The QT

Saturday 15 June 2024
15/06/2024

Dysfunctional care system in critical state

The North East is home to some of England’s most deprived areas, leaving residents living in the worst off neighbourhoods vulnerable to inequalities and an unfair social care imbalance. In the second in our series Do We Care? Jane Hall looks at what’s gone wrong and what the answer may be
  • More than 437,000 people awaiting care assessment needs in the UK
  • North East has 7,000 vacancies for adult social care workers
  • Calls to urgently integrate social care with healthcare

“It is often said that you can judge societies on how they treat the least well off and the weakest, and I think we have got to a point where we are doing, very, very badly as a country when we are unable to provide any level of sufficient care to those people who need it the most.”

Dr Elliott Johnson, a senior research fellow in Northumbria University’s Department of Social Work, Education and Community Wellbeing, is talking about the UK’s broken adult social care system.

Words such as ‘dysfunctional,’ ‘bleak,’ ‘flawed’ and ‘inadequate,’ pepper his conversation as he discusses the failures of England’s social care system and the need for urgent reform.

Few would deny that the sector is in deep crisis following years of chronic underfunding, acute staffing shortages, an ageing population, broken Government reform promises, and the impact of the Covid-19 pandemic, which has not only increased older people’s need for social care, but also exposed the challenges and pressures facing the UK’s healthcare system.



Latest figures from the nation’s independent public spending watchdog, the National Audit Office, show there are 152,000 unfilled care staff vacancies UK-wide — a major contributor to the 437,243 people in England awaiting care-needs assessments, and for exacerbating discharge delays from NHS hospitals.

The statistics also reveal that with local authority finances under significant pressure, around two dozen councils were, according to the NAO, “not confident that they could meet their statutory duties for care in 2024-25.”

Adult social care staffing figures for the North East paint an equally bleak picture. There are currently around 7,000 vacant posts out of a total workforce of 94,000. 

The data compiled by Skills for Care, also shows a staff turnover rate of 26.4% across the region — reflecting the national trend with about 390,000 care workers leaving their roles every year, a third of whom are being lost to the sector altogether.

Average real term mean hourly pay has also dropped for North East care workers from £10.39 in 2021-2022, to £10.08 in 2023.

Government-backed social care reforms have been repeatedly delayed and work supposed to begin last September to create new training places and develop the low-paid care workforce have been put-off for at least six months.

Asked what his view is on the state of adult social care in England nearly a quarter of the way through the 21st Century, and Dr Johnson doesn’t mince his words. “Dysfunctional. I think the real sadness about this is that there are a huge number of incredibly committed social care workers who want to do the best for their clients, and are very often coming from families where they have care responsibilities themselves.

Dr Elliott Johnson describes the UK’s ‘broken’ adult care system as ‘dysfunctional,’ ‘bleak,’ ‘flawed’ and ‘inadequate’

“These are people who want to do the best for their patients and clients, but are so overstretched and so underpaid and so overworked, they are unable to deliver the kind of care that not only they would like, but the families of the people having personal care and those receiving it themselves, would like.

“The pandemic really highlighted how bad things had gotten. We have people on zero hours contracts, agency staff who are having to move between care homes, who are very often having to go in at the very last minute or go in when they are sick, because they don’t have the kind of employment protection that people on permanent contracts have.

“They were given responsibility to deal with the sickest patients that the NHS had who were being discharged into the community because there were no beds in NHS hospitals.

“That is a recipe for disaster. People with incredibly weak immune systems are being looked after by people who can’t afford not to go into work when they are ill. All of this stuff builds over time, but then you have these pinch points, these crises, that uncover just how bad things have got.”

North East England is home to just over 2.6m people based on the 2021 census, 1.09m of whom are aged 50-plus. The data compiled by the Office for National Statistics, shows nearly 200,000 regard themselves as being in bad or very bad health – the highest proportion per head of population in England. 

The North East also recorded the lowest proportion in England reporting very good health at 1.2m, or 44.7% of the region’s population.

More than 250,000 said they are providing unpaid care — giving support to anyone who has long-term physical or mental ill-health conditions, illness or problems related to old age — ranging from less than 19 hours a week up to 50 or more hours.

A third of the North East population lives in the 20% most deprived areas of England, and healthy life expectancy is around 59 years.

Evidence shows that those who live in deprived areas face the worst health inequalities. And this includes the provision of social care. 

