Social Care Housing in England: Trends and Funding (2009-2019)

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Business Analysis and Planning
Topic: “The trend in the social care housing sector in England”
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Executive Summary
The report has been written to identify the trends in the healthcare towards the housing sector. In
England, the health authorities are responsible for providing housing services for the disabled
and vulnerable individuals. At first, the importance of housing sector in healthcare has been
established. Thereafter, the relevant laws along with the legislative history behind providing care
services have been discussed. The financial constraints faced by the government authorities have
been discussed in detail. Additionally, ways by which care services are charged in Lewisham
borough has been outlined. Lastly, using a graphical representation, the trend of housing sector
has been highlighted and discussed.
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Table of Contents
Introduction......................................................................................................................................4
Task A..............................................................................................................................................5
Task B............................................................................................................................................10
Conclusion.....................................................................................................................................16
Reference List................................................................................................................................17
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Introduction
The development in the health and social care sector (H&SC) of England has led to the growth in
creation of improved services for the people. A majority of the funds acquired through taxes are
spent on the social care aspects of the country (International.commonwealthfund.org, 2019). The
country experiences issues in managing the necessities of the public through better social care
plans. The purpose of developing legislative reforms regarding the housing facility for the public
ensures the government is able to pacify the requirements of the people. The government, in
collaboration with the NHS, performs effective housing plans for appropriate health and social
care for the people of England (Federation, 2019).
The following study aims to develop a brief understanding of the social care-housing sector in
England along with the legal framework that established the care-housing structure of the
country. The legislative history of H&SC sector in regards to the growing need of better care
homes in the country has been evaluated in the study. The costing of H&SC services for London
borough of Lewisham has been studied in the following section to develop a better
understanding of the ways the NHS frames prices for the H&SC services offered to the people of
England. Finally, a data presentation has been created to identify the major drivers of trend in the
H&SC sector of England regarding the social care housing spending for the phase of 2009-2019
in England.
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Task A
What is social care housing sector?
Housing is one of the central elements in the social care sector as it is directly linked to the
wellbeing of the service user. The local authorities in England have now considered housing as
explicit and integrated healthcare can be provided via housing services (Easterlow and Smith,
2017). In healthcare, the housing sector can only grow via partnership approach. Here, the
important areas mainly include advice on prevention, care and information. A range of housing
options is available to people who lack basic housing facilities in England. The housing sector
grew because people realised that they are no longer safe in their own homes, especially when
they are suffering from any form of disability and need to live independently. A range of housing
options is available for older people who literally lack the ability to manage their daily tasks. The
need for housing grew because older people prefer to live near areas where they can easily avail
transportation services. Hence, the housing sector in England mainly includes “extra care
housing”, “sheltered housing”, “close care”, “home share schemes” and “housing association
property”.
In 2015-2016, approximately £16bn has been spent for improving the “adult social services” in
England. The NHS is primarily responsible for looking after funding (The Health Foundation,
2019). Almost 80% of healthcare services in the country are funded publicly with the help of
NHS. In this sector, productivity has been improving at a gradual rate. The NHS has been
recently facing various financial constraints and currently the financial performance of the NHS
declined. For instance, in 2012-2013, the NHS funding (The Health Foundation, 2019) has faced
approximately £2.5bn of deficit. The government is thinking about meeting the needs of the
clients and now the trend is in progress. The government published the “Social Housing Green
Paper” for ensuring that the social homes are being managed appropriately. It is the duty of the
government to maintain the government beforehand considers decent quality of the social homes
and therefore risk factors. The influence of Brexit has also caused uncertainty in the economic as
well as political landscape. Nevertheless, in 2018, the social care sector has already set strong
foundations particularly in the housing sector (Glasby, 2018). The demand for competencies and
skills is rising and this brings the opportunity for additional growth.
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What are the laws that established social care housing and who is responsible for it?
The Care Act 2014 provides access to support and housing services for the needy. This law is
applicable particularly for adults who require support and care (Penhale et al., 2017). After
satisfying the needs of the adults, their overall wellbeing can be ensured. The individuals who
are mentally or physically impaired can get access to these services. The services are not for the
children. It is the duty of the government to provide accommodation or housing services to adults
only. The issue of homelessness can be easily tackled by providing housing services. After
assessing the needs of the service users, this legal framework can be useful as it allows the users
to gain supported housing and they can easily secure any possession claim. However, before
Care Act came into existence, the assessment was carried under “section 47” of the “NHS
Community Care Act” (1990).
A range of statutes was present under the mentioned act and these mainly included the “National
Assistance Act 1948”, “Health Services and Public Health Act 1968” and the “Chronically sick
and Disabled Persons Act 1970” in case of adults only. Previously, under “section 21” of the
“National Assistance Act” (1948), the individuals who require support were allowed to
participate in the assessment (England.shelter.org.uk, 2019). The individuals might suffer from
old age, disability or certain chronic illnesses. Therefore, by proving accommodation services,
“care and attention” has been given to these people. It should be noted that merely providing
housing services was not enough to meet their needs and therefore, accommodation-related
services was part of the process. It mainly incorporates helping the service users with their
domestic duties and checking on them consistently.
