New report highlights extent of care deserts

May 15, 2019

A new study commissioned by Age UK has highlighted the extent of 'care deserts' and the local lottery that now exists for people trying to secure residential care or care at home.

Care deserts are areas where there is literally no care to be had, even when older people can afford to pay, leaving significant sections of the population with potentially long distances to travel to get suitable care.

Incisive Health, an independent health consultancy, produced the report for the charity. Care deserts: the impact of a dysfunctional market in adult social care provision analyses the state of the market for care in England and shows what a desperately fragile state it is in, with vacancy rates rising and the number of hours of care provided falling by three million over the last three years – even though demand has continued to rise.

In some areas a lack of staff, especially nurses, is severely limiting the care that providers are able to offer. Incisive Health found that despite a slight rise in the total number of beds nationally over the last five years, some areas, such as Hull, have lost more than a third of their nursing home beds in the last three years.

In its report, Incisive Health states that, 'There are some parts of the country where there are no longer providers available to deliver nursing home services'. Given the inherent vulnerability of the older people who need a place in a care home with nursing, this is a deeply worrying state of affairs, says Age UK, noting that this situation must also be piling pressure on the NHS.

Incisive Health states in its care deserts report, 'In 2017, the Competition and Markets Authority (CMA) argued that the market-based approach to social care was unsustainable without additional public sector funding. Based on our findings, we can go further: the current model has broken down in some areas of the country and is no longer capable of delivering care to people in need. Immediate action is needed to stabilise the system and set it on the course to delivering sustainable care in the long-term.'

As part of the project, Incisive Health looked in-depth at certain regions (Hull, Norfolk, Totnes, Guildford and Leicester) to understand more about local factors and how they help shape the market for care. The research found that:

  • In some areas of the country, such as Hull, capacity is insufficient to meet demand, with high occupancy rates and high levels of informal caring.
  • In areas such as Guildford, there is a good number and spread of services, a possible reflection of the high numbers of self-funders in the South East supporting a more functional market. However vacancy rates and reliance on overseas workers is much higher, and therefore local capacity is very vulnerable to changes in local labour market conditions.
  • In the South West, the distribution of services appears to be a challenge, with limited capacity outside of major urban centres.
  • In Norfolk, indications suggest capacity is more evenly distributed but still thinly spread, impacting on choice, with some areas left with only services rated Inadequate.
  • Overall in the South East, workforce vacancies are a particular issue which, combined with the high numbers of EU staff in the social care workforce, suggests a serious risk of Brexit-related disruption to services.

Care deserts: the impact of a dysfunctional market in adult social care provision also found that 41% of older people living in residential care are now self-funders. The proportion varies, from 18% in the North East to 54% in the South East.

Caroline Abrahams, Charity Director at Age UK said, 'This new report shows how chaotic and broken the market for care has become after years of under-funding and the absence of determined Government action to ensure the right workforce is in place. The end result is laid bare by the authors – the emergence of care deserts and a deeply worrying lack of nursing home places, in particular, leaving some of our most vulnerable older people high and dry. It would be hard to exaggerate how serious the implications of this report are for older people, or indeed for the NHS, which is the place of last resort if no nursing home places are to be had.

'The report shows what an impossible position local authorities are in; they are supposed to ‘manage’ their local care market, but they lack the levers to do so and the big drivers of the problems in the care industry are way beyond their control. Meanwhile, they are desperately short of money to purchase care home places for older people in need, so more and more of the financial burden is being shifted onto those older people who fund their own care, who are paying through the nose to keep the system afloat. This is deeply unfair.'

Julie Ogley, President of the Association of Directors of Adult Social Services, responded to the report saying, 'We need a vibrant care market which gives people choice and control over their lives. As this report demonstrates, the market is becoming increasingly fragile and failing in some parts of the country.

'In our budget survey last year, nearly a third of adult social care directors said they have seen care home providers closing or ceasing to trade over a six-month period, affecting 3,290 people, and almost as many had seen contracts handed back, impacting on 2,679 people. Nearly 80 per cent of our members said that they are concerned about their ability to meet their statutory duty to ensure market sustainability within their existing budgets.

'The majority of social care is provided by small and medium sized enterprises. We have previously raised concerns about the lack of clarity and transparency of some of the larger care providers on who controls the purse strings and makes the decisions about expenditure.

'What is desperately needed from government is a long-term, sustainable funding solution for adult social care, which would also help to recruit and retain our valued and skilled 1.5 million strong workforce.'

Kieran Lucia, Account Director at Incisive Health has also commented, saying, 'The social care system is broken. Despite the best efforts of the dedicated social care workforce, years of political inaction and budget cuts to local authorities have resulted in a system that is no longer capable of delivering care to everyone who needs it.

'Urgent action is needed to stabilise the system and set it on the course to delivering sustainable care in the long-term. The green paper cannot come soon enough.'

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