As the number of people over 85 years old rises dramatically the number of people with care needs is set to increase. At 65, around 16% of people have difficulty with at least one ‘activity of daily living’ like making food for themselves or going to the toilet. This increases to around half of people aged 85. By the time we’re in our late 80s, over one in three of us have difficulty undertaking five or more activities of daily living without help.
Whilst little focus is given to tackling the cause rather than the problem, the need for social care to help people can be delayed - disability and frailty can be prevented through better health earlier in life. Campaigns like One You, moves to increase levels of physical activity including strength and balance, and informal activity like gardening can all help. Adapting environments to enable those with limitations to their capacity to be able to do as much as possible for themselves is also fundamental – including adapting people’s own homes and having active design for all ages to shape the built environment.
The need for social care is of course growing. But the continuation of year-on-year funding cuts for local government and squeezed care budgets has resulted in significant rationing of state-funded social care. According to the IFS there has been a 17% reduction in local authority funding on adult social care between 2009/10 and 2015/16 (IFS 2017). This has partly been offset by NHS transfers and the Better Care Fund but projections suggest a future funding gap opening up of 2.3-2.6 billion by 2020.
To cope with cuts, needs based eligibility criteria have risen so that only the most critical care needs are met. And the consequence of this is that the number of people over 65 years receiving local authority funded social care between 2005/6 to 2013/14 has declined significantly. There has been a particular decline in community based services of 30% (compared to 4% and 6% for residential and nursing care respectively). Who is stepping in to fill this gap? Care and support previously provided by community based services are falling to families and unpaid carers or the voluntary sector.
According to Carers UK the number of carers has increased from 5.9 million in 2001 to 6.5 million in 2011 and is set to rise to 9 million by 2037, and the number of people caring round the clock, for 50 hours or more a week, is also rising rapidly. Cuts in other community based services such as day centres as well as other local services such as libraries also further reduce the community support available. It is these services which can enable someone to remain active and independent in their own home and prevent deterioration.
And the sector urgently needs stabilizing. While there has been a growth in the number of home care providers of 5% from 2010 onwards, both nursing and residential care home providers are exiting the market with declines of 4%. With higher levels of need among those admitted to care homes, and local authority fee levels so low, it is increasingly challenging for care homes to provide a decent quality of care.
A recent report from the Care Quality Commission shows that the health and social care system is at full stretch.
Consequently, there are more people with care needs remaining in their own homes placing an increasing reliance on the voluntary sector. In places where there is a strong network of community and voluntary organisations (like in Leeds, which has invested in neighbourhood networks over the past 20 years), communities have been more resilient to statutory cuts.
In fact, the voluntary and community sector has always played a critical role in supporting people with care needs, including everyday help, especially for those without family carers; support for unpaid family carers, in the form of respite and support groups; and social support and community activities to increase social connections, including inside care homes.
The sector has also led the way on provision of innovative care models such as Shared Lives - home share schemes where typically an older person with a room to spare will be carefully matched with a younger person who will provide an agreed amount of help in exchange.
But is there a limit to how far the voluntary and community sector can and should step in to fill the gaps left by the closure of local public services. Community groups thrive on a mix of needs and abilities among those who are participating. The intensity of support an individual requires may go beyond the capacity of a volunteer or community worker and need professional help.
And whilst the sector can mobilise volunteers it does require funding for some paid staff roles and access to community facilities to run activities and services. Local authorities can play an important role in supporting the sustainability of this sector through small grants, and funding for core costs as well providing other infrastructure.
So if we want to avoid building many more care homes, there needs to be a major shift both in access to high quality, affordable domiciliary care, more suitable housing in which people can remain independent but also receive care and support when they need it, and finally an expansion in the support available in the community. The forthcoming consultation on social care needs to go beyond the statutory sector and look at how to provide for everyone’s care and support needs – including the increasingly important role of the voluntary and community sector.
Anna Dixon is chief executive of Centre for Ageing Better