Adult social care at tipping point – but will it go over the edge?

The Care Quality Commission has warned in its annual State of Care report that adult social care is at a “tipping point” and that quality of care could be compromised unless problems in the sector are addressed. Editor Dan Parton wonders if this call will be answered by government.

Talk of crisis in the adult social care sector has been a staple for years now, as perennial funding cuts have put pressure on services resulting in cutbacks and some disappearing altogether. This talk has largely been ignored by those in power, but when the regulator weighs in and says the sector is approaching a “tipping point”, surely they have to listen?

The Care Quality Commission’s (CQC) annual State of Care report laid it out in stark terms, saying that the sustainability of the adult social care market is approaching a tipping point. Its view is based on the evidence of inspections, information received through CQC’s market oversight function, and a variety of external data.  

Perhaps the most obvious sign of crisis is providers starting to hand back contracts because they are undeliverable, due to pressures on fees that care funders are able or willing to pay and cost pressures, including the impact of the national living wage. Local authorities are expecting more to come.

As Professor Martin Green, chief executive of Care England noted, its members are still being asked to care for adults with complex needs for as little as £2.25 per hour. How can providers be expected to deliver outstanding care on that little funding? Quick answer: they can’t. 

Although it should be noted that the CQC’s report had some positives – most care provided is safe, of a high quality and compassionate – it is the talk of a ‘tipping point’ that dominates, as the CQC said this state of affairs may be challenged in the coming years.

This is the effects of the austerity agenda of the past 6 years, which has seen local authority budgets slashed by 25%, coming home to roost. With social care, one of, if not the largest costs for a local authority, they have often faced the brunt of cuts.

But now it is being found that frontline services can only withstand so many cuts – and it is these services that older people and those with disabilities or mental ill health often rely on to live safely and with dignity in the community.

It should also be noted that these cuts have come at a time when demand for services is increasing – we have an ageing population and people with severe disabilities are living much longer – so councils and providers are having to try and do the magic trick of doing more with less. But there are only so many rabbits that can be pulled out of the hat. Many councils have already ramped their eligibility criteria to the highest possible point.

It was also highlighted that this is having a knock-on effect in the NHS, with increased A&E attendances, emergency admissions and delays to people leaving hospital. Of course, that adds to the pressure on their already stretched budgets.

These are not revelations – many within the sector have been saying this for many years now, although with a gradually increasing sense of urgency. But for the care regulator to make a statement in such terms – it is not generally the sort of organisation to make such proclamations – it underlines how serious matters are becoming.

The massive human cost behind all this should also be emphasised. Hundreds of thousands (if not more) of older people, those with physical or learning disabilities and people with mental ill health, are suffering a reduced quality of life as they cannot access all the services – or any services, in some cases – that they need. The effect that is having on them, and their families, is incalculable. But it is doubtless having an economic effect – to put it in terms that usually make governments listen – as there are some people who would be able to work who cannot because the social care support is not there to enable them to do this, for example.

But, worryingly, the austerity agenda is set to continue until at least 2020. While new Prime Minister Theresa May has swept away a lot of the policies of the David Cameron/George Osborne era, austerity appears to be here to stay. It may even go on for longer, as new Chancellor Philip Hammond has admitted that the national deficit won’t be cleared by 2020. That’s not even starting with the potential effects of Brexit on the nation’s finances.

A common theme among the responses to the CQC’s report from social care organisations was a call for increased funding. Professor Rhidian Hughes, head of the Voluntary Organisations Disability Group, called on the government to act: “It is imperative that government uses the Autumn Statement to put things right for social care.”

They’re all right. 

The Autumn Statement will be crucial. It is a perfect opportunity for the government to back up May’s rhetoric about ‘building a country that works for everyone’ by providing increased funding for adult social care. While throwing money at it will not a universal panacea – the problems in the sector are myriad - it is widely accepted to be underfunded and reversing that could at least save some services in the short-term. It could also sort out the problem of contracts being undeliverable as councils could afford to pay providers an acceptable rate. 

Without it, we face a real prospect of services failing, which will put lives at risk. That cannot be allowed to happen.