NEW ANALYSIS by the Insitute of Public Policy Research (IPPR) and CF – the consulting and data science company – has uncovered a postcode lottery in home-based social care services throughout England.  

The proportion of care provided at home varies considerably across different councils – from as low as 46 per cent in Barnsley to as high as 84 per cent in Hammersmith and Fulham.

Where medically possible, home care is preferable to care in residential care homes or hospitals. Research has shown people strongly prefer care in their home – and that home care increases independence, enabling people to lead more fulfilling lives. Where there is a lack of home care options, patients are more likely to end up occupying hospital beds without clinical justification. In some cases, this can lead to ‘non-beneficial treatments’, which impact quality of life. Alternatively, they may be forced into residential or nursing homes earlier than necessary.

Failing to deliver equal access to home care constitutes a missed opportunity to maximise independence and quality of life, according to IPPR.

The IPPR and CF analysis shows that if every local authority provided home care equal to better-performing similar councils, 80,000 more people over 65 in England could be receiving care at home. Levelling up home care across the country would also save English local authorities £1.1 billion per year from their social care budgets, with new analysis showing community care is around one third of the cost of more institutional residential and nursing home options.

No matter what social care funding solution the prime minister decides on, the risk of people having to sell their home to pay for care will be significantly reduced by providing more care in people’s homes, according to the report. IPPR’s preferred funding plan – free personal care funded by general taxation – alongside a levelled-up home care system would prevent an estimated 80,000 people from facing the catastrophic care costs that force people to sell their homes.

The report explains that while some of this local variation in home care access can be explained by differing demographics, much of it cannot be reasonably explained. The unequal provision of home care in unfair and must be addressed, according to the think tank.

The report says that the drivers of this inequality are unfair distribution of budget cuts, local workforce shortages, cuts to local government commissioning expertise, and a lack of community care infrastructure in some parts of the country.

Community-first social care

IPPR calls for a guaranteed right to care at home where clinically appropriate. Receiving care in the most suitable setting should not depend on where you happen to live in the country, according to the researchers.

To enable all who want it to access home care, the authors argue that the UK government should implement a bold new ‘community-first’ model of social care. This will help ensure that social care reform looks beyond the funding issue to the question of how to empower more people to live flourishing lives while receiving care.

IPPR proposes:

  • Building capacity: Mirroring moves being made by the Biden administration, the UK needs to make a £5 billion upfront investment in boosting home care infrastructure, including rapid response teams, 24-hour support lines, home care packages and new technology to support patients and carers.
  • Supercharging the workforce: Delivering high quality outcomes relies on well-paid, motivated and well-trained social care staff with time to care. The government should introduce minimum pay standards, a new social care Royal College to coordinate sectoral bargaining, and provide more training and progression opportunities.
  • Increasing commissioning firepower: The government should increase local commissioning capacity and expertise, by bringing more skilled staff into local authorities and introducing rigorous training in outcome-based social care commissioning.

The paper suggests these reforms will be most effective if combined with free personal care – which is the fairest, most popular and most practical funding reform option. There is growing cross-party support for free personal care from politicians ranging from Conservatvw MP Jacob Rees-Mogg to Manchester mayor Andy Burnham, and organisations including Policy Exchange and the House of Lords’ Economic Affairs Committee.

Chris Thomas, IPPR senior research fellow, said: “The government needs to think through not only how social care is funded, but also how care is delivered to ensure people can lead flourishing lives, regardless of arbitrary factors like where they live.

“Anchoring care in places people call home is an important way to achieve that. Everyone should have the opportunity to receive care at home, if clinically appropriate, from the first moment they need support. The care options available to you shouldn’t depend on where you happen to reside.

“We urge ministers to deliver a funded and ambitious programme to enable care in the places people call home. A community first model of social care can save money, improve care quality, and align social care support with what people who use care want.”

* IPPR has proposed free personal care as a preferred funding reform option for adult social care. More information here.

* Read Community First Social Care by Chris Thomas here.

* Source: Institute for Public Policy Research