Adult social care is in crisis

In England, adult social care funding is allocated by local authorities and is financially assessed. This means a person’s assets are looked at to see how much money they have and if the council needs to step in and help towards care fees.

The current savings threshold in England before a local authority will help pay towards care costs, is £23,250 — set to rise to £100,000 in autumn 2025. Individuals with savings and assets above this are generally expected to fully fund their care.

Social care is paid for by local authorities through a combination of a grant from central government and local revenue-raising systems, such as business rates, council tax, and the specific social care precept.

But local authorities in the North tend to collect less council tax because property values are lower. As a result, there is less money to support carers and those who need local authority funding to help pay for their care needs.

This has led to a North-South social care divide, as Dr Johnson told The QT: “There are some economic and public health issues that are worse in the North East. The first is that we have a greater reliance on the public sector in the North East for employment, and that has been devastated as a sector since the financial crash in 2008.

“That also means that many of our councils have been affected both by the functioning of the economy, such as business rates and their ability to raise funds in the local area, but also by funding from central government.

“Funding for social care has fallen over that period. Councils are struggling with their own budget cuts. They are not able to reassign funding from other areas that they might have done in the past because their budgets have been cut to the bone.

“They are therefore left without sufficient funding to be able to fund even the bare minimum that is required, and the North East has suffered tremendously in that regard. 

“There hasn’t been the ability for private sector economic activity to make up any of those shortfalls that are being driven by public sector retreat.

“There are huge problems for all councils around the country. Even councils in relatively wealthy areas are seeing their budgets suffering. But the North East faces a particular challenge.

“The North East also has particular health trends that are challenging. We have very high rates of long-term health conditions compared to other areas. We also have very high levels of deprivation.

“All of these factors amplify the issues, and they mean that the failings in the system can’t be dealt with on a case by case basis, on a discretionary basis, by councils that are struggling to deliver even the very basics.

“It is that demographic and that economic aspect coming together that is a particular challenge to the North East.”

Local authorities in England have a duty to provide social care. Credit: Unsplash

Local authorities in England have a duty to provide social care. But with councils struggling to meet their statutory duty, many believe it is time it was taken out of their control and a new national strategy introduced.

According to the Health Foundation, between 2014/15 and 2021/22, adult social care spending increased by an average of 2.6% a year in real terms. Between now and 2032/33, it is predicted funding will need to rise by an average of 3.4% a year to keep up with rising demand.

But currently there is no national budget for adult social care. The amount spent is determined by local authorities based on their own overall finances and other spending pressures, targeted funding transferred from the NHS, and central government grants.

Whilst the Government has provided additional grants for the next two years, the outlook is uncertain beyond 2025.

Dr Johnson, who is part of a group looking at some of the current issues facing social care, said: “I think a strategy is very much required, but more than that we need the infrastructure to implement change.

“There has often been touted the idea of a national care service. I think what we would suggest is that it may be better to utilise the structures that we have and say that having the NHS have responsibility for social care, as well as health care, could lead to a more joined up and collaborative sense of health and social care.

“We think that given we have structures like integrated care systems and integrated care boards and partnerships, they could be used to bring health and social care together under one organisation, under one funding source. That means we wouldn’t have this ping pong back and forth between hospitals and care homes with everyone wanting it to be someone else’s budgetary responsibility.

“But I think we also need to move into the practical doing of saying that social care can no longer be considered a separate function. It is a big part of healthcare and we need to see it as such.

“We need to see it as a free at point of use service instead of what we currently have where it is seen as almost a luxury. 

“There was an IPPR report that looked at the cost of providing free personal care. It didn’t consider accommodation specifically, but free personal care for everyone who needs it, and to do that it would cost approximately 1% of Government spending increase.

“We are looking at really quite small amounts of money to ensure that everyone is able to receive care as they need it, free at the point of use.”

The QT is shining a light on the social care crisis

Dr Johnson added: “It is unsustainable to have a system of a lottery where some people have health conditions where they require residence in care homes and receive 100% NHS funding because they have complex health needs, versus someone who has Alzheimer’s disease, a health condition that requires round the clock care, but we see it as something that they should pay for directly, or that local authorities should fund instead of the NHS.

“These are arbitrary distinctions, and what we need to do is create a system that is streamlined, that is very clear about what it is for, and by bringing it into the public sector rather than relying on the private sector, there is the opportunity to look at substantial savings in accommodation and residential care that could made it free for everyone at the point of use.”

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