1. Rapid Ageing: A Caring Future
Delivering social care in the UK
Ruthe Isden: Public Services Programme Manager, Age UK
9th May 2012

2. Summary
 Later life in the UK: who we care for now and in the future
 The social care system in the UK
 Funding and national framework
 Social care market and providers
 NHS and social care: two very different systems
 The big debates: personalisation, co-production,
prevention, integration and future funding

3. Later life in the UK
 There are 10.3 million people aged 65 or over in the UK
today
 There are 1.4 million people are aged 85 or over – the
people most likely to need care
 These numbers will grow significantly in the future as
people live longer and more people enter retirement

4. Looking ahead: Growth in numbers of
older people 2010-2030
0%
20%
40%
60%
80%
100%
65-69 70-74 75-79 80-84 85+
Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011

5. Health and care in later life
 4 million have a limiting longstanding illness, 40% of all
people aged 65+
 By 2030 there will be over 6 million with a long term
condition
 Over 820,000 people are estimated to be suffering from
late onset dementia in the UK in 2010
 By 2030 there will be over 1 million people with dementia
 1 in 2 people will require care in older age

6. Main causes of care and support needs
(all adults)
Humphries. R, The Kings Fund 2012

7. Who we care for and how: publicly
funded care
Humphries, R: Social Care and the NHS, The Kings Fund, 2011
Numbers of people
aged 65+ using
publicly funded social
care services 2004 –
2010
0
200
400
600
800
1000
1200
2007/8 2008/9 2009/10
Nursing home
Residential care
Community
based services

8. Growing demand for social care services
 Growing numbers of ‘the very old’ people aged over 80
BUT……
 Improvements in healthcare driving life expectancy and
better treatment of complex long term conditions that
require specialised care
 Smaller, more geographically disburse families
 More women in the workplace
 Changing attitudes and expectations – older people want
to be independent and self reliant

9. UK national framework
 Social care is a local government responsibility, they
decide what care to provide and how
 National government sets minimum standards and
criteria only
 Funding is largely provided by national government grant,
but it is not ring fenced
 Last year national government provided £7.3 billion in
funding, however some funding was drawn from the NHS
 National system of regulation for service providers –
mandatory registration with the Care Quality Commission

10. Using social care services in the UK
Anyone can approach
their local council and
ask for an assessment
of their needs
Everyone has to take
a means test and, if
they are eligible, the
council will charge
for services
A needs assessment is
completed by a social
worker or other health
professional
If someone falls within
the council criteria a care
plan will be produced
setting out what
support they need
People are assigned
a level of ‘need’ based
on the national criteria
The council will either
provide money (a direct
payment) or contract
services to meet
their needs

11. Eligibility tests – needs and means
 Needs test has four levels: low, moderate, substantial
and critical
 The test looks at routine household tasks (e.g. shopping,
cooking), personal care (e.g. bathing, dressing) and risk
of harm (e.g. falling)
 Means test measures both income and assets – if these
are above a certain level then an individual is required to
meet all or part of the costs of care.

12. Outside the state system
 Informal care – 6 million people (1 in 8) are ‘informal
carers’ looking after family members, partners or friends
 Private care market – many people pay for their own
care:
– 170,000 (about 41%) people pay their own care home
fees
– somewhere between 168,000-274,000 pay for their
own home care (difficult to estimate as many are
unknown to councils)

13. Social care market and providers
 Nearly 90% of formal care is provided by private or
charity sector organisations
 Part of deliberate policy aimed at developing a market in
care provision to:
– use competition to drive improvement in quality
– create greater diversity of types of services
– stimulate commercial investment in services
 Mixed results – many critics argue it has made services
more fragmented, less accountable and has not improved
quality

14. Care in crisis?
 Poor quality of care services with limited access to
specialist help
 Poor integration and care co-ordination
 ‘Geographical lottery’ – 82% of councils only support
people with substantial or critical needs
 Hard to access – 800,000 older people receive no formal
help
 High individual financial risk – many people risk losing all
their money before receiving help
 Poor support for carers – families find it difficult to get
help or information

