New figures released by Age UK today reveal a ‘double whammy’ of cuts to social care and health services that support older people in the community, and the hugely damaging consequences for them, for our hospitals and for the taxpayer too.
Over the past 10 years, spending on social care services for older people has plummeted by a third (34.2 per cent) from £8.1bn in 2005/6[i] to £5.46bn in 2014/15[ii],. Community care services have been hardest hit with a huge drop of 24.9 per cent (£560m) since 2010/11 alone[iii],[iv].These figures include transfers from the NHS to social care.
Within spending on the NHS, hospitals have taken a much bigger slice of the cake than primary and community care: between 2009 and 2014 the number of GPs rose by 19.9 per cent from 33,564 to 40,236, whereas over the same period the number of hospital based doctors rose by a greater percentage (41 per cent) from 76,400 to 107,813[v].
In addition, there has been a sharp drop in the number of community nurses who help keep older people out of hospital. Between 2009 and 2014[vi] the numbers of:
- district nurses plunged by 27.5 per cent (from 7,851 to 5,690)
- community matrons dropped by 17.1 per cent (1,552 to 1,287)
- nurse consultants in the community fell by 40.4 per cent (from 235 to 140)
Taken together, this means that at a time when the size of the older population is growing at an increasing rate[vii], our system for keeping them fit and well at home has become much weaker.
Between 2007/08 and 2013/14 the numbers of people aged 65 and over attending A&E rose by 66 per cent from 2,642,939[viii] to 4,378,459[ix] and the numbers of people aged 75 and over between 2005/06 and 2011/12 readmitted to hospital within 28 days rose by 34.4 per cent from 152,287 to 204,709[x].
Caroline Abrahams, Charity Director at Age UK said:
“Older people are being hit by a ‘double whammy’ of cuts to the community health and social care services many depend on to retain their independence. Far too often frail older people are without the help they need to stay well at home and end up having to go A&E instead. Others find themselves stranded in hospital because there aren’t enough social care and community health services to allow them to be safely discharged.
“But it doesn’t have to be like this. The solution is more investment in primary and community healthcare, and in social care, and we call on the Chancellor to commit to this in his Budget. A stronger system of community based health and social care would be good for older people, would enable our hospitals to work more effectively and would help the taxpayer too.”
 Due to an audit of the revenue expenditure and financing data, it is not possible to apportion all spend to older people’s social care as possible previously. For example, ‘social care activities’ which accounts for £1.6 billion is now not allocated by age and is therefore discounted from the totals as it includes spend on younger adult’s social care.
[i] Health and Social Care Information Centre (2007); “Personal Social Services Expenditure and Unit Costs, England, 2005/06,” – http://www.hscic.gov.uk/catalogue/PUB00533/per-soc-serv-exp-unit-cost-eng-2005-06-tab-v1.xls
[ii] Department for Communities and Local Government (2014); “Revenue Account (RA) budget 2014 to 2015,” – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/365591/RA_2014-15_data_by_LA_-_Nat_Stats_Release_-_Revised_22-Oct-2014.xls
[iii] Health and Social Care Information Centre (2012); “Personal Social Services Expenditure and Unit Costs – 2010-11, Final release,” – http://www.hscic.gov.uk/catalogue/PUB05794/pers-soci-serv-expe-unit-cost-10-11-deta.xls
[iv] Health and Social Care Information Centre (2014); “Personal Social Services Expenditure and Unit Costs, England – 2010-11, Final release,” – http://www.hscic.gov.uk/catalogue/PUB16111/pss-exp-eng-13-14-fin-nat-exp.xlsx
[v] Health and Social Care Information Centre (2015); “NHS Workforce Statistics – November 2014, Provisional statistics,” –http://www.hscic.gov.uk/searchcatalogue?productid=17324&topics=1%2fWorkforce%2fStaff+numbers&sort=Relevance&size=10&page=1#top
[vi] Health and Social Care Information Centre (2015); “NHS Workforce Statistics – November 2014, Provisional statistics,” –http://www.hscic.gov.uk/searchcatalogue?productid=17324&topics=1%2fWorkforce%2fStaff+numbers&sort=Relevance&size=10&page=1#top
[vii] Office for National Statistics (2013); “Principal Projection – England Population Single Year of Age, 2012-based,” – http://www.ons.gov.uk/ons/rel/npp/national-population-projections/2012-based-projections/rft-table-a3-4-principal-projection—england-population-single-year-of-age.xls
[viii] Health and Social Care Information Centre (2009); “Accident and Emergency Attendances in England – 2007/08,” – http://www.hscic.gov.uk/catalogue/PUB02535/acci-emer-atte-eng-2007-2008-tab.xls
[ix] Health and Social Care Information Centre (2015); “Accident and Emergency Attendances in England – 2013/14,” – http://www.hscic.gov.uk/catalogue/PUB16728/acci-emer-atte-eng-2013-14-data.xlsx
[x] Health and Social Care Information Centre (2013); “Indicator Portal: Emergency readmissions to hospital within 28 days of discharge: indirectly standardised percent, 75+ years, annual trend, P,” – https://indicators.ic.nhs.uk/download/NCHOD/Data/03N_523ISP4DP_12_V1_D.xls
As well as providing nursing care, community matrons act as case managers. They are a single point of contact for care, support or advice, typically for a caseload of around 50 very high intensity users.
As well as providing direct patient care, district nurses also have a teaching and support role, working with patients to enable them to care for themselves or with family members teaching them how to give care to their relatives. They are also accountable for their own patient caseloads.
The nurse consultants are effectively senior specialists, but the fact there’s less in the community is significant. Nurse consultants roles are very different and are created based on the health needs of the local community”.