with vascular dementia four years ago.  Paula, now 62, was his primary carer together with working full-time. She eventually found a day care centre. As husband's disease progressed, she had to find further care as day care finished at 3pm and she needed a carer for him until she got back from work.  This was terrible as the 'carers' never arrived on time and Paula was always being called out of work.  Half the time they did not turn up at all.  The carers were not trained to deal with dementia - they would just sit there with him.  Paula changed her hours at work and took a reduction in salary but in the end, after about a year, she had to give up her job and become a full time carer.  Her husband had to go into care last year which cost the couple £1000 a month.

Paula says, "The illness is bad enough without having to deal with social services. And the maze of home care, NHS appointments, etc". If more support has been available, she says she could have continued working.

-ENDS-

Notes to editors:

Media contact: Hilary Carter
Tel: 020 303 31689
Out of hours: 07071 243 243

1) http://www.ageuk.org.uk/get-involved/campaign/poor-quality-care-services-big-q/care-in-crisis-2012-report/
2) State of Care report 2010-11, Care Quality Commission,  www.cqc.org.uk/stateofcare2010-11.cfm 
3)  http://www.equalityhumanrights.com/legal-and-policy/inquiries-and-assessments/inquiry-into-home-care-of-older-people/
4) Source: ONS Population Estimates, mid-2004 - mid 2010 (accessed via ONS website).
5) www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-information
6) 2011-12 prices calculated using the RPI (all items), averages for financial year 2010-11 and 2011-12 (to August 2011).
7) Analysing only spending by councils with adult social service responsibility (CASSRs), this decrease is 4.9%.

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