The state of adult social care services 2014 to 2017 presents findings from our comprehensive programme of adult social care inspections.
The report looks at what we’ve found about the quality of care across the full range of adult social care services that we regulate.
What we did
In October 2014, we formally rolled out our new inspection framework for adult social care. It includes overall ratings for each service as well as ratings in each of five key questions – whether they’re safe, effective, caring, responsive and well-led.
Between then and February 2017, we’ve completed over 33,000 inspections of around 24,000 adult social care locations.
We recognise there is fragility in the adult social care sector influenced by funding and resource pressures. But as the quality regulator, our focus in this report is on the quality of adult social care services and the impact that this has on people who use services.
What we found
At the end of our initial comprehensive inspection programme, almost four out of five adult social care services in England were rated as good or outstanding overall. Nearly a fifth of services were rated as requires improvement. We are particularly concerned about the 343 locations (2%) that were still rated as inadequate.
We have observed differences in performance from region to region, with the East of England showing almost 10% more locations rated as good or outstanding than the North West.
Of the five key questions that we asked all services, safe and well-led have the poorest ratings, with around a quarter requires improvement and inadequate.
Caring was the best rated key question – 92% good and 3% outstanding.
Community social care services (such as supported living and Shared Lives) were rated the best overall. Nursing homes remain the biggest concern.
Generally, smaller services that are designed to care for fewer people were rated better than larger services.
The public values the information in our inspection reports.
The Conservatives’ policy of means testing the winter fuel allowance for pensioners could contribute to almost 4,000 extra deaths this winter, Labour has said.
Theresa May said removing the annual payment of up to £300 a year from all but the poorest pensioners would release funds that could be pumped into the social care system.
But the shadow chancellor, John McDonnell, published analysis which he said showed almost 4,000 more pensioners’ lives would be at risk through being unable to heat their homes.
No level was given for the means test in the manifesto, published last month, but the Resolution Foundation thinktank suggested one straightforward approach would be to give the payment only to those who receive pension credit, the means-tested benefit for the poorest pensioners.
That would mean 10 million people who currently receive the annual payment missing out – though Labour claims the true figure could be higher, since many who are eligible for pension credit do not claim it.
McDonnell said: “There are now only three days until polls open in this election, and the truth about the Tories’ plans for older people in our country needs to be known. Re-electing the Tories will represent the single biggest attack on pensioners in a generation in our country.
“Removing the winter fuel payments from millions of pensioners could leave thousands of the most vulnerable at even more risk this winter. On top of their dementia tax, it means that pensioners in our country will struggle to heat their homes and keep their homes under the Tories.
Labour cited research saying that half of the almost 10,000 decrease in so-called “excess winter deaths” – the rise in mortality that occurs each winter – between 2000 and 2012 was due to the introduction of the winter fuel allowance, and suggested that could be reversed by the Conservatives’ policy.
The Conservatives rejected Labour’s claims. “This is irresponsible scaremongering by Jeremy Corbyn – who can’t be honest about the fact he is relying on his magic money tree to pay for all of his uncosted promises,” said Damian Green, the work and pensions secretary.
Labour has pledged to keep the winter fuel allowance, and maintain the triple-lock promise on uprating the state pension, as well as funding social care through general taxation instead of expecting wealthier pensioners to part-fund their own care.
The over-65s overwhelmingly voted Conservative at the 2015 general election and Labour has been keen to win them over through a series of manifesto promises.
Professor, Centre for Health Economics, University of York
Having presided over annual funding increases that are among the lowest in the history of the English NHS, the Conservative manifesto offers less generous funding increases over the next five years than the other parties. Even this offer should not be taken at face value.
Just as in their 2015 manifesto, the Conservatives are promising to increase spending by £8 billion on the English NHS over the parliamentary term. But, once elected in 2015, the Conservatives committed to increase the health budget by only £4.5 billion, making up the difference by reducing spending on health education and training, public health grants and capital.
