The home care system in the UK is in a “critical condition” with acute workforce and funding pressures threatening to undermine policies to support older people to be cared for at home, a new report finds.
The study by UK charities the King’s Fund and the Nuffield Trust said many social care providers were surviving by relying increasingly on older people who could fund their own care, leading to the emergence of a two-tiered system.
Six consecutive years of cuts to local authority budgets for social care have seen 26 per cent fewer older people receive help in the UK, according to the report, which found community-based support had experienced the steepest reduction in funded services.
“No one has a full picture of what has happened to older people who are no longer entitled to publicly funded care: the human and financial costs to them and those who care for them are mounting,” the report said.
It said access to care depended increasingly on what people could afford – and where they lived – rather than on what they needed. “This favours the relatively well off and well informed at the expense of the poorest people, who are reliant on an increasingly threadbare local authority safety net,” the authors wrote.
Provider failures inevitable
Faced with these financial and workforce pressures, the possibility of large-scale provider failures was also “no longer a question of if but when”, which would have significant ramifications for continuity of care, said the report.
“In the past 16 months, home care providers have handed back contracts in 59 local authority areas, and in another 48 areas at least one home care provider has ceased trading,” the report said.
It was estimated the gap between needs and resources was set to reach at least £2.8 billion by 2019 and was already placing a significant burden on unpaid carers and families.
Under-investment in primary and community National Health Service (NHS) services further compounded the challenge of supporting older people to remain at home.
In addition to reductions in public funding, the report said home care providers were also facing additional cost pressures from the introduction of the National Living Wage, which is estimated to add at least £2 billion to workforce costs by 2020.
While measures to raise wage levels in the low paid sector were welcomed, providers questioned the affordability of the increases in an already stretched home care market.
Richard Humphries, assistant director of policy at The King’s Fund said the report’s findings pointed to a “burning injustice” in Britain, and older people, their families and carers were picking up the pieces in a failing system.
The findings of the report are based on a literature review, national data analysis, and interviews with commissioners, providers and clients in four local authority sites.
Lessons for Australia
Michael Roberts, a senior advisor with Grant Thornton Australia and commentator on international care systems, said the report detailed the negative impacts of post-GFC economic austerity measures across the UK social services sector.
“The instabilities created in the home care market, negative impacts on consumers and carers, and systemic flow-on effects across the health and welfare sectors are a major concern.”
He said Australia had to grapple with the lessons from the UK on how to best respond when social care systems have to operate in times of economic hardship.
Read the full report Social Care for Older People: Home Truths by clicking here.
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