S1. Report on a Negotiated Topic

The Lack of Funding for Adult Social Care in the UK

Module Name: Contemporary Issues and Debates in Health and Social Care

Table of Contents

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 1- Introduction to the contemporary issues

Lack of funding for adult social care in the UK

Media plays an important role in adult social care sector to disseminate information and

present different controversies issues and debate around the topic to the general public.

Adult social care caters to a number of processes and activities aimed at assisting adults who live with disabilities, mental or physical illness, or older individuals to establish a safe and independent lifestyle (Lu et al., 2021). This program can incorporate personal care which includes support for dressing, washing, and waking up in the morning together with wider social care aimed at helping these individuals engage in social activities and remain mobile and active (Mason et al., 2015). In the UK, social care may involve supporting the adults within their homes (home care), providing support to the adults in day centres, residential care (this is provided by nursing and care homes), reablement services, and the provision of advice and information on how the adult population can experience effective living.

The adult and elderly population in the UK has been increasing exponentially over the years. According to a report released by Kingston et al. (2018), there are more than 11 million people aged above 65 years and this number is anticipated to increase by 2 million in the coming three years. This increase would mean that 22% of the country’s population would be described as elderly. Out of this population, a report released by the King’s Fund (2021) asserted that in 2020, there were more than 838,000 adults who benefited from long-term publicly funded social care; this was mainly offered within the confines of their homes and in nursing homes. The report further noted that there were more than 231,000 cases of short-term care provided; these short-term cases include adults with mental challenges such as depression and stress.

Despite the anticipated increase in the elderly population and increased need for social care for adults living with disabilities and mental complications, the adult social care sector is still experiencing significant operational limitations especially when it comes to reaching out to the elderly in marginalised communities and making timely responses in cases of emergency. These holdups were amplified during the pandemic period as the sector was significantly stretched when it comes to the allocation and utilisation of its resources; in-house facilities, employees, and equipment. Thus, this report seeks to further explore the concept of lack of funding within the adult social care sector. The report explores the current funding strategies utilised by the government and some of the shortcomings experienced in their implementation. The report also provides recommendations on ways through which the funding crisis within the adult social care sector can be effectively addressed.

Image 1: Age distribution of the UK population, 1976 to 2046 (Projected), Source: Office of National Statistics, (2017).

Image 2: Adult social care need distribution in the UK, Source: Office of National Statistics, (2017).

Stakeholders responsible for the provision of adult social care in the UK

The local authorities are tasked with the role of evaluating the care needs of the general public and funding the care of individuals found to be eligible to care (Lu et al., 2021). However, there are also independent residential care facilities and homes that provide adult social care in the UK; most of these independent providers are for-profit organisations. People with disabilities may also prefer the employment of personal assistants who would provide support and care at their convenience.

Specific driving forces influencing service delivery within UK’s adult social care sector

This driving force analysis adopts the PEST analysis model which is an acronym for political, economic, social, and technological factors that influence effective service delivery within the social care sector.

Political analysis: The UK government, over the years, has reiterated its commitment to enhancing adult social care throughout the country through passing legislation and carrying out reforms that would not only enhance funding within this sector but also enhance equality in service provision and access (Nyashanu et al., 2020). This commitment was amplified during the pandemic period when the government quickly moved to increase the bed capacities of hospitals across the country together with working hand in hand with devolved leadership to come up with Nightingale hospitals. Through these strategies, the government has been able to ensure that the adult population in need of special care receives this care conveniently.

Economic analysis: There is an ever-growing demand for adult social care in the UK and this has been triggered by the increased adult population in the country. However, the over-dependence on government funding, with most social care organisations operating on a non-profit basis, makes it hard difficult for the organisations to effectively meet this demand (Kingston et al., 2018).

Social analysis: The current population in the UK is experiencing a significant shift in age distribution with the elderly population increase over the years; it is anticipated that by 2025, the elderly population will account for more than 22% of the total national population (Crewdson, 2016). Furthermore, the prevalence of mental health issues within the adult population has increased significantly over the years, especially after the covid-19 pandemic. These social characteristics have led to increased demand for adult social care across the UK.

Technological analysis: Emerging technologies such as artificial intelligence and robotics are providing adult social care organisations with better and more effective ways of monitoring patients and administration of medical services remotely (Khosravi et al., 2016). However, the financial investment needed to realise the effective implementation of these digital technologies in the social care sector serves as a significant limitation.