They’ll have less wriggle room to pull the same trick if re-elected. This is partly because they’ve reduced the education budget as far as they can by introducing nursing bursaries, which both the Liberal Democrats and Labour have promised to reinstate. And the Conservatives won’t be able to raid the capital budget, because they’re now promising the “most ambitious programme of investment in buildings and technology the NHS has ever seen”. Unlike the other parties, the Conservative manifesto provides no indication of where the extra funding is to come from.
Sticking to their plans
Unsurprisingly, given that they’re in power, the Conservatives aren’t promising radical change to the NHS, committing to the action plan known as the “five-year forward view” and to the so-called “sustainability and transformation plans”, which have been drawn up by the NHS and local authorities to cover 44 geographical areas. These are set to evolve into Accountable Care Organisations, the latest in a never-ending sequence of new organisations to grace the English NHS, but which may quietly lead to the end of the internal market introduced in 1990 by Margaret Thatcher.
The manifesto also commits to the 18-week elective care target, which the NHS has threatened to abandon. The Conservatives aren’t going to allow the NHS to do this. Indeed, one of the subheadings of this section of the manifesto boldly states that they’ll be “holding NHS leaders to account”, which can be interpreted as a veiled threat to Simon Stevens, the chief of the NHS, to toe the political line.
Manifesto may contain a veiled threat to Simon Stevens, head of NHS England. Twocoms/Shutterstock
No concrete details are given about how the Conservatives hope to turn round increasingly poor waiting-time performance, but they seem to expect that better information will help improve the quality and safety of care. The NHS already leads the world in publishing outcomes data for individual doctors and, following initiatives introduced in 2013 when the Conservatives were in coalition with the Liberal Democrats, the manifesto promises to continue to make “clinical outcomes more transparent”.
Replacing migrant staff
Probably in a bid to lure UKIP sympathisers, the Conservatives are laying claim to being the “nasty” party when it comes to dealing with the impact of immigration on the NHS. The annual health surcharge on migrant workers that they introduced in April 2015 is to increase from £200 to £600 a year.
And, unlike the other parties, the Conservatives make no firm commitment to protecting the right to stay in the UK for the 140,000 health and care staff from other EU countries, merely saying they will be a “priority in our negotiations with the European Union”. The long-term ambition is to reduce reliance on overseas labour as more home-trained doctors, nurses, carers and other types of staff enter the workforce. To this end, the Conservatives have repeated their commitment to training 1,500 doctors annually, and also aim to recruit 10,000 more mental health professionals, presumably by the end of the parliamentary term.
They also intend to get more from the existing workforce. Following bitter negotiations, the Conservative government imposed a new contract on junior doctors, phased in from October 2016. If re-elected, they plan to introduce a new contract for GPs, which was agreed in February 2017, and to conclude ongoing contract negotiations with senior hospital doctors.
But they also say the NHS will become a better employer, offering more flexible working conditions, more training opportunities, a greater diversity of career paths and protection against bullying. Given the criticisms that the government has received about NHS workforce planning, it is critical that better workforce plans are developed if any of the manifesto promises are to be delivered.
Within days of the manifesto launch the Conservatives had back-tracked on their plan on how to fund care of the elderly, which was quickly dubbed a “dementia tax” because it would hit people with long-term care needs, such as those with dementia, particularly hard. Instead Theresa May said the issue would be put to consultation.
The manifesto had dismissed the previous consultation, the Commission on Funding of Care and Support led by Sir Andrew Dilnot, which was set up by the coalition government in July 2010 and reported the following year. The manifesto claimed Dilnot’s proposals “mostly benefited a small number of wealthier people”. But this isn’t true: Dilnot recommended that a person’s lifetime contributions to their social-care costs should be capped at £35,000. The Conservatives intended to drop this cap, implying that many people would continue to face potentially unlimited costs. Theresa May has since said that a cap will be set, but not at what level.
Dilnot also recommended that the means-tested limit for home care should be raised from £23,250 to £100,000, meaning that people with assets below the threshold would have their costs covered by the state. The manifesto also promises to set the threshold at £100,000, but, unlike Dilnot, says that the value of the person’s home will be included in the calculation. If this becomes policy many people with long-term health problems, such as dementia, won’t be able to pass on their houses to their family when they die. This, coupled with the lack of an overall cap, caused an outcry, and May’s rapid U-turn.
