By Dr Eleanor Roy, Health and Social Care Policy Manager, CIPFA
The current picture of social care in this country is far from idyllic. Staff shortages and budget cuts are preventing those who need the most help from receiving it. While it is the responsibility of government to fund programmes to help those who are most vulnerable – both old and young – in some areas austerity measures have forced these resources to be stripped down to the basics.
The Johnson government has certainly paid lip service to the idea of 'fixing social care'. However, the time for words is long past. The pending election will need to be about more than campaign promises. The next government will have to take tangible action to make social care a priority if we are to provide quality support and protection to those who need it most.
The evidence is irrefutable. The 2019 Performance Tracker, which analyses data from across nine public services, indicates that health and social care for both adults and children has noticeably declined in quality as a result of cost-cutting measures.
Although all areas of government spending assessed by the Performance Tracker have seen some reduction in quality, adult social care has undoubtedly seen the most setbacks. Public spending on adult social care provision has fallen 2.1% in real terms between 2009 and 2019. Councils have reduced the number of day centres and home adaptations they provide as a result of tightening budgets - 41% of day centres closed between 2010 and 2018. With no concurrent increase in productivity during this time, it would seem that local authorities have not been able to provide the same level of service from these fewer sites. We have also seen a decline in provision of long-term care packages. Between 2009 and 2014 the number fell 27%, and then another 3.4% by 2019. In contrast, the number of short-term packages has increased by nearly 15% between 2014 and 2019.
While it’s true that the service has been able to achieve efficiencies, it will not be able to maintain this over time. As the population continues to live longer in poor health, the forecast growth in demand poses a significant challenge for public spending.
Demand for publicly-funded adult social care is likely continue to increase faster than the amount of money available to spend on it. To continue providing the same quality of care over the next five years, the government would need to spend 11.3% more than it did in 2018/2019.
Children’s social care faces a similar dilemma. There has been a decline in both funding and quality to those currently receiving care. Services in this area are provided to children with the greatest need – those who are disabled, under protection or have been placed in residential or foster care – but there is evidence that vulnerable young people are slipping through the cracks.
The number of children who are the subject of a child protection plan for the second or subsequent time has risen by 20% since 2009. In addition, fewer reviews of child protection plans are being carried out over time, indicating that that fewer social workers are visiting homes, and less long-term support is being delivered to children in need.
Preventative services are also feeling the strain. Government spending on youth services, justice and children’s centres has been slashed by 56% since 2009/2010. Local authority spending has fallen by 62% in the same time period. In order to save funds, some local authorities have limited the definition of ‘child in need’ which has resulted in less children being eligible for care.
While more money for children’s social care was announced in the most recent spending round, demand may grow faster than anticipated. Many local authorities consider adult social care to be the more pressing issue, and could choose to use these additional funds in that area instead. And with only a single year of funding guaranteed, it will be difficult, if not impossible, to plan to meet increasing demands in a sustainable manner for future years, meaning improvements to service quality are likely still a long way off.
It would be disingenuous not to highlight where there is good news. In general, a consistent level of satisfaction has been reported by those who receive adult social care. Regardless, the perception of adult social care on the part of the social care workers and the public continues to decline. This could in part be due to general dissatisfaction of the workforce. As a result of budget cuts, social care workers have had to do more with less in order to maintain the quality of the care they provide. Vacancy and turnover rates in adult social care jobs are high, and continue to rise. This is echoed in children’s services, where social workers have seen restrictions on their ability to get a pay rise.
This isn’t a new conversation. For decades now, the question of how to fund social care has been hotly debated – and political action deferred. As the population has aged, life expectancy has risen and the number of individuals suffering from long-term health conditions has continued to grow: meanwhile funding has been gradually reduced.
However, despite the fact that the evidence shows this already reduced level of performance cannot be sustained, these insights don’t seem to be informing government decision making.
No government can make good spending decisions without understanding the data, and there are substantial gaps in the government’s data pool surrounding social care. We don’t have a national picture for the extent of private funding in social care, waiting times for assessments, or what happens to adults who request but do not receive care.
These details paint a bleak picture for the future of adult and children’s social care in England. While the Performance Tracker shows any government will have to increase spending substantially to meet demand, we would urge parliamentary candidates to consider how their policy decisions can be better informed and evidenced. Without these insights, any government will continue to fall into the crisis-cash-repeat cycle that has characterised politics for years. And it is the health and wellbeing of the most vulnerable members of society that will pay the price.
This article first appeared in Community Care.