Part 2

A critical analysis of the issue including the controversies and debates that surround the lack of funding for adult social care in the UK

The current state of funding for adult social care in the UK

 

Towards the end of 2021, the government released a plan to significantly increase social care and health funding through the implementation of social care and health levy together with the introduction of new taxes (Lu et al., 2021). According to this plan, £5.4 billion of the revenue raised will be utilised to support adult social care reforms over the next four years. Furthermore, in 2019/20, the local authorities spent a total of £23.3 billion in enhancing adult social care; this expenditure was £1 billion higher than that spent in 2018/19 and this can be attributed to the increased service demand triggered mainly by the covid-19 pandemic (Kings Fund, 2021). A breakdown of this expenditure by a report released by the King’s Fund (2021) noted that more than half of the expenditure (65%) incurred by this sector in the 2019/20 financial year was directed towards helping the elderly population while the amount spent on working-age adults was utilised to help those experiencing learning disabilities.

Image 3: The social care funding gap, Source: NHS. (2019)

The cost of receiving adult social care in the UK has increased significantly over the years. In the 2019/20 financial year reporting, the weekly average cost incurred by elderly individuals above 65 years for home care placement was £679. This cost is significantly higher when it comes to working-age adults – £1,317 weekly (NHS, 2019). Furthermore, a report released by Giordano and Neville (2015), noted that more than 50% of individuals over 65 years of age spend more than £20,000 on social care, with the amount expected to increase to more than £100,000 by 2030. NHS (2019), noted that this increased cost of social care discourages most people, especially from low-income social backgrounds from seeking social care, leading to the high prevalence of specific medical conditions within these populations.

The funding challenges

 

In 2011/2010, a personal average of £345 was spent by the government to provide adult social care (Lewis and West, 2014). However, the years that followed were characterised by significant government neglect of adult social care, leading to a reduction in the average per-person adult social care spending to £310 in 2016/17. In addition, as of 2016/17, the average government spending on adult social care in England was 43% lower than the adult social care spending in Scotland; this demonstrates the funding variations across the UK (Nyashanu et al., 2020). As the aging population and increasing disability levels in the UK continue to increase, there is a need for the government to consider increasing per-person adult social care funding by an average of 3.6% annually to maintain care quality and access going forward (Kingston et al., 2018). Without this enhanced funding, there would be an increased gap between the available resources and the spending pressures.

Glendinning (2012), further noted that, unlike the NHS, the funding constraints realised by the adult social care sector has made its access expensive and restricted; accessing adult social care is limited to individuals with the lowest assets and with the most severe needs. This restriction has been implemented by most local authorities to help manage the minimal funds provided by the government. Furthermore, to help reduce the financial burden, local authorities have also resorted to the commissioning of voluntary and private sector organisations to provide the service, ultimately making its access more expensive (Watkins et al., 2017). However, Cunningham et al. (2014), noted that despite the financial aspect, the commissioning of adult social care to private and voluntary organisations has increased social care reach and promoted the improvement of public health.

A study conducted by Nyashanu et al. (2020), noted that between 2010 to 2015, the adult social care sector realised a significant reduction in the budgetary allocations from the local authorities. While these allocations have been improved again between 2017 to 2019, they have just reached the levels they were at in 2010 and this does not account for the change in demand over the same period; economically, the time value of money has significantly changed, and re-establishing the funding levels that existed in 2010 does not serve as a viable solution. In addition, the introduction of restrictions on access to publicly funded adult social care has locked out a majority of the adults in need of social care from accessing public services. This leaves them with the option of utilising privately provided expensive services; the government came up with the Care Act to help curb these high costs but this legislation was never effectively executed (Lu et al., 2021).

Image 4: Adult social care funding scale between 2010 to 2018, Source: Commons Library (2022).

Underfunding has not only affected the local authority’s ability to provide social care services to the adult population but also hindered the capacity of acquiring and maintaining quality healthcare personnel to provide social care services to the increasing demand (Higgs and Hafford-Letchfield, 2018). According to a report by Chester et al. (2014), more than two-thirds of staff working in the adult social care sector receive the minimum wage with zero-hour contracts. In addition, there exists a 7% pay gap between adult social care personnel and that received by nurses within the NHS; in 2017/18, the average pay for social care nurses was £16,000 while nurses and doctors performing a similar role within the NHS received £19,300 which was a fifth higher (Commons Library, 2022). This pay gap has led to significant personnel turnover and shortage; there are only 40,000 nurses within the adult social care sector and it is estimated that almost half of these nurses abandoned their roles within the past half a year (Read and Fenge, 2019).