The manifesto also promises that winter fuel payments to the elderly are to be means tested. One way or another, many pensioners will be made worse off if these promises become policy.
Britain’s social care is in meltdown. Underfunded, understaffed, and overburdened. The latest debacle to hit the sector is the alarming revelation that 900 care workers are quitting every day. Short-term fixes won’t do. The sector needs a drastic overhaul.
On top of an ageing population, which has driven local councils to exhaust their council tax precepts, there is no consistency on the provision of services across the country.
It leaves us as a nation in a state of inequity. And it leaves us with two options. We will have to fork out for private social care or end up using centrally funded NHS hospitals. Because poor levels of care from staff shortages will drive us there.
It’s already happening though. Councils dropped spending by 9% in real terms between 2010 and 2015. And the number of pensioners receiving care from local authorities declined by 26%. The funding gap has been estimated to be £2.3bn.
The only concession the government has made was to allow local authorities greater flexibility over council tax to allocate more to adult social care. Many say this is inadequate. And so far solutions have acted as little more than a sticking plaster applied to a full on emergency.
Rehaul on social care reform
The NHS is centralised, so why not social care? This would ensure everyone got the same level of care no matter how rich or poor their borough is. And in many ways, you cannot consider one without the other. Without good social care, people will use the NHS more.
And when it comes to elderly people, much that happens on the national level within the health service will impact on social care – such as the NHS’s provision of community services like stroke rehabilitation.
Lessons learned abroad
Some economies have gone through their own crises and come out with ‘radical’ solutions. Prior to 2000, Japan did not have a publicly funded health service. Traditionally, family looked after elderly people but eventually more ended up in hospitals because there was nowhere else to go. Japan introduced long-term care insurance offering social care for over 65s according to need. Taxes, premiums, and co-payments funded this capability.
Germany has a similar system to cover basic needs. People in need of social care are assessed on whether they meet the threshold for care. They may then receive benefits in cash which they can use to pay for carers and accessibility renovations, receive in-kind-services benefits, or a combination of both.
But the immediate crisis is arguably to do with staffing.
60,000 EU nationals currently work in social care, which means the labour force may be even more vulnerable post Brexit. In addition the number of people needing daily physical assistance is expected to double by 2030, and the UK will need to recruit and train 1.6 million health and social care workers by 2022 to accommodate this increase.
Many care workers are very low paid, even earning below the minimum wage, with limited opportunities for career progression. Recruitment won’t be enough. Value, training, and prospects will need to be injected into a new workforce strategy to ensure longevity and good quality care.
Ministers need to desperately get back to the drawing board on social care to prevent the rising catastrophe on the horizon of our health system.
Council leaders are calling for “full flexibility” on how they use the £2 billion in social care funding announced by Chancellor Philip Hammond in the Spring Budget, ahead of new guidance being written by the government on how councils should spend the extra funding.
The Local Government Association (LGA) has welcomed the extra funding and says it will help to improve adult social care, but warns it will not be enough to address to fully address wider problems in the system. There is also no guarantee that the extra funding will continue after 2019-20.
Councils are under pressure to use the extra money to help reduce pressures on the NHS, but the LGA says councils should be free to target the funding where it’s needed most. One in five social care referrals are to hospitals, according to the LGA, while other areas of the care system are also in dire need of extra cash – such as services supporting disabled people, and those with learning difficulties and mental health problems.
The LGA says the social care green paper, currently passing through parliament, may be “the last chance” for the government to fix the growing crisis in adult social care provision, adding the whole system needs a “massive overhaul” to ensure its long-term sustainability.
Cllr Izzi Seccombe, Chairman of the LGA’s Community Wellbeing Board, said: “The £2 billion of extra funding announced over the next three years for social care, while not the solution to the crisis, is a significant step towards helping councils plug some of the social care funding gaps they face in the coming years.
“But we want assurances from ministers that councils will retain full flexibility to decide how best this money is used, so we can provide much-needed care and support for our older and disabled residents.
“Councils know where the pressures are in their local areas better than anyone else. It is also essential that there are no delays in releasing the money so that councils can provide extra care and maintain the services that would otherwise have been cut.
