NHS and government ‘flying blind’ as deep cuts prevent hundreds of thousands of older people accessing social care

The NHS and government are ‘flying blind’ in planning services for vulnerable older people because there is no comprehensive way to quantify the impact that social care cuts are having on their health and wellbeing, experts warn today. The warning comes in a new Nuffield Trust and Health Foundation study examining cuts to social services for older people in England, published as MPs prepare to question senior officials and experts on the topic in Parliament today (Wednesday 26 March).

The new research, which is part of the Nuffield Trust and Health Foundation’s QualityWatch programme, reveals that most local authorities are tightly rationing social care for the over-65s in response to cuts, resulting in significant drops in the number of people receiving services like home-delivered meals and day care. It reinforces this month’s National Audit Office report into the state of adult social care and finds that older people’s social care has experienced a 15 percent cut in real terms since the Government’s deficit reduction programme started in 2010. Other key findings include 

- Almost a quarter of a million (245,855) fewer older people received publicly funded community services in the financial year 2012/13 compared to 2009/10, a 26 percent drop. 
- Home and day care spending by councils fell by 23 percent (or £538 million) over the same period.
- The number of older people receiving home-delivered meals has more than halved since 2009/10, falling by 59 percent (54,795 people). This is in response to a reduction in funding of 46 percent for meals over the period.
- While the number of people receiving 10 or more hours of care and overnight care remained constant between 2009/10 and 2012/13, around 42 per cent fewer people received lower-intensity care over the same period. This indicates that local authorities have responded to cuts by focusing on those most at need.
- Transfers of money from the NHS to adult social care have more than doubled since 2009/10, reaching £803 million in 2012/13. This suggests that cuts to social care services would have been even more drastic if not for these transfers.

As well as leaving hundreds of thousands of previously eligible older people without local authority support, the report says that these cuts mean those still receiving publicly-funded services may be at risk of poor quality care. This is because the income paid to social care providers has been squeezed, which may have resulted in staff shortages, high staff turnover or reduced contact hours.

The study seeks to assess the impact of social care cuts on the health and wellbeing of older people and their carers, but finds that, due to a lack of available data, it is not possible to quantify this. Despite increased numbers of older people attending A&E in recent years, for example, the NHS does not record whether someone is a user of publicly funded social care. Moreover local councils themselves do not hold data on those who pay for their own care, only on those whose care is publicly funded.

Holly Holder, report lead author and Fellow in Health Policy at the Nuffield Trust, said:

“Our analysis paints a picture of increased rationing of social care by hard-pressed local authorities in response to deep cuts from central Government, despite the growing numbers of older people in the population. It is highly likely that this is having a negative effect on older people’s health and wellbeing and that of their carers, but without adequate data to assess this impact, the NHS and Government are flying blind when it comes to managing demand and planning for the future.”

The QualityWatch report comes as the Care Bill, currently working its way through parliament, promises a radical shakeup of social care funding from 2016. The Public Accounts Committee will be questioning senior officials and experts on adult social care at 2.15pm on Wednesday 26 March.

Holly Holder continued:

“These cuts have hit community services the most, with local authorities perhaps understandably choosing to focus their limited funds on those most at need. But this is not a long term strategy and nor will it be solved by the Care Bill, which will still leave many people in need unable to access publicly funded social care.”

Jennifer Dixon, Chief Executive of the Health Foundation, said:

“Across the English NHS A&E departments are creaking, in part because of rising demand for care from frail older people. Emergency hospital admissions have risen by almost a third in ten years: many of these were preventable and many were short stay admissions for older people with multiple conditions. Good quality social care can help to prevent attendances in A&E. We welcome that the Public Accounts Committee is questioning experts on adult social care and hope that it will consider wider consequences of social care funding on the NHS. Better data for analysis, of the type suggested by NHS England’s initiative ‘care.data’, would be a good start.”

QualityWatch is a major research programme from the Nuffield Trust and the Health Foundation that aims to provide independent scrutiny into how the quality of health and social care is changing over time.