Seekles and Ormandy (2022), summarised the challenges caused by under-funding into high levels of unsatisfied care needs, unrealistic care costs, increased levels of unpaid social care, and pressures from the workforce. Under unsatisfied care needs, the report asserted that one in every seven individuals above 65 years may not have the opportunity to access the social care required due to increased restrictions to curb expenditure. Furthermore, the report noted that one in every seven adults faces the risk of spending more than £100,000 on social care due to the commissioning trends adopted by local authorities, allowing private organisations to offer social care services at a fee. The report proceeded to note that the high turnover within the adult social care sector threatens the effective provision of needed services and service reach. Without competitive pay structures, the adult care sector risks losing quality and top nurses to other sectors and organisations.

The initiatives adopted by the government to address the funding challenges facing the adult social care sector

 

The UK government has put in a lot of effort to ensure that the adult social care sector is effectively funded, especially between 2016 to 2022. These funds have been provided in the form of ring-fenced and short-term grants through the improved Better Care Fund initiative. The central government has also tasked the local authorities with the responsibility of increasing its revenue collection using council tax and channelling the extra revenue to adult social care (Commons Library, 2022). The implementation of these initiatives has led to the development of a 3% social care levy by the local governments, the release of £300 million as social care grant by the central government to help enhance adult social care in the 2020/21 financial year, and the provision of £2.1 billion to the local governments through the Better Care Fund scheme (Commons Library, 2022).

During the 2021 Autumn spending and budget review committee, the government reaffirmed its commitment to increase adult social care funding by approving a £6.1 billion grant to all local governments for the next three years which would help supplement the Social Care and Health Levy already at the disposal of the local governments. The government also increased the social care grant by £636 million in the 2022/23 fiscal year to help cover the inflationary changes and increase the settlement flexibility by up to 3% (Commons Library, 2022)

Proposed recommendations for overcoming the funding challenges

 

An improvement of the existing funding system: This recommendation is underlined by retaining the existing adult social care funding approach but adjusting it to incorporate other incremental transformations that would enhance success. Some of these incremental transformations include adjusting the annual budgetary allocations based on the prevailing inflation rates. This would serve as a less expensive transformational approach as there would be no changes in the political and financial costs.

The adoption of the floor and cap options as proposed by the conservative party: The implementation of this recommendation would entail the elimination of the current lower and upper thresholds with a single threshold. This would ensure that no patient is exposed to the stress of making payments above a given level; the implementation of a specific cap amount was indefinitely postponed by the government and this report recommends abolishment of this postponement.

The introduction of free personal care plans: The free personal care plan has been successfully implemented in Scotland for over 15 years now. Under this model, individuals above 65 years old will be allowed to access social care services mainly because of their needs and not due to their ability to afford the set amount. The packages provided should, however, vary from one person to another and would allow for less expensive access to medical care.

The adoption of a single budget for adult social care and health: This strategy would entail a consolidation of adult social care and health funding into a single budget for both the local and the national governments. Although this recommendation would require the implementation of a different management approach, it would lead to the generation of extra funding for adult social care.

There is a need for the adult social care sector to move away from focusing on acute and remedial service provision to a community-centred model characterised by the adoption of preventive models: The adult social care sector has not invested a lot of time in the implementation of preventive models that would allow people become more independent. The sector, however, focuses on the injection of monies into offering emergency services for remedial and acute states which are rather too expensive. Thus, the government needs to consider ways through which available funds can be channelled toward the implementation of preventive models that would help curb negative health trends before they fall out of hand. Prevention would also help reduce the over-reliance on intensive care facilities which are expensive to maintain.

Increasing the pay for adult social care nurses: The long-term sustainability of adult social care is compromised by the high employee turnover realised over the last 12 months. This unattractiveness of the sector is attributed to low wages and working conditions. Therefore, there is a need for the government to channel significant funding toward increasing the wages of adult social care nurses, ultimately enhancing their willingness to stay in the sector for the long term. Kingston et al. (2018), noted that increasing workforce salary would require an additional 5.2% in government allocations to the adult social care sector.

