Social Care in England: challenges and current thinking

Robert KettellSocial Care Strategic Policy and FinanceDepartment of Health

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

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 ChallengesBirmingham 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

• Assistive technology• Prevention and re-

ablement• Personal budgets• Etc.

Efficiency savingsEfficiency savings

• Reduced residential care use (40% of total spend)

• Reduced emergency hospital admissions

• 3% target for 2010/11 in social care

OutcomesOutcomesMenu of interventionsMenu of interventions

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

Currently the average 65 year old can expect to need care that would cost around £30,000 during retirement

The current system

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.