Age-UK say efforts to patch up social care are "living on borrowed time"

policy digest

28 / 02 / 2017

Health and care of older people in England 2017
Age-UK, February 2017

This report from Age-UK looks at the current state of health and social care for older people. It concludes that a proper discussion about how we fund health and care services for our growing older population “cannot be put off any longer”. Current approaches to propping up the social care system are said to be “living on borrowed time”, particularly now that the NHS is under growing financial pressure. They state that one in eight older people now live with some level of unmet social care need.

The report begins by assessing the health and care needs of the ageing population, noting that in the last ten years the number of people aged over 65 in England increased by nearly 21 per cent, with the greatest increase in those over 85. This is a trend that will only continue – with projected rises to the number of people aged 65 and over of 48.9 per cent in the next 20 years. Increases in disability-free life expectancy have also taken place over the last ten years, but the authors note that they have fallen back since 2010-12. As a result the gap between life expectancy and disability-free life expectancy is growing, leaving more work for health and social care. 

The report goes on to consider trends in social care over the past decade. It notes that funding for older people’s social care stayed relatively steady in real terms between 2005/06 and 2010/11, before falling rapidly up to 2013/14, with a modest, then more substantial rise in 2014/15 and 2016/17 respectively. There had been an increasing reliance on NHS funds, via cash transfers and pooled budgeting arrangements. This is in the context of an increase in the population of people over 65 from 8.03 million in 2005/6 to 9.71 million in 2015/16. Age-UK’s own analysis indicates that nearly 1.2 million older people now don’t receive the help they need with essential daily living activities, an increase of 17.9 per cent on last year and 48 per cent since 2010.

Looking at projections for the future, Age-UK propose that “public spending for older people’s social care would need to increase by a minimum of £1.65 billion” by 2020/21 in order to keep pace with demographic and unit cost pressures. In addition they calculate that increasing funding by £4.8 billion now would ensure adequate access to social care for all older people with one or more unmet social care needs, rising to £5.75 billion by 2020/21. They propose that this additional support could have a major impact on older people’s ability to maintain their independence and avoid more costly healthcare.

Moving on to look specifically at healthcare, the report notes that recent increases in NHS funding have “been far from sufficient to plug the growing financial deficit”. They observe the patterns of funding, noting that increases in funding for secondary care have not been matched by investment in primary care. Looking at workforce numbers, the report notes that there has been very little overall growth. Numbers of nurses have risen overall, but this growth has been concentrated in acute services, with numbers of community nurses in fact declining.

Looking at demand, the report says that increases in demand pressures on primary and community care have clearly taken place, but these sectors lack the data infrastructure to quantify these demands and assess how they are coping. They do observe increases in hospital admission rates for ambulatory care sensitive conditions, which if effectively managed in primary and community settings should not lead to hospital treatment. Rates of admission for these conditions in those aged over 75 have risen rapidly, including UTIs (admissions up by 96.2 per cent since 2005/6) and pneumonia (up by 171.4 per cent over the same period). The report also covers the recent rises in demand for urgent and emergency care, inpatient activity and delayed transfers of care which have been widely reported.

The report concludes by stating that pressures on hospitals are “simply the most visible manifestation of a whole system that is struggling to cope” and restating the need for a proper discussion about how health and care are funded for the growing older population. It states that this conversation “cannot be put off any longer”.

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