Long term care is in crisis. There is no longer any doubt – the failures within the system are becoming increasingly apparent. Long-term care is one of the only major areas of public policy untouched by the present Government and in 2007 that must change: it is not an issue that will go away if ignored. As Ivan Lewis MP, Minister for Care, said at our Age Agenda Conference in March 2007 - “The status quo is not an option”.

The acceptance of the need for a debate by the government comes as a consequence of overwhelming evidence of the extent of the problems in the system. On 26 March, it was 12 months since Sir Derek Wanless published his 2006 seminal King’s Fund report on long term care “Securing Good Care for Older People: Taking a long-term view” . He outlined the problems in the system. The initial proposal – known as Scenario 1 – states that the Government needs to put billions of pounds of extra funding into the long-term care system simply to maintain current standards and levels of care. He suggests that total costs would need to rise from £10.1 billion in 2002 to £24 billion in 2026. This scenario must be seen as a short term option – if only because the standard of care is already too low. This year the Government did not put extra money into the care system and we have all seen the dramatic effects.

Local Authorities all over the country have tightened service eligibility criteria, increased charges to older people or reduced services. For example, Staffordshire is closing 22 care homes and Cumbria is increasing day centre charges from £3.30 to £13.30 – and no doubt next year they will cut day centres because no one will be able to afford to use them. The worst example has to be Lambeth – they are tightening eligibility criteria from substantial to critical needs and then charge £35 a day to access day centres. We are appalled that a Local Authority could even consider taking such steps.

Local government, it has to be said, is not completely at fault. Firstly, it is under immense pressures to find efficiency savings – and the large amount of money going to older people in social services budgets is not ring-fenced. However, councils have not helped themselves. Hammersmith and Fulham London Borough Council, for example, has cut council tax, but massively increased charges and cut services. More fundamentally, by not providing a hand rail on stairs, or community services to keep older people active, or sufficient care at home, you are increasing the likelihood of people to ending up in care homes more quickly than would otherwise be necessary. The human cost is dramatic – older people want to stay at home- but so are the financial costs. Falling over for want of a hand rail costs the public purse tens of thousands of pounds.

Secondly, the older population is increasing and people with high needs are being dealt with. The biggest impact will be felt most when the baby boomers now in their 50s or early 60s start becoming 70. Some of the effects of the demographic pressures are already starting to be felt because people are living much longer than ever before. The number of people with dementia alone is expected to more than double in the coming decade. However, local government cannot point to this as a primary cause: the amount of older people assisted by the social care system has fallen over the least few years.

Thirdly the NHS is passing on care that should be their responsibility. Two thirds of council chiefs said that NHS cuts in their area was hitting social care. They have a point – “cost shunting” does happen and there is no doubt that the behaviour of the NHS is affecting social care. For example, we think there are about 75,000 people in the UK missing out on continuing care. This is funded by the NHS – but instead the people affected become self-funders, or their nursing home care is funded in by social services.

The NHS Confederation disagrees. In response to the latest cost shunting allegation by the Local Government Association (LGA), the Confederation replied: “It is frustrating… that the LGA at a national level has accused NHS organisations of cost-shunting - inevitably when there are two parties involved there is always another side to the story.” However the person in the middle is often a vulnerable older person. Essentially, the NHS argument is that local government is reducing the services it supplies – and in turn more people end up requiring NHS support. Long term care is taking Catch 22 to the next level.

The cutting back of services in the last couple of months is important – but does not show the failures across the system. A key issue is misplaced incentives: at present there are no real incentives for anyone to act in a long term way. The NHS and social services are failing to deliver anywhere near enough preventative care – this increases the costs for the public purse, whether forcing people into hospitals or care homes. It also – and this is to often forgotten – prevents many older people leading richer lives.

Older people themselves are not prepared for the costs and choices they may face. In part, the unrealistic expectations older people hold of their “from the cradle to the grave” care – is as a result of the failure to build a sustainable policy. The last British Social Attitudes survey showed that the public do not intend to save for care costs and do not want to sell their homes. The first attitude is not good for the system, the second is unrealistic.

The quality of services is also too low. For those in care homes, Local Authorities are putting too little money into paying for their care. This means that self-funders and relatives are subsidising the care of others, and that staff are inadequately paid and the quality of service ends up being substandard – even when the care home and staff are well intentioned. It is a similar picture for care workers visiting people’s homes: poor pay, not enough time to deliver the appropriate care and little support means that they are unable to deliver the quality and quantity of services that older people need.

Funding of long term care is not an issue that will go away if it is ignored. In fact, the opposite is true. It will be an increasingly serious issue for the Government, not least because of the huge projected increases in the number of people living until they are very old. The number of people with dementia alone is expected to more than double, in the coming decade

Future of care

It’s time to take a fresh look at this issue. The Government should lead a policy conversation into the values and principles most of us accept as important and help us all to understand what are the key issues and questions that we must face as individuals and a nation. It must not just allow the strongest voices to dominate the debate.

Sir Derek Wanless outlined more ambitious scenarios, but also new methods of funding care. We must also learn the lesson from the NHS: we need to reform and then invest. We need to look at the level of care we provide; the incentives built into the system; and who will pay and how. Only then can we substantially increase the money to improve the quality of services.

The conversation – or debate – on long term care is critical. At present, relatively few people know at first hand just what a mess we have drifted into. As our population ages, more and more people will be confronted with this uncomfortable truth. You can see the anxiety already. Now is the time to discuss honestly and openly about making the system work for all.