Part 3

Conclusion and recommendations

The increased elderly population in the UK together with the increased prevalence of mental and psychological conditions within the adult population has created high demand for adult social care services. However, the government has not been able to adjust its funding frameworks based on the increasing demand, and this has led to unequal access to social care and a reduced workforce which challenges the long-term sustainability of the sector. In addition, local governments have also gone ahead to commission the provision of social care services by private organisations which are expensive, making the whole service inaccessible to individuals with lower financial capabilities. To overcome these challenges, the government has been keen to improve adult social care funding in the form of grants. Local governments have also introduced levies to enhance revenue generation and the subsequent finances channelled towards the adult social care systems. It is recommended that the government should consider the integration of adult social care and health budgetary allocations together with setting aside capital for the improvement of adult social care nurses’ wages. There is also a need to introduce free personal care plans and the adoption of floor and cap options.

References

Chester, H., Hughes, J., and Challis, D. (2014). Commissioning social care for older people: influencing the quality of direct care. Ageing & Society, 34(6), pp.930-950.

Commons Library. (2022). Social Care Funding in the UK [Online] Available at https://commonslibrary.parliament.uk/research-briefings/cbp-7903/#:~:text=Social%20care%20funding%20from%202022,pay%20for%20adult%20social%20care. [Accessed on 14^th November 2022]

Crewdson, J.A. (2016). The effect of loneliness in the elderly population: a review. Healthy Aging & Clinical Care in the Elderly, 8, p.1.

Cunningham, I., Baines, D. and Charlesworth, S. (2014). Government funding, employment conditions, and work organization in non‐profit community services: a comparative study. Public Administration, 92(3), pp.582-598.

Giordano, A. and Neville, A. (2015). Collaborating across health and social care: joint funding an adult protection Coordinator post in Caerphilly, UK. The Journal of Adult Protection, 17(2), pp.139-147.

Glendinning, C. (2012). Home care in England: markets in the context of under‐funding. Health & social care in the community, 20(3), pp.292-299.

Higgs, A. and Hafford-Letchfield, T. (2018). ‘At what cost? the impact of UK long-term care funding policies on social work practice with older people: a literature review. Ethics and Social Welfare, 12(3), pp.229-243.

Khosravi, P., Rezvani, A. and Wiewiora, A. (2016). The impact of technology on older adults’ social isolation. Computers in Human Behavior, 63, pp.594-603.

Kings Funding. (2021). Facts and figures about adult social care [Online] Available at https://www.kingsfund.org.uk/audio-video/key-facts-figures-adult-social-care#:~:text=How%20many%20people%20receive%20adult,or%20in%20their%20own%20homes. [Accessed on 14^th November 2022]

Kingston, A., Comas-Herrera, A. and Jagger, C. (2018). Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study. The Lancet Public Health, 3(9), pp.e447-e455.

Lewis, J. and West, A. (2014). Re-shaping social care services for older people in England: policy development and the problem of achieving ‘good care’. Journal of social policy, 43(1), pp.1-18.

Lu, H., Burge, P., and Sussex, J. (2021). Measuring public preferences between health and social care funding options. Journal of choice modelling, 38, p.100266.

Mason, A., Goddard, M., Weatherly, H., and Chalkley, M. (2015). Integrating funds for health and social care: an evidence review. Journal of health services research & policy, 20(3), pp.177-188.

NHS. (2019). The real cost of fair adult social care system [Online] Available at https://www.health.org.uk/news-and-comment/blogs/the-real-cost-of-a-fair-adult-social-care-system [Accessed on 14th November 2022]

Nyashanu, M., Pfende, F. and Ekpenyong, M. (2020). Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK. Journal of Interprofessional Care, 34(5), pp.655-661.

Office of National Statics. (2017). An aging population [Online] Available at https://fullfact.org/health/ageing-population-and-e/ [Accessed on 14^th November 2022]

Read, R. and Fenge, L.A. (2019). What does Brexit mean for the UK social care workforce? Perspectives from the recruitment and retention frontline. Health & social care in the community, 27(3), pp.676-682.

Seekles, M.L. and Ormandy, P. (2022). Exploring the role of the UK renal social worker: The nexus between health and social care for renal patients. PloS one, 17(9), p.e0275007.

Watkins, J., Wulaningsih, W., Da Zhou, C., Marshall, D.C., Sylianteng, G.D., Rosa, P.G.D., Miguel, V.A., Raine, R., King, L.P. and Maruthappu, M. (2017). Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ open, 7(11), p.e017722.