The Census and the Future of Adult Social Care

In the News

The importance of this demographic data has not been lost on those with an interest in adult social care. Speaking to the Financial Times, Charlie McCurdy, Economist at the Resolution Foundation stated that these new demographic figures and the ageing population “will have huge implications for both local and national economics, and politics”. Meanwhile, Professor Sarah Harper of Oxford University brought up the point of the growing workforce needs in rural areas, highlighting the need “to encourage more workers to move to those areas to provide the future health and social care workforce”.

The quality… of care services could be further worsened

Professor Sarah Harper is well-practised in assessing what an ageing population might mean. In 2016, she chaired the Lead Expert Group for the Government Office for Science’s report Future of an Ageing Population. One of the report’s key findings included the prediction that, as well as added pressure to existing health and care systems, the number of people requiring unpaid care would have increased by more than a million in the period 2007 to 2032.

This month, a report by the County Councils Network (CCN) shows that prediction may have been conservative, revealing that the elderly population of county and rural areas has already risen by that figure since the 2011 census. Councillor Martin Tett, the CCN’s adult social care spokesperson believes that while people living longer is to be welcomed, this growth in over 65s in rural areas “will have a significant impact on adult social care” and that without changes to funding and how money for adult social care is distributed, “the quality and accessibility of care services could be further worsened.”

The political consequences of this have already been debated on both sides of the political spectrum. Labour’s former Executive Director of Policy Andrew Fisher wrote in The i that politicians have ignored this long-term trend, resulting in increasing pensioner poverty while potentially requiring us to start paying more into our pensions. Pensions is something Conservative peer and former Shadow Pensions Secretary Lord Willets agrees will need examination, with the pensions age potentially having to increase.

Interview 

This month, Professor Jill Manthorpe CBE of King's College London emphasises that the growth in older people is not something to see as problematic. What is, however, is the lack of work done to respond to existing issues in the sector such as the workforce.

What, from an adult social care perspective, was the key takeaway from the census data?

The census data has revealed that across England and Wales, more than one in six people (18.4%) were aged 65 years and over on Census Day in 2021. This is a higher percentage than ever before. The rise in numbers of older people is steady with smaller rises in the number of other age groups. While there has been an increase of 20.1% in people aged 65 years and over since the last census, there has been an increase of 3.6% in people aged 15 to 64 years, and an increase of 5.0% in children aged under 15 years. One of the offers from the Office for National Statistics on the early data is an ability to look at a particular local authority area and see it in relation to all the others. So a key takeaway messages is the need to look at the differences in numbers between local authority areas as well as the overall growth in the numbers of older people amid a growing population.

Furthermore, at national level, life expectancy for men between 2018 and 2020 was highest in England (79.4 years) and lowest in Scotland (76.8 years) (differences for women are less marked). Within England, there remain substantial regional differences notably a three-year gap between the North East (77.6 years) and the South East (80.6 years).

These inequalities are often forgotten when talking of growing numbers of older people. For adult social care the numbers matter, often at this local and regional level, and are probably not a great surprise. It is perhaps the rest of society and policy makers in other arenas that still need to address the implications of an ageing society.

Will the adult social care sector be able to cope if the current rate of growth in the elderly population continues?

This is an interesting question as it presumes that the adult social care sector is coping at the moment and assumes that older people are the main ‘demand-side’. As the newspapers have been reporting on the coping ability of the sector at the moment in some detail – mainly pointing to problems in coping as they affect the NHS – I will leave this point to one side and talk about the need to acknowledge that older people are only part of the ‘demand-side’; a great deal of adult social care expenditure is on support and care for younger adults (acknowledging that family care plays a massive role in care for all groups).

Growth in the numbers of older people is to be celebrated – they or we are not a regret or a problem. Most do not have any need for social care and indeed are providing it to their friends and family. What we need to address are preventable needs for social care and the vast inequalities in health and wellbeing that mean some older people do not live well in old age. Seeing older people as ‘the problem’ is unhelpful and ageist.

The sector is set to receive £5.4 billion in extra funding over the next three years from the health and social care levy. Is that increase enough to help the sector meet current demand, let alone future demand?

At the present time, the future of the Health and Social Care Levy is rather in dispute but if we are to look at the proposals of the December 2021 White Paper People at the Heart of Care, there are welcome announcements of plans and commitments around training and development for social care staff.

