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Chapter 1 - Background

At the same time, with more people living into old age - many with long-term,

multiple or complex conditions - the demand on health and social care services

is increasing exponentially. Aside from dedicated social care services for older

people, our elders make up a significant proportion of health service users:

• People over 65 account for 80 per cent of hospital admissions that involve stays

of more than two weeks, according to the King's Fund. And, as they go on to

say, the cost of their stay tends to incur greater costs: "Older people are more

likely to stay a long time in hospital, to be moved while there, to experience

delayed discharge, and to be readmitted within a month as an emergency".8

• People over 85 incur the biggest health and social care costs. They are not just

the fastest growing demographic group - the number of people over 85 has

doubled in the past three decades,9 but they are also those most in need of care

- where people under 65 use an average of 0.2 emergency bed days per year,

those over 85 use an average of five bed days per year (a ratio of 25 to one).10

• As the population grows older, ageing-related diseases, such as dementia

and Parkinson's disease, are becoming more common and people's needs

are more likely to span across the divide between health and social care.

The growth in the older population also coincides with huge spending pressures

on adult social care, despite councils' best efforts to protect budgets. Councils

spent £14.6 billion on adult social care in 2013/14 - 35 per cent of local

government spending.11 As one of the biggest service users, older people in

particular will be affected by the cuts. Over 65s currently account for 51 per

cent of local authority spending on adult social care.12 It has been estimated

that there has been a growing mismatch between demand and public funding

from at least 2005 and that by 2021, the spending gap on adult social care

will be between £7 billion and £9 billion.13

1.2 Government reforms

The difficulties that this report highlights are far from hidden and the Coalition

Government has taken significant steps to better integrate health and social

care services. Among the main policies introduced in this parliament are:

• The Health and Social Care Act 2012 radically redistributed the

national and local management of public health services, transferring

responsibilities for public health budgets to local authorities and

creating Health and Wellbeing Boards and Directors of Public

Health. This was driven by an attempt to make commissioning more

locally-driven and produce better health outcomes, more efficiently.

• After an extensive period of planning and preparation the £5.3bn

Better Care Fund (BCF) is due to go live in April 2015. The BCF aims

to create a single locally-pooled budget to incentivise the NHS and

local government to work more closely together to support hospital

discharges and prevent unnecessary emergency hospital admissions.

• The Care Act 2014 will be the biggest overhaul of social care since 1948.

Most significantly the Act will cap the amount people will have to pay

for care in their lifetime to £72,000 (although with accommodation and

food costs not included, it is estimated that only seven per cent of men

and less than 15 per cent of women will benefit from the cap14), and set

a national minimum eligibility threshold, with the intention of reducing

variation in access to care between different areas. Councils will also 8 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

9 Office for National Statistics,

Population ageing in the United

Kingdom, its constituent countries

and the European Union, (March


10 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

11 Local Government Association,

Care crisis will require councils

to divert £1 bn from other

services (January 2015)

12 Wiggins, K, "Social care

spend falls by 2%" LGC (19th

September 2013)

13 Demos, Commission on

residential care (2014)

14 Institute and Faculty of Actuaries,

How pensions can meet

consumer needs under the new

social care regime (May 2014) 99


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