We are all living longer, but the full implications of this are only beginning to dawn on us, and nowhere is this more apparent than with social care.
In the UK the number of people aged 65 and over are projected to rise by nearly 50 per cent in the next 20 years, with the ’85 and over’ group growing fastest. These ‘oldest old’ have most need for social care, so, as their numbers increase, care demands will too.
This trend is not, however, wholly new; we are here because the numbers of older people increased over the last decade but net expenditure on older people’s social care flatlined or fell. The result is that today an estimated 850,000 older people with significant needs get no formal help at all. And every day the gap widens.
This isn’t all, since many older people have had their care packages reduced or charges increased. Others are being forced out of the state system as eligibility thresholds are raised, leaving them to organise and fund their own care. Families are having to pick up more of the load. 300,000 carers left the workforce in 2011, wiping £5.3bn from GDP.
The UK is not alone with these problems but, still, this is a truly terrible position to be in, and there is real and unacceptable suffering. So what should we do?
First we have to be honest about the gravity of the situation and clear about the problems. They are essentially threefold: there is insufficient social care; what exists is of patchy quality; and under the current rules people face an unmitigated risk of ‘catastrophic cost’ if they are unlucky enough to have modest assets and to require long-term care.
In some ways the last problem is the most straightforward because the Dilnot Commission has proposed a workable solution – a cap on costs and a higher threshold as central elements of a risk-pooling approach, backed by government, which is essential if it is to work. Individuals would be able to insure against their risk.
The problems of reach and quality are complex and point up the need for transformational system change. Investment to bring spending into line with the demographics is essential but not sufficient; we also need a coordinated approach across the NHS and social care. If we can smooth the edges between them so that when, say, an older person is discharged from hospital the care is in place so they can recover properly at home, it would be infinitely better for them and much more efficient too. Indeed, some say that without this the NHS will be unsustainable, such is the pressure on hospital beds due to poor coordination with care. More generally, an NHS fit to meet the needs of its majority users – older people, many with long term conditions like diabetes – would focus relentlessly on prevention and good primary care, which would benefit everyone.
Who pays? The answer surely lies in a partnership between individuals and the state, as with the Dilnot solution to the problem of catastrophic cost, with strong protection for the vulnerable and less well-off. But anyone who thinks there is an easy answer – for example, by tapping better off older people’s housing equity or means-testing universal benefits – will be disappointed.
Why? Because of a host of factors that are easily overlooked, above all the huge inequality among our older people, with fewer affluent ‘baby boomers’ than often believed, and with many more merely getting by and one in six in poverty. In addition, housing equity can only be used once and is worth less than often assumed. Everyone needs more savings to fund extended lives; and take-up among older people for means-tested benefits is discouraging.
Finally, remember too the significant numbers of disabled adults using social care and the increasingly unsustainable care burden on families. Social care is for all of us, we will all gain from its overhaul and the cost of fundamental reform should be shared.
Caroline Abrahams is director of external affairs at Age UK. For more on the challenges facing social care, see The Purple Papers, particularly Patrick Diamond’s chapter, Tackling Britain’s ‘care crunch’
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