Care quality cuts – shaming and disgraceful

I have been banging on about the crisis in the funding of adult social care – the resources to support adults with physical and mental disabilities and frail pensioners – for several years.1 Each impending crisis has been bought off with last-minute temporary funds, instead of having the political courage to agree a long-term funding solution.

Despite the rising numbers of people requiring support, more than half-a-million fewer people are receiving support than a decade ago, and that figure is growing day-by-day. The residential home sector is also in crisis. Some of the biggest private operators have been loaded with debt, had the property legally separated from the operating companies, and are now in financial meltdown as fees don’t keep up with costs. Sometimes it feels that we are only a breath away from a catastrophic meltdown of the sector.

What has been more difficult to assess has been the impact on the quality of services, as well as on the quantity. Talking to adults receiving support services, their families and care staff themselves, I have been left with a clear impression about a decline in the quality of services as well. Various performance indicators had also suggested that.

But there was no definitive comprehensive research to confirm that…that is, until last week, when the Institute for Government and CIPFA published their 2019 Performance Tracker2 . This analyses data from across nine public services, and indicates that health and social care, for adults and children, has noticeably declined in quality as a result of cost-cutting measures.

Note, not marginal decline, but noticeable, measurable decline of the quality of care being received by our families – wives, husbands, partners, brothers, sisters, aunts, uncles, cousins, parents and grand-parents. How shaming and disgraceful is that?

And it has all taken place over the last decade of Conservative governments which, despite all the woolly, warm words and the promises of dignity and security, have left vulnerable people lying for hours without care in A&E departments, without sufficient staff in hospitals and homes to provide safe care, and frail older people without the quantity of support they require.

This is what the Performance Tracker revealed:

Although all areas of government spending assessed by the tracker have seen some reduction in quality, adult social care has undoubtedly seen the most setbacks. Public spending on adult social care provision has fallen by 2.1% in real terms over the past decade. While it’s true that the service has been able to achieve efficiencies, it will not be able to maintain this over time. As the population continues to live longer in poor health, the forecast growth in demand poses a significant challenge for public spending.

  • Demand for publicly-funded adult social care is likely continue to increase faster than the amount of money available to spend on it. To continue providing the same quality of care over the next five years, the government would need to spend 11.3% more than it did in 2018-2019.
  • With only a single year of funding guaranteed, it will be difficult, if not impossible, to plan to meet increasing demands in a sustainable manner for future years, meaning improvements to service quality are likely still a long way off.
  • In general, a consistent level of satisfaction has been reported by those who receive adult social care. Regardless, the perception of adult social care on the part of workers and the public continues to decline. This could in part be due to general dissatisfaction of the workforce. As a result of budget cuts, social care workers have had to do more with less in order to maintain the quality of the care they provide. Vacancy and turnover rates in adult social care jobs are high, and continue to rise.
  • There are substantial gaps in the government’s data pool surrounding social care. We don’t have a national picture for the extent of private funding in social care, waiting times for assessments, or what happens to adults who request but do not receive care.

It concludes:

  • These details paint a bleak picture for the future of adult social care in England. …any government will have to increase spending substantially to meet demand, we would urge parliamentary candidates to consider how their policy decisions can be better informed and evidenced.
  • Without these insights, any government will continue to fall into the crisis-cash-repeat cycle that has characterised politics for years. And it is the health and wellbeing of the most vulnerable members of society that will pay the price.

As I said, shaming and disgraceful. The Tories have a lot to answer for.

1 Affairs of State, 3 October 2019,

2 2019 Performance Tracker

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