“Reducing pressures on our hospitals is important, but we must also remember that social care is about much more than just freeing up hospital bed space.
“It is about providing care and support for people to enable them to live more independent, fulfilled lives, not just older people, but those with mental health conditions, learning and physical disabilities.
“The funding announced in the Budget is just a starting point. It is critical that the Government’s Green Paper on social care includes local government leaders playing a central role in finding a long-term solution that reforms and fully funds our care system.
“This is essential if we are to do more than just help people out of bed and get washed and dressed but ensures people can live independent, fulfilling lives in the community, and relieve pressures on care providers and avoid widespread failure amongst organisations providing care.
“With councils facing further funding pressures and growing demand for support by the end of the decade, this is the last chance we have to get this right.”
Thinking about living well into your old age and wondering about the options for where to live?
Why not come and find out about Extra care in Barnsley .
Barnsley currently has 4 Extra Care Housing schemes* across the Borough, places where people over 55 live securely and comfortably, keeping their own space but having the peace of mind that help is around should it be needed.
Does this sound like something you think you might want for yourself or someone you care for? If so we need your help.
We are wanting to find out more about whether Extra Care is something that people who live in Barnsley might be interested in, either for themselves or someone in the family, and if so what could we do to improve on what is offered at the moment.
Come along and find out more at our information workshop on Monday 13th March 10.30-12.30 at the Town Hall in Barnsley, and join us for a cup of tea and a slice of cake.
Local authorities are ‘the forgotten cousins’ of public expenditure, as the financial crisis facing social care gathers pace, Unite, the country’s largest union, said today.
Unite, which has 80,000 members in local government, said that the chancellor Philip Hammond needs to address the estimated £2.6 billion shortfall in local authority social care provision, as he prepares to deliver his first budget on Wednesday (8 March).
Unite said that social care needed additional new money from the chancellor and not, what it described as, ‘a futile robbing Peter to pay Paul’ financial sleight of hand.
Since 2010, local government has faced the brunt of the cuts to public spending with 37 per cent cut from the local government budget between 2010 and 2015, with a further 56 per cent due to be axed by 2019/20.
Along with Unite, the Local Government Association, the King’s Fund, Nuffield Trust and the Association of Directors of Adult Social Services have all called for the more than £1 billion needed to fund adult social care next year alone.
Unite national officer for local government Fiona Farmer said: “For too long local government has been ‘the forgotten cousin’ when it comes to public expenditure. Since 2010, council budgets have been slashed – and then slashed some more.
“Local government, which now also has the added responsibility for ‘public health’, is faced with a growing population of the elderly and the vulnerable, yet the pot of money in real terms is rapidly diminishing.
“It is clear that certain sections of the Tory party have woken up to the scale of the impending crisis. It was the Conservative-controlled Surrey county council that was contemplating a referendum on a 15 per cent rise in council tax to pay for social care.
“What we need is genuine new money; we don’t want a futile ‘Robbing Peter to pay Paul’ scenario, with other vital budgets being raided by a light-fingered chancellor seeking to assuage mounting public concern.
“If the social care funding crisis is not addressed urgently, cash will be diverted from such important services as libraries, roads, youth services and parks putting a further strain on those services that local communities rely on every day.
“Britain is the world’s sixth largest economy and it is incumbent on the chancellor to find the necessary cash for local government, so that those in need of social care can live in comfort and dignity.”
Today Barnsley Labour group passed a budget aimed at protecting our most vulnerable residents from the national crisis in adult social care created by the Tories. 3% of extra council tax this year is ring-fenced for adult social care to try and fill the funding black hole the Tories have created. But even this 3% won’t be enough.
There is a crisis in adult social care in this country. Thanks to medical advances and the NHS, people are living longer – but that also means we have more older people who need care and have complex needs. In spite of the growing demand for social care, the Tories have repeatedly cut social care budgets leaving a national black hole of £2.3 billion.
The current way of paying for adult social care isn’t fair and isn’t working. In Barnsley we’re ring-fencing 3% of extra council tax for adult social care – but even that won’t fill the gap the Tories have created.
Help us tell the Tories that enough is enough, sign our petition below: