The problem no one wants to face up to

Ruth Thorlby, Nuffield Trust, explores budget cuts to public services, and the impact these have had on the use of the NHS.

Blog post

Published: 02/04/2014

The challenges facing the NHS are never out of the headlines: hospitals in debt, clogged up Accident and Emergency departments, stressed out GPs. Among the many reasons given for this sad state of affairs is the ‘ageing’ population.

Government ministers are always quick to point out that even though they’ve had to make big cuts to the rest of the public sector, spending on the NHS has been protected in real terms since 2010 because it is such a vital service. Vital for all age groups, but especially older people, as old age often brings more health problems.

But could these cuts to other public services be making the job of the NHS much harder? What if spending money on non-health services might be a better use of public money, to keep people well and actually reduce the pressures on the NHS?

These cuts have come at a time when demand for social care is rising

Last week, QualityWatch, a joint research programme from the Nuffield Trust and Health Foundation, brought out a report which documented the scale of cuts to social services to older adults since 2010.

The figures are shocking. Local authorities, which organise and pay for services such as meals, day care, nursing homes and equipment like grab rails, have reduced their spending on these services by 15% since 2010, spending over a billion pounds less on social care for older people in the 2012/13 financial year than they were in 2009/10.

This has meant fewer services: nearly a quarter of a million fewer people are receiving services in their home, like meals or day care. Less money is now being spent on nursing homes (15% reduction) and on residential care (13%) than in 2009/10.

These cuts have come at a time when demand for social care is rising. The proportion of people surviving into old age has been growing steadily for several decades. This is of course good news for all of us, but the likelihood that we will need help with the normal activities of daily living increases the older we get.

The last census in 2011 asked people over 65 if they needed help with the activities of daily living: over quarter said they needed ‘a little help’ and another third said they needed ‘a lot’ of help.

But anyone who has come into contact with social care services will know that it is now very hard to qualify for public help. Your needs have to be high, and if you have more than a modest level of savings, you will have to pay for some or all help yourself.

Local authorities, faced with more people needing help than they have resources, have tried to target their limited funds on those who need care most, for example there has been almost no reduction packages of day care for more than 10 hours a day, but big falls in people receiving less than two hours’ of care.

So, what impact will these large cuts to social services have had on the health and wellbeing of older people who’ve had services cut back or – worse still – no longer qualify for any state help at all? The really shocking answer is that we don’t know.

Although the NHS has very good information about how many people attend their GPs or go to hospital for care, there has been no systematic recording of whether a person who is admitted to A&E after a fall, for example, is also using public social care, and no information at all about whether someone is relying on informal help or paying for their own care.

The informal care given to older adults, either by spouses or other family members, is huge and growing. The National Audit Office recently estimated that the ‘value’ of informal care being given to all age groups could be as much as £97 billion a year, almost as much as we spend on the NHS.

There’s also no information about the health and wellbeing of this army of carers. Carers are almost certainly acting as the ‘shock absorbers’ of these social care cuts, but it is likely to be taking a heavy toll on their physical and mental health.

The government recognise that these cuts to social services might be making things harder for NHS services, and have allocated £2 billion of NHS money to be spent on joint health and social care projects across the country from 2015.

This is welcome. But the cuts to social care have been so deep, that much of that money could be spent taking the level of care back to what it was before 2010, without changing any of the underlying funding problems.

The chronic underfunding of public social care has meant that many local authorities have struggled to spend money on ‘prevention’ – trying to keep people well so that they don’t need to go into a nursing home, and services have tended to be concentrated on people who have already deteriorated to crisis point.

What’s needed is an honest debate about how best to keep ourselves and our older citizens well for as long as possible, and how best to pay for this.

This blog was also published on the Yorkshire Post website.