By Graham Vanbergen: The inevitability of the elderly care crisis we are witnessing today has been an obvious one that academics and industry experts have warned about for 40 years. And over the last thirty years, we have seen some flimsy attempts to reform social care, only for them either to be a can kicked down the road or for them to vaporise completely. The truth is simple – political disagreement about the level of reform and their basic unwillingness to confront it are at the root of the problem.
Just to start, the numbers are mind-boggling at best.
There are just over 17,000 care homes in the UK; 14,535 in England, 1,024 in Wales, 1,025 in Scotland and 405 in Northern Ireland. Collectively, they accommodate somewhere between 430,000 and 490,000 people with a maximum capacity of 515,000 beds. It takes seven members of staff to care for five residents. Approximately 70 per cent of all care home residents suffer from some form of dementia or similar memory problems, and the consequence is that care homes in the UK employ almost 700,000 people.
These figures take into account private care homes, voluntary care homes and public care homes run by local authorities and the NHS.
In the UK, GOV.UK has estimated that the care home sector is worth around £15.9 billion a year.
On top of this, the government spent nearly £22 billion last year on adult social care. However, it should be noted that in 2010, the last Labour government was spending £23.2 billion on adult social care and with both a rising population of elderly people and inflation, this austerity-driven slump in spending is rapidly causing problems.
In addition, there are 550,000 people waiting in the community for assessment or care, according to the Association of Directors of Adult Social Services. Many are elderly and frail. Many will fall ill – or just fall – and many will find themselves heading for the experience of entering an NHS hospital only to find no way out of a bureaucratic nightmare that many families will never understand. There are around 14,000 people in NHS beds waiting to be moved to places that simply don’t exist.
The reality is much worse though. Although there are 550,000 waiting for a care assessment – it is calculated by the NHS that – “there were almost 2.0 million requests for adult social care support from nearly 1.4 million new service users received by local authorities in 2021-22. This is equivalent to 5,420 requests per day in England alone.” The system has imploded by the sheer weight of the problem.
The problem is money.
In a utopian world, there would be a secondary NHS provider that cared for the elderly in premises specifically for them. A resident would pay for that care to a point where they couldn’t – and then the state would pick up the bill. The limit of that contribution is hotly contested between political parties – and shamelessly, both parties have used elderly social care as a political football in a point-scoring exercise that has benefitted no one.
For instance, the Dilnot Commission, which was set up by David Cameron and reported in 2011, proposed a lifetime cap on care costs. It has twice been endorsed by parliament of both parties, and they both shot down proposals at different times. One party killed it by calling it a “death tax,” and the other got its revenge by calling it a “dementia tax.”
Another recent example is Jeremy Hunt, the chancellor. He was very enthusiastic in his support for the Dilnot proposals when he chaired the House of Commons health select committee. In the 2019 Conservative election manifesto, he promised to “fix social care” by introducing an improved funding system. Boris Johnson then promised an £86,000 care cost cap to be introduced this October – but now that Jeremy Hunt is the chancellor – the whole idea was ditched in his own Spring budget. The problem has only got worse, will continue to get worse – and fixing it will cost more – the more it is ignored.
The numbers confirm the dire state of what the country is facing. Over 11 million people in England and Wales were 65 or older when the last census was taken in 2021. And just to make sure we know what the numbers are, two years ago there were enough people aged over 90 to fill every single care home bed in the country. And the statistics don’t make things easier. For instance – the proportion of over-65s in 2011 was 16.4 per cent of the population, but by 2021 it was 18.6 per cent. It’s not hard to work out what that number is likely to be in just eight years’ time. And how about this number? There are 857,000 more adults with disabilities over the age of 65 right now than were just ten years ago.
And, yet, the numbers keep getting worse. A report in The Times newspaper last January stated – “According to Age UK, 1.6 million older people do not receive the support they need with activities essential for living, 2.6 million over-fifties have some kind of unmet need for care and 28 per cent of people who have asked for a social care assessment had been waiting six months or more. In 2020/21, 37,370 people died without receiving the care they had asked for and 14,000 people a day are having their request for care turned down.”
Think about that for a moment. 14,000 elderly people a day are being refused help, and 102 people die waiting.
Leaving aside the fact that ten per cent of all jobs in the elderly care sector remain vacant – which only gets worse by the month, some insurance providers are now bailing out because the financial liability of the industry is unstable and as service levels fall – the prospect of being sued rises exponentially.
As the headline of this article says, the elderly care crisis exploding in our faces is now affecting the lives of the generation looking after their parents as well. Five years ago, one in five people aged 50-64 in the UK were carers to an older family member. And one-third of the country’s 6.5 million informal carers are aged 65 and over. And that number is now rapidly rising. Along with it are more dangers. A Guardian report in 2017 was to the point when it said – “The evidence shows the deep sense of obligation felt by family members and the extraordinary lengths they go to in order to care for their parents. The evidence is also of widespread carer fatigue and breakdown – carers are twice as likely to suffer from mental health problems.”
And to add to the spiral, there’s another problem. There are more older people in need of care than there are adult children able to provide it. Five years ago, there were 1 million over-65s without adult children in the UK, a figure expected to double by 2030. That one million were living at home and not in need of care. But you just know what’s coming down the road for them.
This whole depressing subject is centred around political failure and cowardice. With an average term of 3.8 years per government since the war (up to Cameron, of course), there is no real incentive to deliver a policy robust enough to solve the problem. As we’ve seen, it isn’t just those desperately waiting for care or family members shouldering the weight of it all but the NHS is having to support elderly care at the cost of others. ‘Bed-blocking’ as they like to call it – is denying 14,000 other people on waiting lists. The elderly are not blocking anything – they are stuck in a system caused by years of can-kicking politicians. The most recent gesture of £200m to help decant these bed-blockers from hospitals into non-existent care home beds is nothing more than a desperate government signalling that they have no idea on what to do. And with an election looming yet again, nothing will be done.
All the above is more than just depressing. But just wait until a family member enters the care crisis where confusion, uncertainty and the moral vacuum of our so-called leaders really does come to life.
Caroline Abrahams, charity director at Age UK, says. “There can be no salvation for our hard-pressed NHS unless and until the long-standing problems afflicting social care are recognised and gripped. When it comes to government-led health and care policymaking, short-termism has usually been the order of the day.”