Adult Social Care and Unmet Needs

The UK social care system, which in its current form dates largely from the post- Second World War welfare state settlement, has both expanded hugely in recent decades, and by common consent is now dysfunctional in various respects. It is not without irony that Thorlby et al., (2018:3) pointed out that, whilst the 70th anniversary of the NHS was marked with much celebration, the same anniversary of social care passed largely unnoticed. The fault line established 70 years ago between health care which is provided by a national agency and free at the point of use and social care which is means-tested and provided by local government, remains a fundamental source of inequity and unfairness today.

These issues include the level of national funding and how that is determined, the allocation and availability of funding among social care authorities, the individual budget decisions and choices made by those authorities and the way decisions on funding and care packages are taken for individuals with social care needs. Two very important questions that arise from this dysfunctional system, are the extent to which the rights of individuals, for example under the Care Act 2014, are being respected and, if not, what is the level and urgency of tackling those unmet needs.

This report considers the academic and other material which has been produced in recent times to address these and related questions. It has been validated by the experience of the authors and contact with active professionals in the field, but is in essence a literature review. Further empirical work would be able to address in detail the problems in the national and local funding systems and the levels and types of unmet need, and consider the proposals which are being put forward currently to remedy these issues and identify those which have the greatest chance of success in terms of helping individuals in need.

This report was commissioned by Access Social Care with the following aim and objective in mind:

Aim
The overall aim of this review was to present a picture of levels of unmet need in relation to social care in England since 2008 to the present, so as to encapsulate austerity measures and the Care Act 2014.

Objective
The objective was to bring together academic analysis to gain a better understanding of unmet need, with a view to informing better decision making.

Main findings
• The number of people with a disability in the U.K. has continued to rise in recent years, and is now around 21% of the total population, or 14.1 million people
• There is also an increasing number of people with learning disabilities who
thanks to medical advances are now not only surviving childhood but living
much longer. Their needs will call for particular attention in coming years.
• The number of older, and oldest-old, people is also rising as it is in many countries. Currently there are over 703 million people over the age of 65 Between 2015 and 2030 there will be some 500 million more people over 60 in the world. In the U.K. the number of people over 85, when needs tend to
increase sharply, will double from 1.6 million by 2041.
• These changes and pressures on adult social care however have not been
matched in the last decade by increases in available resources or by clearly articulated and robustly modelled strategies for tackling these incipient challenges. Since 2010 the amount spent by councils first fell sharply and has since recovered slowly to near the same real times level, but during a decade when demand and needs have risen considerably. There is a broad consensus
across local authorities of all political stripes that social care is underfunded.
• The numbers of people receiving social care has fallen by 7% between
2015/16 and 2018/19.
• Unsurprisingly then, many studies identify large and increasing numbers of
people who are not receiving the social care they need and to which they may
well be entitled under the legislation.
• There is, though a dearth of studies that specifically look at unmet needs –
especially for people from BAME backgrounds and LGBT groups.
• ‘Need’ and ‘unmet’ need remain conceptually complex, with functional-based
approaches to measure it remaining the default. More qualitative accounts of what unmet need means for the everyday lives of people with disabilities are missing.
• Although actions are often discussed to remedy some of these identified problems there is no current plan or timetable for doing so.

Recommendations.
1. Immediateactionisneededtoaddressunderfundingofsocialcareespecially given the increased pressures COVID-19 has placed on the system.
2. Afullandempiricallysoundpictureofthelevelsandtypesofunmetneedfor social care.
3. Onthatbasisabetterandsharedunderstandingoftheresourceswhichwouldbe needed over time to move towards meeting those needs.
4. Analysisoftheimpactsofthoseresourceimplicationsforlocalgovernmentand the extent to which that is viable in the current system given their other responsibilities.