15. NHS and social care: what’s the
difference?
NHS Social care
•Provides primary, secondary and
tertiary healthcare services
• Free at the point of need
• Comprehensive, universal
services
• Fully funded through general
taxation
• Locally commissioned, but within
a clear national system
• Fairly little local variation in
services provided
• Provides care in care homes, in
day facilities and in people’s home
• Means-tested and needs-tested at
point of need
• Local councils set local criteria
and commission care
• Far fewer national rules or
guide lines
• Huge geographical variation in
types of services, funding and
rules

16. The big themes: integration
‘ensuring social care, health and housing services operate
together efficiently and effectively’
 Key issues:
– care co-ordination and complementary points of entry
to maximise benefits
– professional integration – common culture and ways of
working
– systems working outside silos and sharing budgets
– shared vision and leadership across systems
 Failure to integrate = inefficient use of resources, poor
outcomes, crisis care and excess hospital admission

17. The big themes: personalisation
‘making social care services more responsive to individual
needs and giving people great choice and control’
 Key issues:
– recognising people as ‘experts’ in their lives and
condition – ‘individuals know best what they need’
– challenge ‘I know best’ professional culture and ‘gift’
model of care
– challenging the medical model of care
– providing of good information and advice
– making sure services are accountable to service users
 Big challenge in making personalisation work for older
people who may lack mental capacity or have rapidly
changing needs

18. The big themes: co-production and community
solutions
‘working in partnership with service users to design and
deliver services’
 Key issues:
– people not ‘passive consumers’ but able to contribute
to creating care and care relationships
– engaging service users, families and the community in
designing health and care services and economy
– building on community assets to find individual and
collective solutions
 Research demonstrates better, more cost-effective
outcomes

19. The big themes: prevention and early
intervention
‘seeking to prevent or delay the need for social care services
by maximising independence and health’
 Key issues:
– must change the way we think about and provide
health and care – otherwise demand for care services
in future may become unsustainable
– often huge, unexploited potential to improve health
and wellbeing through effective interventions
– early intervention – ‘a little bit of help’ – delivers huge
long term benefits by maintaining independence
– must remove barriers to people investing in prevention

20. Life expectancy and healthy life expectancy
65 70 75 80 85 90 95
Shortest
Average
Longest
Shortest
Average
Longest
Years
Years in good health Years not in good health
Males
Females

21. The big themes: future funding issues
 UK had a £500 million gap in funding 2010/11 – this is
growing every year
 Need to invest in prevention to improve cost-
effectiveness of system overall in future
 Getting the balance of spending right across older
people’s services – inadequate social care funding has
big impact on healthcare
 Individuals must contribute, but there needs to be a fair
way to manage and pool risk

22. Public spending on older people
2010/11
Social security
benefits
Social care
NHS
£0bn
£50bn
£100bn
£150bn
Dilnot et al: Conclusions and recommendations of the Commission on Funding of Care and Support, 2011

23. Social care reform in the UK
 ‘Dilnot system’
– Capping care costs to protect individual wealth and
pool risk
– Fairer means testing to protect people on lower
incomes
– New system to create a ‘national offer’ that is the
same in all areas
– Stronger role for the private insurance market
– Greater emphasis on community solutions and
personalisation

24. Key messages
 Care is increasingly a mixed economy with diverse
solutions including family, community and state
 Form must follow function
 Health and social care are two halves of a whole,
it is dangerous to invest in one and not the other
 Placing older people at the centre of creating care
is cost-effective and delivers better outcomes

25. Ruthe Isden
Public Services Programme Manager, Age UK
Contact:
By email: ruthe.isden@ageuk.org.uk
By phone: +44 203 033 1478
By post: Tavis House, 1-6 Tavistock Sq, London, WC1H9NA, UK