Facing An Adult Social Care Crisis
- V Evans
- Sep 10, 2024
- 8 min read
Updated: Oct 22, 2024
As many of you will be aware, the new Labour Government is facing an uphill task with both the economy and with public and social funding. One of the largest growing areas across the United Kingdom is adult social care. We have an aging population, and this means a greater number of people are reaching an age where they require support in the form of social care. This can be within the individuals own home (domiciliary care) or in a care home or assisted living facility (residential care).
In the last 40 years the number of people aged over 65 has increased by 52% (over 3.5 million people). This increase has been most prevalent in rural and coastal areas. The national average in 1 in 5 people is over 65 but is some rural and coastal areas the average in 1 in 3 people. The number of people aged between 65 and 79 is predicted to increase by 30% over the next 40 years. The fastest growing age group of the population is those over 80. This is set to more than double to over 6 million people.
Wales has a higher proportion of older people with lower levels of financial means compared to the rest of the UK. Social Care Wales predicts that the population aged 65 and over needing help with self-care activities will grow from just under 200,000 in 2013 to almost 285,000 in 2030, an increase of 43%.
Increasing numbers of older people have never been married, and/or are ageing without children. 15% of women and 20% of men aged 55-59 had never been married or in a civil partnership in 2021 compared to 8% of women and 12% of men in this age group in 2011. This will increase the number of elderly people who don’t have any informal family support in the future. It has been shown that those without this informal support usually require residential care earlier than those with family support.
Adult social care is not only accessed by the elderly. In 2020 over 1 million adults received care in England, with 155,400 of these registered as having a learning disability. The prevalence of disability among working-age adults has increased over the last decade. The most recent data in 2024 shows that the prevalence of disability among working-age adults is 23% – up from 15% in 2010/11. There has also been a rise in the number of people struggling with their mental health. More than 1 in 7 UK adults say their mental health is currently either bad, or the worst it's ever been.
Many people will still have an outdated and stereotypical idea of social care, but over the last two decades the laws and governance have been sharpened and tightened to create strong principles of care which are focused on each person’s individual needs and their well being. This is referred to as person centred care and is one of the core principles of the 2004 Care Act and its subsequent updates. The standard of care is built upon five principles: dignity and respect, compassion, be included, responsive care and support and well being. To put it simply, every person has the write to a social care package that not only meets their most basic needs but also helps enhance their well being.
The care elderly or disabled people receive can be funded in several ways. This can be through Continued Health Care (CHC) through the NHS for those with increased medical needs. For those fortunate enough to have the money it can be privately funded. For many it is funded or part funded through the local council run Social Services.
In 2024 we are facing a funding crisis in the social care sector. Local Councils are predicting a shortfall of millions of pounds. My own local Adult Social Services alone are predicting a £30+million shortfall. How the different councils respond to this shortfall will be varied. Some of the thresholds for funding my increase, with people paying for a larger proportion of their care.
More immediately, councils will look to cut back services and care packages. Staff leaving Social Services will not be replaced, putting greater pressure on those still there trying to manage the situation. Care companies are already being contacted to see if any of the elderly people they visit have calls that can be cut. There have even been suggestions that they would review some packages that need two carers (doubles) for moving and handling to see if they could be managed with one. If services for early intervention and prevention are cut then people who would have had prior support to promote independence will enter care earlier, creating further demands on the sector.
They are trying to strip services back to only cover the very basic care that people ‘need’ the most. This may sound sensible but is completely against the principles of the Care Act that has modernised and honed the care sector so well over the last two decades. It states in the Care Act that ‘The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into.” It also states that ‘Meeting needs’ is an important concept under the Act and moves away from the previous terminology of ‘providing services.” Care cannot be truly ‘person centered’ if its main dictator is finances and not outcomes. For a person to have positive well being it requires more than just the absolute bare minimum of their requirements to be met. This falls back under the old and outdated practice of ‘providing a service’ and not ‘meeting needs’.
There is also a rise in micro care companies, which is being encouraged as they have lower overheads. These companies are so small that they do not get regulated by the CQC (Carer Quality Commission). This is the body that ensures the quality of social care in England through inspection and standards of compliance. This means that in 2024, 29% of care is now not regulated due to this large rise in micro care companies. This is 6,800 of 18,500 adult social care organisations. Without regulation the quality of care provided, and level of staff training can be wildly varied. Without the correct training, the risk of injury or accidents during moving and handling is much higher. Micro care is effective for social support but should not be a solution for care calls.
