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The Debate over Social Care

The worsening plight of social care and the financial problems posed for local government have been unveiled by a new. But how can the problems be addressed, and is it right to aim for social care to be integrated with the NHS as part of a longer term development?

Find HERE a summary by Brian Fisher of some of the discussions among campaigners since our November conference.

These are complex questions. The debate is an important one in shaping the policy of any future government to replace the Tories, so we invite campaigners to respond and develop this discussion, offer us your thoughts and suggestions, and help us develop a parallel campaign for properly funded and publicly accountable social care in parallel with the fight to defend, reinstate and fully fund our NHS.

Send any contributions (or suggested links and other material) to us at hcteditorial@gmail.com.

New ADDITIONAL reading


Links to other articles and analysis on social care:

  • Where are we at with social care for adults with learning disabilities? - Very well informed blog, which concludes:
    "I think it shows that councils are trying to protect social care funding for adults with learning disabilities relative to the huge cuts in income they have experienced.
    "However, this isn’t nearly keeping pace with the number of people needing social care support, and there are worrying signs that there are likely to be large numbers of adults with learning disabilities either getting no support at all, or getting support that isn’t right for them, with immediate and longer-term consequences for them and their families."

  • MPs Briefing: Opposition Day Debate Adult Social Care Funding - ADASS warns that "The ongoing financial challenges facing adult social care could have significant consequences on the delivery of statutory duties. Respondents to the recent ADASS Autumn Survey either had no confidence or partial confidence that their social care budget will be sufficient to meet statutory duties relating to Market Sustainability (88.66%) by the end of 2019/20."

  • Private firms are making big money out of children's social services - Guardian article lifting the lid on another area of privatisation, shows that:
    "Almost three-quarters of children’s homes in England are privately owned and managed, and almost half of all local authorities do not provide and manage any children’s homes.
    "Almost a third of all children in foster care in England live with foster carers provided through private agencies.
    "In 2015, Corporate Watch reported that eight private foster care agencies (there are many more) made profits of more than £40m while also making big payments to senior managers."

  • How cuts changed council spending, in seven charts - BBC data from December 2018 that gives more details useful for campaigners

  • Changes in councils’ adult social care and overall service spending in England, 2009– 10 to 2017–18 - IFS report with damning statistics on the rapid rundown and underfunding of social care

  • Home care in England: Views from commissioners and providers - A new report from The King’s Fund and the University of York drawing on the views from commissioners and providers finds that the market for home care providers is extremely fragile, with squeezed margins and low fees forcing providers to leave.
    In 2017 providers handed back home care contracts in more than one in three local authorities, and some of the largest providers have withdrawn from the publicly funded home care market altogether. 40% of home care workers leave their jobs each year, and more than half of them are on zero hours contracts.

    Staff shortages are a ‘relentless challenge’ for home care providers in many places. It finds concerns that fees paid by some local authorities are too low to maintain quality services, leading to high turnover of providers and staff.

  • Changes in councils’ adult social care and overall service spending in England, 2009–10 to 2017–18 - Useful statistics on social care spending from the IFS

  • Complaints over social care in England nearly trebled since 2010 - The Guardian reports:
    "Complaints and inquiries about adult social care have nearly trebled since 2010, a damning report reveals, prompting warnings that the industry is struggling to cope with funding pressures."

  • Social Care - forthcoming Green paper - HoC Library briefing - A very useful collection of data and historical policy debate.

  • Hundreds of care home patients have died dehydrated or malnourished - Guardian report based on official figures:
    "More than 1,000 care home patients have died suffering from malnutrition, dehydration or bedsores, new figures reveal.
    "At least one of the conditions was noted on the death certificates of as many as 1,463 vulnerable residents in NHS, local authority and privately-run care homes in England and Wales over the past five years..
    "The figures have been obtained by the Guardian from the Office for National Statistics (ONS), which completed an analysis of death certificates at the newspaper’s request.
    "It follows a separate Guardian investigation that revealed some of the country’s worst care homes were owned by companies that made a total profit of £113m despite poor levels of care."

