- Social care in England supports over 1.8 million people annually with a total spend of £16 billion. It assists those over 18 with independence, participation in society, and protection. - Challenges include an aging population that will increase those needing care by 1.7 million by 2026, rising expectations of choice and universal coverage, and fiscal pressures as costs rise 2% annually while funding only increases by 2%. - Reforms propose integrating services better, supporting the workforce, and introducing a quality framework. Funding options center around partnership models where people pay a set amount and the government covers the rest, or insurance models to cover additional costs.

1. Social Care in England: challenges
and current thinking
Robert Kettell
Social Care Strategic Policy and Finance
Department of Health

2. 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

3. 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)

4. 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

5. 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.

6. 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.

7. Current Challenges

8. Current Challenges
Birmingham University Report

9. Current Challenges

10. 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.

11. 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

12. 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

13. 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

14. The policy response – long term

15. How we will achieve our vision
• Integrate services better
• Support the workforce
• Introduce a quality framework for care and support

16. 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

17. 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.

18. 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.

19. 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.