Social care crisis risks ‘two-tier’ blow to the poor, ministers warned

The growing crisis in adult social care risks creating a “system for the rich” that leaves poor communities unable to access the essential help they need, ministers are being warned.

Two care homes are closing for every new facility that opens as providers attempt to stay afloat amid a multibillion-pound shortfall in funding. However, evidence seen by the Observer suggests places are disappearing from care homes that already have a shortfall of beds, while new facilities are opening for those who can pay their own way.

Martin Green, chief executive of the social care trade body Care England, warned there was a real risk of a two-tier system emerging that would see the poorest suffer the most. “If you go to some places there are no new care homes being built and the stock available is running to the end of its life, or not fit for purpose,” he said. “It’s not just about capacity dwindling – there is nobody coming in those areas to replace them. It will be an attrition process. You end up with a social care system for the rich, and really poor experiences for the poor.

“There is a huge amount of external investment ready to go into this sector. But, of course, it’s all based on high-end, high-quality, self-funding clients. The challenge is to make sure social care is available to everybody.”

Uproar emerged last week over the impact new immigration rules could have on an already struggling sector. Care workers can earn as little as £16,000, well below the £26,500 threshold for entry required under the proposals. There will be no route for workers classed as unskilled. Social care providers also have to cope with a large increase in the minimum wage this year.

There were 111 new care homes registered with the Care Quality Commission (CQC) during 2019, the lowest number since 2015 and about 12% down on the previous year, according to research by the CSI Market Intelligence consultancy. Publicly owned homes closed at by far the fastest rate. It suggests places are opening where there are already services on offer and closing in areas that already have a shortfall, causing “care deserts” in some areas, and too much competition in others.

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Experts warn that private investment continues to flow into expensive facilities, which risks creating huge disparities in the care given to rich and poor. However, other analysts warned care deserts were emerging in which services were unavailable regardless of an individual’s ability to pay.Green added: “People in affluent areas are going to have endless choice of £2,000-a-week, high-end services. Given what’s happened at the election and what the prime minister said about people loaning him their vote, he should understand that this needs to be dealt with. Successive governments have fudged the issue. The prime minister has created a hole by saying no one will have to sell their house [to pay for social care].”

The CQC has warned of cases in which care providers will not support people funded by local authorities because the fees they receive from councils no longer cover the costs of delivering the care. Providers are now sometimes asking families to pay top-ups or ending placements when private funding runs out. One CQC staff member said recently: “I do think if you’re not privately funded we are operating a two-tier system of accessibility.”

The government has confirmed an additional £1.5bn for social care in 2020-21, but councils warn it is far from enough. According to the Health Foundation thinktank it would cost £4.1bn to stabilise the system to meet demand pressures by 2023-24.

Hugh Alderwick, assistant director of policy at the Health Foundation, said: “Adult social care in England is broken and needs fixing. Increasing numbers of people are unable to access the care they need for things like washing and dressing, and social care providers are at risk of collapse. Yet successive governments have ducked reform, and people and their families continue to suffer unnecessarily.”