Are we heading for a doomsday scenario in the care of older people? 

Professor Lee-Ann Fenge
22nd September 2016

When looking at the news it’s hard to imagine that we are facing a crisis of unprecedented proportions in the care of our ageing population. 

On-going discussions about Brexit, Strictly Come Dancing or the Brangelina divorce dominate the headlines. However, last week a report by the Kings Fund (Humphries et al. 2016) highlighted the growing crisis in the social care system which is struggling to meet the needs of older people. 

A number of key factors are coming together to create this crisis. Over the past five years, local authority spending on the support needs of older and disabled people has fallen by 11 per cent in real terms and the number of people getting state-funded help has plummeted by at least 25 per cent. Public spending on adult social care is set to fall to less than 1 per cent of GDP (Humphries et al. 2016). This has occurred at a time when demographic changes and increased life expectancy has resulted in increased demand for intensive home care support (ONS, 2011; UKHCA, 2012a; Lewis and West 2014). 

The percentage spent by local authorities on older people is a fraction of NHS budgets. According to the Kings Fund report (Humphries, 2016) this equates to a local authority spend of £7.23 billion on social care for older people, whereas the NHS budget in 2014/15 was £116.4 billion (two fifths on older people). This obviously has a knock on effect on those who are now eligible for local authority funded provision, and increasing numbers of older people now need to fund and arrange their own care arrangements. Pressures on health and social care budgets results in increasingly delayed discharges from hospital. If a winter Flu epidemic occurs, it is likely that the health and social care system will quickly be pushed into meltdown. 

Another challenge facing the sector concerns the recruitment and retention of staff, and it is suggested that the care sector could face a shortfall of more than 1 million care workers by 2037 (Independent Age 2015). Issues related to low pay and low status continue to act as disincentives for employment in the care sector (Skills for Care, 2011a). The independent / private sector is now the dominant provider of home-care and care home provision (Eborall et al., 2010; UKHCA, 2012b), however many of these agencies are facing financial challenges as local authorities pass on cuts in their budgets to contracts with these care providers. These are complex problems which have no easy solutions. However, if we are to avoid a meltdown in adult social care in the not too distant future, government and society as a whole needs to engage in a wider debate about what we are prepared to fund and what local authorities can afford. 

We live in an ageing society, and at some point these issues will affect us both personally as well as collectively. A long-term strategy across successive parliaments is required to identify creative solutions to these challenges, and this may include increased taxes to provide sustainable services and different ways of configuring health and care provision. 

We can draw on the work of Tronto (2002) to re-vision care as a central shared value within society and a universal need. This may lead to a social transformation of the value of ‘care’, including the status and pay of care work. 

We all need ‘care’ and therefore have a stake in sustaining health and social care services. As a wealthy nation we have choices and this includes how much should be spent on essential public services to support the health and well- being of all citizens. It is time we moved away from trying to stem the leak in the dam with match sticks – surely we all deserve better than this. 


Meet the author(s)

Professor Lee-Ann Fenge

Director of the Centre for Seldom Heard Voices
Lee-Ann is Professor of Social Care in the Faculty of Health and Social Sciences. She is a Registered Social Worker and has always been committed to advancing the professional evidence base of social care practitioners.
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