However, the high vacancy levels, substantial turnover of staff and loss of continuity of care for people with care and support needs all need to be addressed now. Funding related to pay, terms and conditions would help as would a workforce strategy for adult social care.

The House of Commons Health and Care Select Committee has just reported on Workforce: recruitment, training and retention in health and social care and I had the privilege of being an advisor to its standing panel of experts. Naturally, I would commend a read of this report and recommendations. We sifted through a huge amount of evidence and heard from both care providers and people with care and support needs. They were very worried about the future.

Given current issues relating to staffing in the sector, what steps are necessary to ensure that there is sufficient staffing to cope with the expected increase in demand?

Skills for Care has just published its annual overview of staffing in the social care sector, The size and structure of the adult social care sector and workforce in England, with a very disturbing finding that the number of filled posts in adult social care is down for the first time on record, while vacancy levels are rising. This is not good.

It is not that demand for social care is declining more that the sector is not able to make up for the numbers of staff leaving, despite its many and varied efforts at recruitment. These include taking up of almost every suggestion made – incentives to join the sector, publicity, offers of flexible working, and international recruitment of care workers and nurses.  

So ‘necessary steps’ to get sufficient staff will have to be different in size and scale. This explains the chorus of calls for a national workforce strategy to shape workforce planning now and in the long-term. Such a strategy will have to link with NHS plans of course as there seems no point in the two not ‘speaking to each other’ and access to training in the same way as training is offered to NHS staff would be one step – shared if possible.

Sajid Javid called the Health and Care Act the most significant change to the system in a decade. In light of this population growth, is the Act, along with its changes, already out of date?

In a June 2022 (how long ago that all sounds) speech to NHS Confederation the previous Secretary of State for Health and Care, Rt Hon Sajid Javid MP referred to the many changes underway or being developed: a digital health and care plan; a health disparities White Paper; 10-year Plans on cancer, dementia and mental health; a reset of the NHS Long Term Plan; and a Health Education England Workforce (for regulated professionals alone) Framework followed by the NHS’s first 15-year workforce strategy.

Meanwhile the Health and Care Act 2022 is now on the statute book and we will have to see how its changes are shaping up and relate to all the other activities. One good explanation of the new Act’s many provisions is provided by The King’s Fund and I, probably like many people, will be consulting this guide to check on developments and definitions (such as working out what is a place, a neighbourhood, an ICS Board and ICS Partnership Board).

Drawing together the questions posed above, the ambitions of the new Act that care should improve for people with multiple long-term conditions because of greater abilities to collaborate are clearly relevant to older people. In this way the Act is not out of date by any means.

Opinion

This month, Baroness Andrews, Chair of the House of Lords Adult Social Care Committee, outlines how our social care system is already at full stretch, and that failure to act on the findings of the census is a dangerous move.

Reasons to be cheerful! We are living longer than any generation has ever lived. According to the UK census, more people than ever before are in the older age groups, with 11.1 million people in 2021 aged 65 years and over, up from 9.2 million in 2011.

Unquestionably, such an achievement in our lifetime is something to celebrate. But over the past few months, the House of Lords Adult Social Care Committee, which I chair, has been preoccupied with a challenging question: if the social care system is struggling to cope with current demand, how will it ever be able to face the expanding number of older adults, many of whom will be living with complex needs?

In recent years, reduced budgets for adult social care combined with increasing demand and ultimately, a global pandemic, have created a perfect storm for the sector. Those most affected by these difficulties are, of course, disabled and older people, as well as their friends and families – often described as the ‘hidden army’ of ‘unpaid carers’.

Whatever age we are, we want to be able to decide for ourselves the sort of relationship we have with our relatives and friends. It seems like such a basic principle. But for those who have care needs, this no longer seems to be the case.

With social care resources so stretched, many disabled and older people have to rely on care and support from parents, children, siblings, neighbours, wives or husbands. Bound by ties of love and obligation, they are often left no choice but to become an ‘unpaid carer’. At home, often in isolation, they are the invisible web of love and support that shores up the entire social care system.   

Those who gave evidence to our Committee, told us with great dignity of their poverty, their mental and physical distress, their lost homes, jobs and careers. They speak for many. 

Most of them said that they find joy and fulfilment in providing care for their loved ones; but they also felt ignored, alienated, and stripped of any choice or control over their own lives.

The greatest danger to our social care system is to do nothing. Recognising and rewarding unpaid carers makes economic as well as human sense. They are part of the solution. Let us make sure they can play that part with dignity and respect.