Birmingham researchers warn of impact of ‘lost decade’ in adult social care

Urgent reform of the funding of UK adult social care is needed to save a desperately overstretched system which has now reached breaking point, warn policy experts at the University of Birmingham.

The crisis is partly the result of a ‘lost decade’ in which policymakers systematically failed to act on alarms raised back in 2010, say the researchers in a hard-hitting report published in the Journal of Social Policy.

In what is described as “the first analysis of its kind to present policy makers with different scenarios for adult social care funding and reform, to view these in practice (by comparing them to nearly a decade of policy) and to set out the relationship between future economic growth and the provision of sustainable adult social care”, the team, led by Professor Jon Glasby in the School of Social Policy, asserts that without swift Government intervention, the adult social care system could quickly become unsustainable. The 2020 update was funded by the Economic and Social Research Council part of UK Research and Innovation,  as part of the research titled “Sustainable Care: connecting people and systems, 2017-21”, led by the University of Sheffield’s Professor Sue Yeandle.

The article draws on and updates a 2010 review of the reform and costs of adult social care – commissioned by Downing Street and the UK Department of Health – which concluded the system was widely recognised as “broken” and that, with no action, the costs of adult social care could double within two decades. Moreover, this would be the case for current services and approaches (which had already been strongly criticised for failing to fully and appropriately meet need), leading to significantly higher costs with no improvement.

Jon Glasby, lead author of the report and Professor of Health and Social Care at the University of Birmingham, said:  “Our research has explored the future reform and costs of adult social care, and the high cost of inaction.  In 2010, we were adamant that doing nothing was not an option.  Our 2020 update shows that, without swift Government intervention, the adult social care system could quickly become unsustainable.  Even though this research was carried out before the start of the COVID-19 pandemic, urgent action is likely to be even more pressing in the current context.”

Not only were these warnings not heeded – but the situation has since got worse.  Adult social care has always been organised differently and funded less generously than health care, and has faced a combination of pressures caused by demographic change, increased costs, and rising need,  compounded by cuts to public expenditure. Ambitious plans for a ‘National Care Service’ were not implemented, while the austerity agenda led to a decade of spending cuts, service pressures, and a growing sense of crisis. Predictably, the result has been greater unmet/under-met need, more self-funding, lower quality care, a crisis among care providers, and much greater pressure on staff, families and partner agencies.  Cuts have also fallen heaviest on older people, with services for working age people less affected.  Despite the legitimate needs of other groups, it is hard to interpret this other than as (at least in part) the product of ageist attitudes and assumptions about the role and needs of older people.

While the situation is urgent, the human misery caused by this ‘lost decade’ is not as visible as financial pressures on more prominent, popular and better understood services, such as hospitals or schools:

“When social care for older people is cut to the bone, lives are blighted, distress and pressure increase, and the resilience of individuals and their families is ground down”, says the paper. “Yet this happens slowly – day by day, week by week, and month by month. It is not sudden, dramatic or hi-tech in the way a crisis in an A&E department may be, and tends to attract less media, political and popular attention…  With yet more urgency than in 2010 we warn: Doing nothing is NOT an option.”

The article is published by the Journal of Social Policy, and is entitled ‘A lost decade?  A renewed case for adult social care reform in England’, by Jon Glasby, Yanan Zhang, Matthew Bennett and Patrick Hall (all at the University of Birmingham.)