Integrated Care & Social Care

Social care cuts ‘not isolated’ from overstretched NHS, think tanks say

Elderly patients are increasingly struggling to access medical and social care and facing delayed transfers of care, the King’s Fund and the Nuffield Trust have said in a scathing new report.

In the past five years, emergency hospital admissions of older people have risen by 18%, compared to 12% for the general population, and 50% of older patients are admitted to hospital against 16% of the general population.

The report suggested this was partly due to cuts in local government spending on elderly people’s social care, which has fallen by 6% since 2010, and partly to problems in primary and community care.

It argued: “The situation for older people has been compounded by pressures elsewhere in the NHS. Cuts to social care should not be viewed in isolation from overstretched general practice and community nursing and the uneven distribution of intermediate care beds; these are all factors identified by our interviewees.

“Under-investment in primary and community NHS services threatens to undermine the policy objective of keeping people independent and out of residential care.”

Visits to GPs by patients aged over 85 have increased by 28%, compared to 15% for patients as a whole, at a time when primary care is facing funding and staffing shortfalls.

In addition, the report highlighted a “lack of clarity about activity and demand” in community care. For example, the number of district nurses is falling despite increasing demand.

The biggest sign of the overlapping problems with health and social care, it said, is the growing rate of delay transfer days for elderly patients.

Bed days for elderly patients reached 19.4 million by 2015, with delayed transfers costing the NHS £820m a year.

The report’s authors agreed, saying: “NHS providers and commissioners must work more effectively together to address a problem that imposes a significant cost on the NHS and is taking an unacceptable toll on older people, their carers and families.”

Ruth Thorlby, deputy director of policy at the Nuffield Trust, added: “Shortages of home care staff and affordable care home places mean older people are often stuck in hospital, putting both their lives and vital NHS processes on hold.

“The number of older people needing care is increasing and yet we are continuing to put less money in. Unmet need is rising, providers are threatening to pull out of contracts, the wellbeing of carers is deteriorating, access to care is getting worse.

“A government that wants to create ‘a country which works for everyone’ should not tolerate the oldest and most vulnerable falling into a social care system riddled with holes.”

The report said elderly people are increasingly reliant on private care or care by family members, while those most in need are missing out on care altogether.

It warned that spending on elderly care will face a deficit of £2.8bn - £3.5bn by 2020.

Opportunities in the Autumn Statement

The report’s authors said that the government should use the upcoming Autumn Statement to bring forward more money from the Better Care Fund, achieve a pooled health and social care budget for every local authority by 2020, and develop a strategy to boost the workforce.

Richard Humphries, assistant director of policy at The King’s Fund, said: “The failure of successive governments to reform social care has resulted in a failing system that leaves older people, their families and carers to pick up the pieces.

“Putting this right will be a key test of the Prime Minister’s promise of a more equal country that works for everyone – there is no more burning injustice in Britain today than older people being denied the care they need to live with independence and dignity.”

Professor Jane Dacre, president of the Royal College of Physicians, called today’s report a “sobering” read that highlights the “perilous state of our social care services”.

“At a time of their lives where they should be confident that they will be looked after compassionately and comprehensively, older people should not be bearing the brunt of cuts to social care,” she continued. “The report describes the ‘increasingly threadbare safety net’ for those relying on council services alone, a situation which also highlights increasing inequalities in health in the UK.

“The report identifies that cuts to primary and community care are undermining attempts to keep people independent and in their own homes. When these systems fail, it often results in prolonged hospital admissions, creating a vicious circle.

“The NHS also faces a daily struggle to find appropriate services for older people who no longer need to be in hospital.  We must all work together to create joined-up, properly funded and organised services to give older people the care they deserve.”

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