Navigating the shifting landscape of social care

State-funded social care, especially for older adults, it’s an integral part of the care GP Practices provide. In this summary of a report published by NHS Confederation, we dive into the intricate world of social care, unravelling the challenges it poses and its far-reaching implications for healthcare.

CREDIT: This is an edited version of an article that originally appeared on NHS Confederation

Social care is, and will continue to be, a critical partner in developing sustainable services; therefore, understanding the care provider market and trends in provision is essential. This analysis brings together demographic trends with data on workforce, Care Quality Commission-registered services, and funding to provide an overview of total capacity and national trends across the health and care sector,

Focus on state-funded social care for older people

Our primary focus is on state-funded social care for older adults, as this demographic represents the largest group requiring care and support. However, it’s important to recognise that the need for care and support is increasing among working-age adults and children, adding complexity to the landscape.

Rising demand amidst limited expansion

Over the last five years, we’ve witnessed a 4% increase in the population of people aged 65 and over in England. This has been mirrored by a similar increase in requests for care within the state-funded sector. However, rather than expanding to meet the growing needs of older individuals, state-funded social care has contracted, leaving a substantial portion of our ageing population without the support they require.

This contraction in state-funded social care has left a significant number of individuals aged over 65 with unmet needs, relying on informal care or self-funding for access to essential services. Self-funders constitute nearly 46% of care home residents and contribute to an estimated £1 in every £4 spent on home care provision. Despite not qualifying for state-funded care services, these individuals represent a significant portion of NHS patients with complex needs.

The urgent need for social care access

Limited access to social care services has resulted in several adverse consequences. Many regions lack effective, coordinated health and care services capable of identifying and intervening to help older people at risk. This leads to increased demand for urgent care, hospital admissions, and extended hospital stays. Moreover, the shortage of care availability hinders the discharge of older people from hospitals, resulting in poorer outcomes, increased service reliance, and reduced acute capacity overall.

The elusive impact of investment

Despite some nominal investments, consistency and adequacy in funding have remained elusive. Rising costs have prevented the expansion of service provision. Social care funding has experienced real-term growth, reaching £26.9 billion in 2021/22 (inclusive of approximately £3 billion in pandemic-related grants). However, this falls significantly short of the £31.8 billion estimated by the Health Foundation to restore service capacity to 2010/11 levels, considering pay increases comparable to the NHS’s trajectory.

The changing landscape of funding

Significant changes in the composition of social care funding have transpired during this period. A substantial portion of the funding increase came from the NHS, with much allocated towards discharge capacity. Nevertheless, delayed transfers of care have tripled since 2018/19, indicating ongoing challenges in this area.

Navigating cost dynamics

Increased spending has not translated into higher levels of service provision. Two key factors explain this: firstly, a significant portion of additional funding aimed at addressing pandemic-related costs, and secondly, mounting expenses for both residential and home care providers leading to higher unit costs.

The workforce conundrum

Recent trends in funding, shifts in the market, and workforce constraints have emerged as key factors impacting social care capacity. While there have been investments, they have been sporadic and insufficient, unable to surmount escalating costs. The workforce shortage has become more pronounced, with one in ten posts remaining vacant, a situation exacerbated in the post-pandemic era. International recruitment has become a critical lifeline in addressing this crisis.

The imperative of workforce capacity

Addressing the shortfall in social care workforce capacity is an urgent priority, with far-reaching implications. The government must unveil a comprehensive workforce plan for social care akin to the one released for the NHS, outlining strategies to tackle existing vacancies and future challenges. Measures like establishing a fully funded minimum care wage can bolster the sector. Overreliance on overseas recruitment, while valuable, cannot be the sole solution.

The call for a sustainable future

Simultaneously, a commitment to increase overall investment in social care is indispensable. Funding should transition from conditional, short-term packages towards a realistic long-term settlement, providing clarity and stability for providers, local authorities, and the broader sector.

A sustainable future hinges on strengthening community capacity in both health and social care. Investment and time are prerequisites for success, particularly in the management of hospital discharge into the community, a pressing concern shared by the health and care sectors.

In conclusion, the challenges facing the social care sector are multifaceted, and addressing them demands a comprehensive approach encompassing funding, workforce capacity, and long-term planning. Only by tackling these challenges collectively can we provide the right care at the right time and ensure the well-being of our ageing population.