Many elderly people are not socially active and can spend most of their time isolated with only the television for company. So, above the assistance with personal care, medication, meals or housekeeping, most value the social aspect of the calls most of all. Cutting a 45-minute call down to 30 minutes to just cover the bare-essentials may not sound like much, but to many that 15 minutes is invaluable to their mental well being. There is a risk that service users with social calls may have them removed as they will not be seen as essential, preventing them from participating in activities they enjoy or valuable social interactions.
I have heard many people ask, ‘if people are lonely why don’t they go live in a care home?’. Firstly, many people wish to stay in their own home, where they are comfortable and have happy memories. It’s everyone’s basic human right to chose where they live whilst they still have the capacity to do so. Secondly, it is not a solution to the current crisis because domiciliary care is far less costly to fund for most people than residential care. These residential care homes will feel the effects of the lack of funding too. There will have to be reductions in costs through lowering staff numbers even further and reducing the cost of non-essentials such as enrichment activities.
Rushed care calls also make it difficult for care staff to pick up warning signs for medical conditions, adverse reactions to medication and potential safeguarding issues. Subtle indicators may be missed when several tasks are squashed into the shortest possible time frame, leaving the carer little time to stop and interact. Despite not being medically trained, often care staff are best placed to notice arising issues because they see the individual regularly and get to know them well. This is a key part of the role and one that is often underestimated by those who have never been involved in the sector or had a loved one receiving care.
Stripping doubles calls down to one carer is quite a frightening prospect for care staff. These calls have been assessed as requiring two carers for the health and safety and reduction of risk for both the service user and the carers themselves. If there is pressure on Occupational Therapists to review these calls and take them down to one person if it’s just about ‘doable’ then there will undoubtedly be an increase in accidents and injuries, as well as discomfort and a lowering of dignity for the person being moved. Back pain and musculoskeletal disorders are already common in the care sector which can lead to inability to work.
There is already a considerable amount of pressure on the sector to take the slack from the NHS, with customers being discharged increasingly early to reduce demand on beds. This stress is felt at all levels from Registered Managers right down to care staff. Increased risk and fear of being blamed for incidents will only make it harder to recruit and keep staff. This is already difficult as poor funding in the sector means that wages are low despite the high responsibility.
Recruitment can be difficult in care due to the low wages. An estimated 131,000 posts remained vacant in 2023. This impacts how much care can be delivered by domiciliary care organisations and put considerable pressure on understaffed care homes. The number of vacant posts would be doubled without the increase of international recruitment (e.g. sponsorship). In the last 3 years the number of international recruitment's has increased from approximately 15,000 to 105,000.
Care workers have benefited from the introduction of the National Living Wage although the rise is still not in line with inflation and has fallen below the average pay of shop workers. This increase in wages puts a strain on the Social Care companies who have not seen an equal rise in the income from care packages. In fact, funding into care has been completely stagnant. Council funded packages often barely cover staffing costs, if they cover them at all, and companies rely on the private customers to keep them afloat. This is exacerbated by the rising costs of other overheads, for example insurance, IT, uniforms, rent and utilities. This creates a huge problem for the care companies, especially the smaller franchises or family run companies who often have the highest standards of care.
This is already not sustainable in the long run and suddenly having packages thinned will have an immediate negative effect. There will be a drop in income that is not instantly easy to fill. For example, removing a tea call from a package only leaves a gap for a tea call to replace it. There are virtually no packages that are just a tea call, and it would have to be in the right area to fit the run in question. This could push some companies who are already struggling into oblivion.
There is already a significant unmet need for social care. Nuffield Trust estimated that fewer than half of older people with care needs were receiving support. Long-running cuts to local authority budgets have meant that funding has failed to keep pace with demographic pressures. Currently, nearly one-third of requests for local government funding result in no support. If companies begin to fold, then we will have a ‘care crisis’ across every nation in the United Kingdom. This will have a knock-on effect on the already floundering NHS who will have greater difficulty ‘clearing beds’ for new patients from discharging people to care in the community.
We need urgent action to prevent us reaching that crisis point from central government at Westminster and the devolved powers in Wales, Scotland and Northern Ireland. Firstly, an emergency bill to inject some cash into the sector in the short term, followed by some proactive and long-term action. Those who have had care or had loved ones who have benefited from care will have a first-hand understanding of the need to safeguard the sector for the future. For those who have not had any direct or indirect participation yet; at some point you or someone you care for will need support. If you want that support to be readily available and of a good standard, then your voice is needed now to ensure the services remain in place.
Care About Care Website
Data Resources
Our Ageing Population | The State of Ageing 2023-24 | Centre for Ageing Better (ageing-better.org.uk)
The size and structure of the adult social care sector and workforce in England (skillsforcare.org.uk)
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