Social care in the UK

Rapid Ageing: A Caring Future

Delivering social care in the UK

Ruthe Isden: Public Services Programme Manager, Age UK

9th May 2012

Summary

Later life in the UK: who we care for now and in the future The social care system in the UK Funding and national framework Social care market and providers NHS and social care: two very different systems The big debates: personalisation, co-production,

prevention, integration and future funding

Later life in the UK

There are 10.3 million people aged 65 or over in the UK today

There are 1.4 million people are aged 85 or over – the people most likely to need care

These numbers will grow significantly in the future as people live longer and more people enter retirement

Looking ahead: Growth in numbers of older people 2010-2030

0%

20%

40%

60%

80%

100%

65-69 70-74 75-79 80-84 85+

Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011

Health and care in later life

4 million have a limiting longstanding illness, 40% of all people aged 65+

By 2030 there will be over 6 million with a long term condition

Over 820,000 people are estimated to be suffering from late onset dementia in the UK in 2010

By 2030 there will be over 1 million people with dementia 1 in 2 people will require care in older age

Main causes of care and support needs (all adults)

Humphries. R, The Kings Fund 2012

Who we care for and how: publicly funded care

Humphries, R: Social Care and the NHS, The Kings Fund, 2011

Numbers of people aged 65+ using publicly funded social care services 2004 – 2010

0

200

400

600

800

1000

1200

2007/8 2008/9 2009/10

Nursing home

Residential care

Communitybased services

Growing demand for social care services

Growing numbers of ‘the very old’ people aged over 80 BUT……

Improvements in healthcare driving life expectancy and better treatment of complex long term conditions that require specialised care

Smaller, more geographically disburse families More women in the workplace Changing attitudes and expectations – older people want

to be independent and self reliant

UK national framework

Social care is a local government responsibility, they decide what care to provide and how

National government sets minimum standards and criteria only

Funding is largely provided by national government grant, but it is not ring fenced

Last year national government provided £7.3 billion in funding, however some funding was drawn from the NHS

National system of regulation for service providers – mandatory registration with the Care Quality Commission

Using social care services in the UK

Anyone can approach their local council and ask for an assessment

of their needs

Everyone has to takea means test and, if they are eligible, thecouncil will charge

for services

A needs assessment is completed by a social worker or other health

professional

If someone falls within the council criteria a care

plan will be producedsetting out what

support they need

People are assigneda level of ‘need’ basedon the national criteria

The council will eitherprovide money (a direct

payment) or contractservices to meet

their needs

Eligibility tests – needs and means

Needs test has four levels: low, moderate, substantial and critical

The test looks at routine household tasks (e.g. shopping, cooking), personal care (e.g. bathing, dressing) and risk of harm (e.g. falling)

Means test measures both income and assets – if these are above a certain level then an individual is required to meet all or part of the costs of care.

Outside the state system

Informal care – 6 million people (1 in 8) are ‘informal carers’ looking after family members, partners or friends

Private care market – many people pay for their own care: – 170,000 (about 41%) people pay their own care home

fees– somewhere between 168,000-274,000 pay for their

own home care (difficult to estimate as many are unknown to councils)

Social care market and providers

Nearly 90% of formal care is provided by private or charity sector organisations

Part of deliberate policy aimed at developing a market in care provision to:– use competition to drive improvement in quality– create greater diversity of types of services– stimulate commercial investment in services

Mixed results – many critics argue it has made services more fragmented, less accountable and has not improved quality

Care in crisis?

Poor quality of care services with limited access to specialist help

Poor integration and care co-ordination ‘Geographical lottery’ – 82% of councils only support

people with substantial or critical needs Hard to access – 800,000 older people receive no formal

help High individual financial risk – many people risk losing all

their money before receiving help Poor support for carers – families find it difficult to get

help or information

NHS and social care: what’s the difference?

NHS Social care • Provides primary, secondary and tertiary healthcare services• Free at the point of need• Comprehensive, universal services• Fully funded through general taxation• Locally commissioned, but within a clear national system• Fairly little local variation in services provided

• Provides care in care homes, in day facilities and in people’s home• Means-tested and needs-tested at point of need• Local councils set local criteria and commission care• Far fewer national rules or guide lines• Huge geographical variation in types of services, funding and rules

The big themes: integration

‘ensuring social care, health and housing services operate together efficiently and effectively’

Key issues:– care co-ordination and complementary points of entry

to maximise benefits– professional integration – common culture and ways of

working– systems working outside silos and sharing budgets– shared vision and leadership across systems

Failure to integrate = inefficient use of resources, poor outcomes, crisis care and excess hospital admission

The big themes: personalisation

‘making social care services more responsive to individual needs and giving people great choice and control’

Key issues:– recognising people as ‘experts’ in their lives and

condition – ‘individuals know best what they need’– challenge ‘I know best’ professional culture and ‘gift’

model of care – challenging the medical model of care– providing of good information and advice – making sure services are accountable to service users

Big challenge in making personalisation work for older people who may lack mental capacity or have rapidly changing needs

The big themes: co-production and community solutions

‘working in partnership with service users to design and deliver services’

Key issues:– people not ‘passive consumers’ but able to contribute

to creating care and care relationships– engaging service users, families and the community in

designing health and care services and economy– building on community assets to find individual and

collective solutions Research demonstrates better, more cost-effective

outcomes

The big themes: prevention and early intervention

‘seeking to prevent or delay the need for social care services by maximising independence and health’

Key issues:– must change the way we think about and provide

health and care – otherwise demand for care services in future may become unsustainable

– often huge, unexploited potential to improve health and wellbeing through effective interventions

– early intervention – ‘a little bit of help’ – delivers huge long term benefits by maintaining independence

– must remove barriers to people investing in prevention

Life expectancy and healthy life expectancy

Shortest

Average

Longest

Shortest

Average

Longest

65 70 75 80 85 90 95

Years in good health Years not in good health

Years

Males

Females

The big themes: future funding issues

UK had a £500 million gap in funding 2010/11 – this is growing every year

Need to invest in prevention to improve cost-effectiveness of system overall in future

Getting the balance of spending right across older people’s services – inadequate social care funding has big impact on healthcare

Individuals must contribute, but there needs to be a fair way to manage and pool risk

Public spending on older people 2010/11

Social security benefits

Social care

NHS

£0bn

£50bn

£100bn

£150bn

Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011

Social care reform in the UK

‘Dilnot system’ – Capping care costs to protect individual wealth and

pool risk– Fairer means testing to protect people on lower

incomes– New system to create a ‘national offer’ that is the

same in all areas– Stronger role for the private insurance market– Greater emphasis on community solutions and

personalisation

Key messages

Care is increasingly a mixed economy with diverse solutions including family, community and state

Form must follow function Health and social care are two halves of a whole, it

is dangerous to invest in one and not the other Placing older people at the centre of creating care

is cost-effective and delivers better outcomes

Ruthe Isden

Public Services Programme Manager, Age UK

Contact:

By email: [email protected]

By phone: +44 203 033 1478

By post: Tavis House, 1-6 Tavistock Sq, London, WC1H9NA, UK