(Title Image: BBC Wales)

Finance Committee

The cost of caring for an ageing population (pdf)

Published: 12th October 2018

“It is clear that funding for the care of an ageing population in Wales needs to be reviewed. The evidence has shown concerns over workforce pressures, particularly problems with the recruitment and retention of people providing services to older people.” – Temporary Committee Chair, Llyr Gruffydd AM (Plaid, North Wales)

1. Cutting one budget can affect services that haven’t been cut

Spending on adult social has remained broadly flat in Wales while it’s been cut by 6.4% in England between 2009-10 and 2015-16. However, spending isn’t keeping pace with the growing population of over-65s; a study found spending would have to increase by £123million a year to reach the same per-head level as in 2009.

The number of over-65s in Wales is expected to increase by 35% between 2016-2036, rising to just under 27% of the total population of Wales. One of the main trends has been a shift from care being provided in specialist care homes to home/domiciliary care; the issue there being that gaps in 24-hour care coverage are often filled by unpaid care – the estimated value being worth £8billion.

The Committee concluded that while statutory services were important, cuts to non-statutory services – such as subsidised bus services, leisure centres and libraries – can have a negative impact on the budgets that have been protected or maintained, such as the NHS.

2. It’s unclear whether care assessments are being carried out properly

The Social Services & Wellbeing Act 2014 set national eligibility criteria for accessing services, but witnesses believed that the criteria meant that people were being assessed as eligible for local authority care if their needs can only be met by social services – meaning people weren’t receiving the support they once had.

Age Cymru and the Carers Trust questioned whether similar assessments for unpaid carers were actually being carried out, or carried out correctly, with many people applying for an assessment being redirected away from the local authority application process and towards charities. This means many carers aren’t receiving the support their legally entitled to receive.

The Minister for Social Services, Huw Irranca-Davies (Lab, Ogmore) said that formal support wasn’t inconsistent, but he accepted it was “only scraping the surface”.

3. Care costs are complicated and there’s a lack of awareness as to who is responsible for what

Charges for non-residential care in Wales are capped at £80-a-week (as of April 2018) and people are able to retain £40,000 of their own money and assets before being charged. Both measures have been broadly welcomed and the Welsh Government made an additional £.5million available to councils to fund it.

Social Care Wales highlighted confusion amongst the public as to who pays for what and how much when compared to healthcare, which is free at the point of delivery. There are also some variations between what different local authorities charge. It was also said by the WLGA that people who self-fund their own care home places are cross-subsidising local authority placements by more than £100-a-week.

4. There are options, but no clear preferences, as to the way forward

The WLGA and Older People’s Commissioner called for a “national conversation” on the role of social care and how to fund it in the future. However, many witnesses said that while funding is an issue it was equally about how that money should be spent – something Care Forum Wales said we still haven’t figured out yet.

The Finance Secretary told the Committee that there was an expectation that funding will come from four different areas in the future: local authorities, self-financing, unpaid care and a possible social care levy.

A social care levy could be a straightforward increase in income tax or a contributory-based system (similar to national insurance credits) – as proposed by Prof. Gerald Holtham and Tegid Roberts for the Institute of Welsh Affairs. However, Prof. Holtham admitted that some of the initial figures were based on “ballpark” expenditure estimates and require further detailed work.

Interestingly, Prof. Holtham suggested that the levy could be invested in infrastructure, housing and business to generate some sort of additional return. There was, however, a general preference for a UK-wide solution if possible.