Key Trends in Adult Social Care: Challenges & Prospects

1. Plenary 2: Social Care Research, Policy & Practice:Social Care: policy, pressures & prospectsRichard HumphriesSenior Fellow, The King’s FundVisiting Professor, University of Worcester

2. Key trends in adult social care – latest evidence summarised: https://www.kingsfund.org.uk/publications/social-care-360

3. Four challenges for adult social care Public spending per head on adult social care in England, Northern Ireland, Scotland and Wales between 2008/09 and 2015/16 Money • Money is not keeping up with rising needs & numbers • £7b less in council social care budgets since 2010 • Current funding gap in social care - £1.5b • Spend is lower than most comparable advanced countries • General agreement we need to spend more • No agreement about where the money should come from • In the meantime – social care costs shifted towards individuals & council tax payer

4. Four challenges for adult social care Service delivery People & communities Money Workforce • Only 5% of social care workforce is professionalised – low pay, high turnover • Recruitment & retention is a widespread problem • Nursing homes compete with NHS for scarce registered nurses • Unpaid carers out-number paid workforce by 2 to 1 • 280,000 more care staff needed by 2025 – where will they come from? • There is no national workforce strategy • Money is not keeping up with rising needs & numbers • £7b less in council social care budgets since 2010 • Current funding gap in NHS & social care - £5b • Spend is lower than most comparable advanced countries • General agreement we need to spend more • No agreement about where the money should come from • In the meantime – social care costs shifted towards individuals & council tax payer • services & budgets in separate silos • care is fragmented & poorly coordinated • current provider market not sustainable • Wide & unexplained variations • under-investment in prevention, care at home & independent living • under-use of technology & housing-based models • over-reliance on admissions to hospitals & long term care • younger people don’t want traditional services • system complex & hard to navigate • Public awareness of social care is generally low • Awareness of likelihood of needing care & support, how much it will cost and who will pay is even lower • So individuals are poorly prepared & unable to plan ahead • self-funders – still ‘lost to the system’? • What is the role of families, friends and local communities? • Resilience & asset-based approaches

5. Insert children’s services slides Source: Association of Directors of Children’s Services

6. Unfinished business?

7. a brief history of attempted reform: Conservative Governments 2015 & 2017 Labour Government 1997- 2010 Conservative/Lib Dem coalition 2010-2015 Green Paper promised by summer 2018 2010 White Paper 2000 Government response 1999 Royal Commission 2014 Care Act 2011 Dilnot Commission

8. Conclusions & implications: • Immediate prospects for national reform are bleak • Solutions/work arounds will be local & bottom-up • Interface with NHS & other public services • Developing the evidence base more important than ever • We must use increased research capacity wisely!

9. Thank you • @richardatkf r.humphries@kingsfund.org.uk