Timebomb of care for the elderly?
When it comes to how we are going to care for the elderly in the not-too-distant future, the figures look worrying indeed. Within the next five years, it is forecast that Shropshire will need 5,131 care-home beds to meet the predicted growth in demand. And it is also forecast that in five year's time, there will be just 4,377 care-home beds available in the county, leaving a shortfall of 754 beds.
A new report by consumer organisation Which? poses some rather difficult questions about how we are going to care for the elderly in the very near future. It shows that of 150 local authorities in England, only 20 are on track to meet the required number of care home places. So where are these people going to go?
"I think we are going to have to look at different ways of caring for the elderly in future," says David Coull, chief executive of Shrewsbury-based Coverage Care. Mr Coull says the figures need to be treated with a degree of caution, pointing out that in years to come we will see an increasing number of people being cared for in their own homes. But he says until something is done to address the Cinderella-like status of the care sector, compared to the politically-charged NHS, then the issue of coping with our rapidly ageing population is not going to go away.
According to the Which? investigation, there are 3,296 care home beds in the Shropshire Council area at the moment, and 1,009 in Telford & Wrekin.
However, to cope with growing demand, it has been forecast that an extra 219 beds will need to be found in Telford by 2022, and an extra 607 in Shropshire. Which? says at just to maintain provision at the present level, an extra 219 beds will be needed in Telford, and a further 607 in Telford. But the Which? study says there is little chance of the care system being able to cope with the extra demands, with only an extra 72 beds forecast for Telford – creating a shortfall of 15 per cent – and with no extra provision at all expected in the rest of the county, creating a shortfall of 18 per cent.
Shropshire is by no means the worst part of the country in this respect – the same study forecast a 53 per cent shortfall in Bracknell Forest, Berkshire – but the rural nature of the county, coupled with an ageing demographic does create problems. The study identifies Telford & Wrekin as one of six local local authorities which are expected to see an increase of 20 per cent or more in the number of residents over the age of 80 over the next five years.
This will inevitably have a knock-on effect for the NHS. A study by experts at Oxford, Liverpool, York and Glasgow universities warned that the delayed discharge of patients – who are forced to remain in hospital after treatment because of a shortage of suitable care – was causing up to 8,000 deaths a year. The research team said that operations were being delayed for weeks on end because beds were taken by people who were fit to be discharged.
Mr Coull, whose not-for-profit organisation provides both care homes and services where elderly people are looked after in their own houses, says looking purely at the number of beds does not give the full picture, but he says there is a real problem.
"We should be looking more at the number of staff rather than the number of beds," he says, saying in many cases it is far better that patients are cared for in their own home. But he says there is a shortage of care homes in some of the more remote parts of the county, where ever-more-stringent requirements from the Care Quality Commission have forced some of the small, family-run care homes out of business.
"You are not going to get the big boys, the likes of Barchester, Four Seasons or Bupa in the rural areas, such as south Shropshire," he says.
"You might well get them in Telford or Shrewsbury, but how can you justify spending £6-8 million in one of the more remote parts of the county?"
Perhaps as one might expect, local government says a shortage of funding is at the centre of the problem.
Councillor Izzi Seccombe, of the Local Government Association, says: “While the £2 billion announced in the spring budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3 billion funding gap by 2020."
She says councils need to be given more flexibility in how they can spend the additional funding in the places where they feel it will be most effective.
Councillor Paul Watling, cabinet member responsible for adult are at Telford & Wrekin Council, says the authority is planning for an increase in the number of places required.
"However the extra pressure this will place on our budget is very clear," he says. "That is why we must continue to lobby the government for fair funding. Telford & Wrekin faces this issue because of the unique nature of our population, which as a former new town, is now ageing.”
Mr Coull agrees that cuts to local authority funding have made a major impact, and says that the care sector always comes second to the NHS when it comes to funding.
And he also says the NHS is viewed as an unattractive client by private care providers, notorious for haggling over bills and paying its bills late.
He says treating the care sector as the poor relation to the NHS is short-sighted, as spending a little more on social care could save the health service millions.
"A bed in an NHS hospital costs something like £2,800 a week," he says.
"In a care home, you might think that paying a £1,000 sounds like a lot of money, but that includes round-the-clock nursing care.
"If you stay in a hotel chain that's going to cost you £500, and the only care that will include is somebody selling you coffee."
Councillor Seccombe says it is crucial that the Government makes an announcement in the autumn budget about how it plans to tackle the problem.
"It's absolutely critical that the Government works with local government leaders in delivering a long-term sustainable solution for social care," she says.
"To tackle the problems we face tomorrow, we must start planning today.
“This must address the issue of long-term funding, but it must also create the conditions necessary to ensure the development of the right kind of care and support services, that can meet the demand of an increasing number of adults with care needs.”
Probably few in local government will disagree, but Theresa May – if she is still Prime Minister by that time – will doubtless be chastened by her last attempt to address the issue in the Conservative Party's ill-fated election manifesto. Funding the burgeoning demand for social care in an ageing population is a potato which successive governments have found too hot to handle, but it is one which will inevitably come to a head one day.
As David Coull points out, it is one thing to announce record funding for the NHS. But it won't achieve the desired results if ends up being spent on keeping people in hospital who really should be at home.