We are all living longer, which is good, but there is also a downside with many of us living longer with chronic illnesses and dementia. For councils, this is also creating a major stress because of the substantial costs of looking after the frail and elderly who choose to stay in their own homes.
Social care, as it is known in the UK is funded by local authorities which must stick to their budgets by law, and which have also had their funding for care cut by 30% in the past five years. Adult social care for 2016/17 will cost UK local authorities almost £20 billion (34 billion AUD) or 35% of their net budgets.
The English health and local authority associations tend to lobby governments separately and both sectors are notoriously un-joined up, with the NHS in particular jealously guarding its protected budgets. However the penny has now dropped among health chiefs that cuts to social care in local government are having a knock-on effect on hospital admissions. Elderly patients are blocking beds because there is no proper care for them in the community when they are discharged from hospital. Local authority-run nursing homes are closing and elderly residents who might be looked after in their own homes are ending up in hospital wards whose bills are much higher than home care but which are met by the national taxpayer rather than the local authority.
In the last few months of 2016 there was for once, complete unity among the health and local authority lobbies that the government must put more money into social care, if only to reduce the cost on the NHS. In December 2016 the government responded with an extra £900 million over two years for English local authorities. In fact some of this cash was recycled from other funding while most came from increases in the local property tax levied by local authorities – the council tax. The problem with relying on council tax to fund social care is that councils in poorer areas have a low council tax base despite having high adult care costs. Even assuming this extra cash materialises it is still below the projected shortfall of £1 billion every year until 2020.
The ‘extra £900m’ was widely derided by the health and local government sectors for failing to address the central problem which is that longstanding local government cuts in adult social care, as predicted, are pushing up costs in the NHS. One answer might be to nationalise adult care by centrally funding it just like the NHS and making it free but no government wants to take on that financial headache. Another solution is to integrate the NHS and care sectors to break down the silos that bedevil both sides and enable a more joined-up approach with shared budgets. Some areas are well advanced in integration, such as Manchester and Scotland, but this is not uniform. There is therefore as yet no long-term solution to a crisis that can only worsen.