News Opinion

Where the care market doesn’t exist

Joel Lewis, Policy Officer for Health and Care at Age UK

Older people across the country are finding it increasingly difficult to get high-quality care; the Government needs to do much more to reduce the social care postcode lottery

A recent analysis of Care Quality Commission (CQC) inspections data has shown that many older people living in some of the poorest areas will have no choice but to access care from services deemed sub-standard, unless they’re able to look for care further away from home.

Nearly one in four (24%) services in the ten most deprived areas were rated as ‘requiring improvement’ or ‘inadequate’, compared with one in six (15%) in the wealthiest. This is a miserable situation, and it’s one of many examples of the so-called ‘inverse care law’, whereby those in the greatest need often seem to receive the poorest service.

The situation is made worse when you consider that the areas in which there are many older people on low incomes, whose care costs are the responsibility of their council, are also usually the places with a low tax base, meaning the local authority is in no position to raise enough money locally to fund them.

Contrary to what members of the public often hope and expect, social care does not offer a universal safety net like the NHS. It can often be impossible to shop around if your needs are pronounced, services simply aren’t there to meet them and/or you can’t afford to pay the top rates demanded. Private paying care home residents subsidise those who are State-funded to the tune of 41%.

Even older people with the means and willingness to pay may find care hard to come by. Age UK recently reported that ‘care deserts’ are appearing in some places where it is next to impossible to get care, even if you can theoretically afford it. This seems to be a more common phenomenon in some rural areas, and in affluent parts of the country where it is hard for providers to attract and retain care staff. Care work is notoriously poorly paid – at similar levels to retail or hospitality – so where better paid and less onerous jobs are available people looking for work may choose to do these instead.

Lack of access to high-quality care has helped contribute to 1.4m older people in England living with some level of unmet need. This means they are struggling to complete day-to-day essential tasks like getting up, washed, dressed and fed. Variations in quality and access are also putting more pressure on families, with the number of informal carers rising by over a million over the last seven years.

Since 2015, local authorities in England have been able to add a small extra levy, the ‘social care precept’, onto council tax bills. However, the dramatic fall in social care funding means that even councils in the wealthiest areas acknowledge that the precept alone will not raise the significant sums needed to provide care for the increasing numbers of older people requiring it.

There is also another threat on the horizon which it is feared will only increase the care postcode lottery. This is the planned introduction of 75% business rate retention by 2020/21. Affluent areas with thriving local economies will no doubt relish the opportunity to retain a higher share of locally generated revenue. However, those already struggling with low tax bases, weak local economies and high numbers of residents with more complex health conditions will be further reliant on central government support. Unless something changes the experts say that by that date, which after all is only two years away, there will be a £1.5bn social care funding gap.

The level of inequality in terms of care provision between different geographical areas is already stark then, and getting worse. In addition, the current local mechanisms being used to raise more money for care are little more than a sticking plaster. All this shows the pressing need for a national solution to the crisis in care. The serially delayed Green Paper must demonstrate real ambition in responding to this, and in bringing about a long-term solution for the funding of this essential public service on which millions of older people, disabled adults and their families and other informal carers depend.


Edel Harris





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