'Means test gets meaner' in England as 120,000 more seek social care but 14,000 fewer get it

Some 120,000 more people asked for social care but around 14,000 fewer people received it in England between 2015/16 and 2019/20, as the ‘means test continued to get meaner’, according to the think tank The Kings Fund.

The King’s Fund’s annual Social Care 360 report, based on 2019/20 data, shows a sector in ‘deep decline’ with more people requesting support but fewer getting the help they need.

Social care operates a financial assessment (means test) to decide who is eligible for publicly funded care but the means test has got 'meaner' because thresholds were not rising in line with inflation, the report reveals.

“Following a decade of neglect, there is a continuing gulf between what people need and what they receive,” says lead author Simon Bottery, Senior Fellow at The King’s Fund.

“The latest data paints a bleak picture with few causes for optimism. Even where measures have improved, there are often caveats. Demand is likely to go on increasing but local authorities do not have the money to meet it."

The means test ‘upper threshold’ (which decides the level of savings and other assets people can have and still qualify to receive publicly funded care) has not changed since 2010/11 and remained at £23,250 in 2020/21.

When inflation is taken into account, the threshold in fact went down, so fewer people were eligible for publicly funded care.

If the social care means test threshold had kept pace with inflation it would be £5,995 higher at nearly £30,000, than it currently is, so more people would qualify for support.

The King's Fund report warned: ‘By not increasing the threshold in line with inflation, successive governments have made the means test even meaner: it has become harder for people to get publicly funded social care, reducing its cost to the taxpayer.'

The Minimum Income Guarantee has also not increased in line with inflation and this means adults with disabilities can be charged more for care at home.

Satisfaction has fallen

User satisfaction with publicly funded care has also fallen and less people are using direct payments, suggesting a fall in the personalisation of care.

Direct payments allow people using care services more choice and control over their own support but for the third year in a row, fewer people are using direct payments.

The number of people using direct payments fell from 126,000 in 2018/19 to 123,000 in 2019/20.

Think Local, Act Personal, a partnership of over 50 organisations focused on transforming care through personalisation and community-based support, has said: ‘People’s experience suggests that the law has not been implemented as originally envisaged, and the full benefits of direct payments have not been realised.’

Local authority spending on social care has finally returned to the levels of 2010/11, but not if you take population growth into account - spending per person has fallen. Care worker pay has improved but is not rising as fast as other sectors resulting in social care job vacancies remaining high.

The King’s Fund stated: 'We expect Covid-19 to make the situation worse. Demand will increase but receipt of care will, likely, not. Costs will go up but expenditure is unlikely to keep pace.’

People can now earn more working in supermarkets and cleaning than as care workers. Average care worker pay in the independent sector in 2019/20 was £8.50 an hour, an increase of 3 per cent in real terms since 2018/19.

The report also revealed that compared to the size of the older population, the number of nursing home and care home beds has consistently fallen over the past nine years.

To halt the decline in social care, the report recommends:

More money

The Health Foundation estimates that an extra £1.9 billion will be needed to meet demand for adult social care by 2023/24, and funding is also needed for existing unmet need and to improve the quality of services. More funding is also required to cover the extra costs of Covid-19, to support the provider market, fill vacancies and pay staff a fairer wage.

Improving eligibility

Eligibility should be widened so more people are entitled to support.

Workforce reform

Workforce reform is essential to deliver better pay, training and development to compete with other sectors and deliver the care needed.

More choice and control over care

People need more control over the care services they use, with government action needed to increase the number and quality of direct payments and support other ways of promoting choice and control.

More focus on prevention

Prevention should take centre stage for local authorities and national government with more investment in services such as reablement.

Urgent attention on carer support

As formal services closed during the pandemic, carers took on more support. A new settlement for them must be part of reform to give them more support.

The Social Care 360 report adds to mounting pressure on Boris Johnson’s government to commit to social care reform in the Queen’s Speech on 11 May.

Simon Bottery added: "If we are to avoid reporting on a further bleak round of indicators in future years, we urgently need the long-term, wide-ranging reform for adult social care that the Prime Minister promised after the general election.”