  • Fair care: A workforce strategy for social care - New IPPR report on the social care system argues that says nearly half of the 1.3million people working in the care sector are earning less that the real living wage of £9 an hour, with one in four (325,000 people) on a zero-hours contracts.
    It warns that unless pay and conditions are improved there could be a shortage of 400,000 care workers by 2028.
    Nearly two-thirds of home care workers are only paid for contact time and not for travel between the homes of people they care for.
    One in three carers said they often don’t have enough time to prepare a meal or help with washing and bathing, while a staggering 89 per cent said that they don’t get enough time even to have a chat with clients.

  • Financial sustainability of local authorities 2018 visualisation - NAO figures showing the massive scale of cuts in local government funding from Westminster since 2010.

  • Stop telling people who need social care they aren’t eligible – be honest, there isn’t enough money - Interesting article from The Conversation: "Being told by an official that you don’t need the help you believe you do, just so as not to create an inconvenience for them, is not semantics, it’s deception. There is not sufficient money in the system."

  • The NHS and Social Care are one family, we need to love them both – Keep Our NHS Public - Updated discussion article from Keep Our NHS Public

  • Forecasting the care needs of the older population in England over the next 20 years - The Lancet Public Health article highlighted by the Guardian on August 30

  • While Brexit dominates, the crisis in social care is deepening - Polly Toynbee joins some dots in a hard hitting Guardian update on the growing crisis in social care

  • Beyond barriers How older people move between health and social care in England - Another reminder of how far the current health and care system is from any real "integration". Following comprehensive reviews of 20 local authority areas, the CQC has called for a new approach to the way the country runs health and care services.
    The ‘Breaking Barriers’ report followed people’s journeys through the health and social care system and identified gaps where people experienced poor or fragmented care, with findings showing “the urgent necessity for real change.”

  • Delay to green paper caps dismal 48 hours for social care - Still no sign of ministers recognising any urgency for action on social care crisis

  • £1bn needed to stave off crisis, say social care bosses - Social care directors send another warning on under-funding

  • The revision of the Relative Needs Formulae for adult social care funding and new allocation formulae for funding Care Act reforms - Complex researched report with lots of maths, but basically arguing far an adjustment of the formula for allocating financial support for social care, from PSSRU.

  • Adult social care services on brink of collapse, survey shows - Guardian report says that research published in June 2018 by the Association of Directors of Adult Social Services (Adass) shows councils “cannot go on” without a sustainable long-term funding strategy to underpin social care.
    Adass warns that continuing cuts to budgets risk leaving thousands of people who need care being left without services.
    It reveals English councils plan to push through social care cuts of £700m in 2018-19, equivalent to nearly 5% of the total £14.5bn budget. Since 2010, social care spending in England has shrunk by £7bn.

  • ADASS BUDGET SURVEY 2018 - A report from the Association of Directors of Adult Social Services (ADASS) warns that:
    “Insufficient social care, together with reductions in primary and community health services mean that for more people hospital may be the only option.
    “Alongside the £7bn reduction in adult social care funding since 2010, resulting in less spending on prevention, there has been little meaningful investment in primary and community health care and prevention of ill health, with fewer GPs, a 45% reduction in district nurses since 20103 and a 10% reduction in the Government grant for public health since 2015/16.
    “Significant increases in hospital attendances and admissions over the last winter, leading to increased demand for social care on discharge have been experienced by 95% of councils as a pressure.”

  • A fork in the road: Next steps for social care funding reform - A joint report between the Health Foundation and the Kings Fund, which highlights low public awareness of social care and a lack of agreement on priorities for reform as major barriers to progress, despite apparent political consensus on the need for urgent action.
    It argues that reforming the current system will be expensive, but states that if reform is chosen, England is now at a clear ‘fork in the road’ with a choice between "a better means-tested system" and one that is "more like the NHS" -- free at the point of use for those who need it.

  • Plight of care home residents laid bare in damning report - Independent online report covering appeal by 80m charities for change of government line of squeezing social care as quality declines in care homes.

  • Adult Social Care: An Intractable privatisation? - Professor Bob Hudson

  • Financial sustainability of local authorities 2018 - National Audit Office

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