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Social care in the UK
1. Rapid Ageing: A Caring Future
Delivering social care in the UK
Ruthe Isden: Public Services Programme Manager, Age UK
9th May 2012
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. 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. 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. 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. Main causes of care and support needs
(all adults)
Humphries. R, The Kings Fund 2012
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Ruthe Isden
Public Services Programme Manager, Age UK
Contact:
By email: ruthe.isden@ageuk.org.uk
By phone: +44 203 033 1478
By post: Tavis House, 1-6 Tavistock Sq, London, WC1H9NA, UK
Editor's Notes
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