Social care in crisis

Almost every story about care homes includes the word “crisis”. So what are the problems and just how bad have things got?

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Last month, the social care minister Helen Whately found herself on the verge of tears when she addressed a health conference. She was telling a story about her 100-year-old grandmother, who had been taken to hospital after a fall and ended up spending five months there, “mostly waiting for discharge”, in Whately’s own words.

The delay had resulted from problems of finding external care for her grandmother. Before the fall she had been managing to live independently in her own home, but when finally discharged from hospital she was bed-bound and died two weeks later.

Whately said she told this story to show how important the problems of social care were to her rather than to illustrate the system’s failure. But the Conservative-supporting magazine The Spectator had a different take.

Whatley simply wasn’t in a position to announce the big reforms that are necessary to stop that kind of story being so commonplace, commented the assistant editor Isobel Hardman. There wasn’t the political impetus or capital, or the time, so widespread had the social care crisis become.

“It has become the wallpaper to elderly life and death,” wrote Hardman, “and that means it is harder for what should be a scandal to get the attention and outrage it deserves”.

When a leading Tory commentator openly admits it is now taken for granted the social care system is in dire straits rather than hides behind boosterism and obfuscation – the government’s usual tactics – you know the picture really is as bad as that painted by press reports.

The Care Quality Commission reported that almost half of care homes inspected in England had been found to be failing

Just this year, headlines have included “Staffing crisis leaves many English care home residents’ basic needs unmet” (Guardian), “Care homes in crisis as number of ‘inadequate’ ratings surge since pandemic” (Telegraph), and “Care homes have beds but no staff, government warned” (The Independent).

In January the Care Quality Commission, the independent regulator on care homes, reported that almost half of care homes inspected in England had been found to be failing. Of 2,934 inspections carried out in the year to 31 December 1,224 were rated as either inadequate or required improvement.
Such stories are far from new. For as long as they have existed care homes have faced problems of finance and questions about the quality of service.

Admittedly, the bar was set very low in the 19th century, when the government of the day tried to implement a basic care framework for the elderly and infirm by creating workhouses, so called because residents had to earn their keep. Men were employed breaking up large stones for roads or crushing bones to make fertiliser while women were expected to knit and sew. The earliest workhouses were designed to instil fear and make people avoid them at all costs. Today they evoke the grim Victorian world of Oliver Twist, forced labour, beatings, malnutrition and neglect.

Conditions improved by the time they were finally abolished in 1930. The following year the earliest publicly funded care homes were brought into existence. In the 1931 census, 54,920 people in England were looked after in what were then known as nursing homes. Today the total figure of care home residents is over 430,000, around four per cent of all people aged 65 and over.

In some areas, especially the south of England and West Country, the number of available beds is struggling to keep up with demand for them since people now live longer because of better medicines, healthcare, diet and lifestyle. A UK-wide snapshot of this trend to longevity can be seen by comparing the number of residents aged 65 and over in 2022 (11.8 million) with the figure for 1990 (9.1 million).

In England, funding for social care has not kept pace with this growth. Since social care is mainly financed through local government, an almost £20 billion reduction in the government’s funding of council expenditure since the Conservatives came to power in 2010 has left councils struggling to balance the legal commitment to social care with other core responsibilities.

It was to remedy a looming future shortfall in funding that the government introduced its much-trumpeted health and social care levy, which came into force 12 months ago through an increase in National Insurance contributions. But experts warn this still won’t fix some of the main problems, particularly a staffing crisis. While £500 million from this new levy is being allocated to workforce issues, it is not funding increased wages – said to be desperately needed for recruitment and retention of staff – but rather on training and qualifications.

The charity Skills for Care has warned that staff vacancies in care homes are now above 10 per cent, which is more than the level during the pandemic. Recently, the FICCH project (Financial Impacts of Covid-19 on Care Homes) interviewed managers, care-giving staff and support staff and found that many people don’t believe carers required more training. “What they do need is improved working conditions and better pay,” FICCH said, adding that if training was needed it should be for new nurses to work in care homes.

The problem of funding the system was exposed in March by Care England, which represents independent care home operators. It found a £2.3 billion shortfall in council money needed for care homes. As a result some councils were paying homes several hundreds of pounds a week less for each resident than what was said to be “the fair cost of care”. This has led to standards falling.

One way of dealing with the problem is a shift towards community-based care

If there are questions about the funding provided for care homes, there are also now major reservations about how the money is spent. In January this year it was revealed that the boss of Runwood Homes, the UK’s sixth largest for-profit care home group, paid himself at least £21m over five years. The homes charged residents over £1,000 a week, with bills said to be often covered by the taxpayer, while inspectors reported finding multiple breaches of staffing, safety and leadership rules, including residents being left in dirty incontinence pads and staff accused of rough handling.

Increasingly, one way of dealing with the problem is a shift towards community-based care. As a result thousands of elderly people are being looked after in their own homes. Unfortunately, there are now mounting problems in this part of the system which, if it failed, would see care homes swamped and unable to cope.

The network of carers in the community is in crisis. A hole of at least £650m has been found in funding for these community carers, although that figure is likely to be a significant underestimate and could be over £1 billion, according to providers.

Christopher Jordan, founder of the charity Disability Talk, told Big Issue North the £76.75 a week it was paid amounted to less than £2 an hour in many cases, yet without these carers it would cost the state billions. He claimed that many carers didn’t bother to “jump through all the goverment’s hoops” to register, and did the work unpaid.

A couple of weeks ago he challenged Whately to become an unpaid carer for a week. “Your skills should include cooking, washing, cleaning, bathing, dressing, gardening, shopping, diary management, transportation management, finance and accountancy,” he wrote in his invitation. Jordan says he did not receive a response, however. Big Issue North approached Whately’s office for a comment.

Claire Rintoul, chief executive of the Sheffield-based charity Sheffcare, says that not enough money is being invested in social care. “Nobody wants to fix it, nobody wants to own it. That means we can’t afford to pay staff what they’re worth. It makes it difficult to recruit staff. It makes it difficult to retain staff. I just think it’s a national disgrace.”

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