Social care in the UK


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  • There is no doubt that we need to spend more on social care and support. This is for two reasons: because the system we have currently is inadequate and because of the significant increase in demand, particularly among older people.
    This chart shows that over the next 20 years, the number of older people age 65 to 69 will grow by 40%.
    The number of people age 80-84 will grow by 70%.
    The number of people age 85 and over (the group that is the most likely to have care and support needs) will double in size.
    This is great – we are living longer than our predecessors.
  • The test for residential care is a national system
    people with more than £23,250 in savings or capital (including housing) must meet the full cost
    councils will pay for people with less than £14,250
    between £14,250 - £23,250 you will contribute towards the costs on a sliding scale
    The test for domiciliary care is locally determined
    for people with income and assets a particular level councils can charge for all or part of the cost of care
    most councils use the £23,250 and £14,250 thresholds for assets (excluding property)
    income charges vary but there is a minimum level people’s income cannot drop below
  • Social care in the UK

    1. 1. Rapid Ageing: A Caring Future Delivering social care in the UK Ruthe Isden: Public Services Programme Manager, Age UK 9th May 2012
    2. 2. 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
    3. 3. 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
    4. 4. 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
    5. 5. 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
    6. 6. Main causes of care and support needs (all adults) Humphries. R, The Kings Fund 2012
    7. 7. 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 Community based services
    8. 8. 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
    9. 9. 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
    10. 10. Using social care services in the UK Anyone can approach their local council and ask for an assessment of their needs Everyone has to take a means test and, if they are eligible, the council 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 produced setting out what support they need People are assigned a level of ‘need’ based on the national criteria The council will either provide money (a direct payment) or contract services to meet their needs
    11. 11. 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.
    12. 12. 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)
    13. 13. 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
    14. 14. 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
    15. 15. 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
    16. 16. 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
    17. 17. 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
    18. 18. 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
    19. 19. 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
    20. 20. Life expectancy and healthy life expectancy 65 70 75 80 85 90 95 Shortest Average Longest Shortest Average Longest Years Years in good health Years not in good health Males Females
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. 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
    25. 25. Ruthe Isden Public Services Programme Manager, Age UK Contact: By email: By phone: +44 203 033 1478 By post: Tavis House, 1-6 Tavistock Sq, London, WC1H9NA, UK