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Social Care in England: challenges and current thinking

Social Care in England: challenges and current thinking



Mr. Robert Kettell,

Mr. Robert Kettell,
Social Care Strategic Policy and Finance,
Department of Health



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    Social Care in England: challenges and current thinking Social Care in England: challenges and current thinking Presentation Transcript

    • Social Care in England: challenges and current thinking Robert Kettell Social Care Strategic Policy and Finance Department of Health
    • Social care in England Social care is the wide range of services designed to: - support people to maintain their independence - enable them to play a fuller part in society - protect them in vulnerable situations It is for all adults aged 18 and over. Total number of people receiving support in 2008/09 - 1.8 million • Of which: – Over 65 – 1.2 million – Under 65 – 600,000 – Residential care (including nursing care - all ages) – 250,000 – Community care (all ages) – 1.5 million
    • Social care in England (continued) • Total spend on adult social care services (2008/09) - £16bn • Broken down by age: – £9bn is on the over 65s – £7bn is on the under 65s • Broken down by setting: – £7.5bn is on residential care – £6.5bn is on home and community care – £2bn is on other costs (esp. assessment and care management)
    • How is social care funded? Social care funding is allocated by local authorities. Local authorities fund social care in two ways: 1. Through general expenditure, which is divided into: - Funding provided by central government = £73bn in 2008/09 - Raising money from local people through council tax = £25bn in 2008/09. Total revenue spending by local authorities = £98bn Around 15% of this total (£14bn) is spent on social care. 2. Payments collected from people receiving care from the local authority = £2bn
    • Who receives state-funded social care? • Assessment is based on both needs and means • Need assessment – – national framework for assessment, based on risk to independence, but – local discretion around eligibility. • Means assessment – – National framework for assessment – national eligibility for residential care (i.e. those with assets of over £23,000 do not qualify for state support) – local discretion over eligibility for home and community care.
    • How is social care organised in England? Local authorities: • Assess eligibility ; allocate personal budgets ; commission services on behalf of care users ; shape market • Provide limited in-house services (but this is increasingly rare) Private and third sector: • 30,000 independent providers, many of which are small businesses and organisations. • Employ around 1.5m people • Over 90 per cent of residential care places and more than 80 per cent of home care hours are provided by the independent sector.
    • Current Challenges
    • Current Challenges Birmingham University Report
    • Current Challenges
    • Current Challenges Demographic change • Changes in demography – ‘baby boomer’ generation about to enter retirement • Younger people with disabilities are living longer • This means more people with care needs: increase of 1.7 million expected by 2026 Increasing expectations • Social care is means tested – some are forced to sell their homes to pay for care • Variation of services across the country – leads to accusations of “postcode lottery” • Increasing expectations – people want choice and control over services Fiscal pressures • Challenging short term fiscal climate – need for efficiencies.
    • Short term pressures and efficiencies • Demand pressures = 2% per year • Costs of delivering services = 2% in real terms per year So, to fund the current system we need to increase funding by 4% in real terms per year - or find efficiencies. But efficiencies in social care are challenging: • Low paid workforce • Person – to – person service • Long term programme of de-institutionalisation
    • Response Menu of interventions Menu of interventions Outcomes Outcomes Efficiency savings Efficiency savings • Assistive technology • Reduced residential • 3% target for 2010/11 • Prevention and re- care use (40% of total in social care ablement spend) • Personal budgets • Reduced emergency • Etc. hospital admissions
    • Menu of interventions Reduce demand • Prevention services – POPPs pilots • Crisis response • Re-ablement and intermediate care Reduce costs • Assistive technology – telecare services • Personal budgets – including Direct Payments and mainstream services • Improved procurement
    • The policy response – long term
    • How we will achieve our vision • Integrate services better • Support the workforce • Introduce a quality framework for care and support
    • The funding options The current system Currently the average 65 year old can expect to need care that would cost around £30,000 during retirement
    • The funding options - Partnership Partnership – People will be supported by the Government for a set proportion of the cost of their care, more if they have a low income.
    • The funding options - Insurance As well as receiving a set proportion of the cost of their care, the Government would also make it easier for people to take out insurance to cover their remaining costs.
    • The funding options - Comprehensive Everyone gets care free when they need it in return for paying a contribution into a state insurance scheme whether or not they need care.