The “Social Value Act” (2012), is another legislation that has been established in England for
reducing inequalities and providing housing services. It should be further noted that there are a
range of service providers in the care setting who are responsible for supporting the care users.
For example, the independent advocates are responsible for representing the laws whenever,
service users face difficulty in understanding the entire care process (England.shelter.org.uk,
2019). The vulnerable people require the support of independent advocates while undertaking the
assessment process. In case, the local authority fails to arrange an advocate for the service user,
then the entire assessment would be considered as “unlawful”. Additionally, carers are also
accountable for meeting the care needs. The Care Act creates provision in order to sustain carers.
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The overall health outcomes of the individuals directly depend upon the carer. The carers
provide respite care, night sitter services and assistance with all kinds of domestic tasks.
What are the legislative history and context in which “value for money” matters. Consider
the financial crash and other legislation in social care over the last 20 years.
The statutory services were available before 1939 and the Poor Law referred to as “Public
Assistance following the Local Government Act”, 1929, has been enacted to help the destitute
people. Funding was provided on weekly basis and along with that, clothing was also provided.
However, the law was quite stigmatising in nature. In 1955, approximately 10% of people in
England have been identified as “permanently handicapped” (Abel et al., 2016). Under the
“National Assistance Act” (1946), the older population has been again subdivided into two
groups- the ones who are sick and has been admitted into hospitals and the ones who need “care
services” only. The second type has been admitted in residential homes.
As per the NA Act, it is the duty of the local authorities to offer residential accommodation and
attention to the disabled individuals. Thereafter, in 1950s and 1960s, the concept of community
care came into existence and consequently new homes have been established. However, because
of financial constraints, few homes have been established. Various governments has tried
sustainable means of funding social care services and since 1990s, effective ways has been found
by the government to guide service users regarding the method of payment after availing care
services. Gradually, there have been major policy implications and the government bodies have
understood the importance of a strategic budget. In 2015-2016, it has been established that with
the help of the Spending Review, the need for a strategic budget in social care has been
understood (The King’s Fund, 2013).
In England, financial crisis is one of the major reasons behind funding issues and this in turn has
been creating additional pressure on the government. The ageing population has been increasing
and this particular group has complex health requirements. Further, the central government over
the last few years has reduced their funding. There has been rise in the care costs. However, the
local authorities are determined to safeguard the “social care budgets” by cutting down several
service budgets. The economic trends in UK can successfully outline the financial crisis faced by
the country. In 2009, the GDP contracted by 4.6% and in 2010-2011, the overall growth was
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average. Consequently, there was a deficit in the budget (Historyandpolicy.org, 2019). The
unemployment rate increased particularly in 2008-2011. The “Ten-year bond rates” also declined
in 2008-2011. Contrarily, the spending on healthcare services was stable. There have been policy
responses and changes occurred in the overall “public funding” for the healthcare sector.
The government in March 2017 budget published the Green Paper (Jarrett, 2019). The paper
mainly provides a guideline for service users regarding ways to make payments after receiving
care services. Moreover, the “NHS White Paper” has also been published for improving quality
of care by making patients a priority and encouraging the practice of autonomy and
accountability (The King’s Fund, 2019). The government to incorporate certain legislative
changes also launched the “Health and Social Care Bill” and it acted as a major way of dealing
with the financial crisis. Integrated care has been possible and key healthcare bodies such as the
NHS or CQC were responsible for promoting integrated care. The “Public Health England” was
established which is responsible for looking after public healthcare matters; however, it is not
responsible for looking after the local level.
Discuss how health and social care services are costed, using examples of your local
government of choice.
In a local authority in England, it is obligatory to be eligible for funding. If individuals have
assets or savings, then they have to pay for their own services. For instance, if individuals have
savings more than £23,250, then they should pay for their care (Moneyadviceservice.org.uk,
2019). After getting qualified for receiving financial help, the individual can simply ask his/her
local authority to organize services. The individual is also liable to get direct payments and can
seek help from someone who will manage the budget. In some instances, the local authority
might also refuse to agree with the service user’s requirements and in this case, the individual
has the right to challenge the authority. Self-assessment is another tool by which people can
assess their needs. Through the help of online medium, the individual will be able to understand
their needs and then demand for financial help.
In Lewisham Borough, it is considered that people need to contribute after acquiring healthcare
services. However, it is necessary to ensure that individuals are not charged on unreasonable
means. The council ensures that there is no variation in ways by which individuals are charged
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and the entire process should be transparent. People should also have control over their decisions
and service providers should be client-focussed. The rules for charging should be consistent and
prevention of anomalies is essential.
There is a legal basis behind charging patients. As per the Care Act 2014, depending upon the
condition of the service users, the healthcare settings should charge them. The council has the
authority to charge individuals after they have identified their eligible needs. Under section 17
(Care Act), it is the duty of the local authority to perform financial assessment. The assessment is
carried out to calculate the income of the person before charging them for the care services
(Councilmeetings.lewisham.gov.uk. 2019).
Additionally, the Care Act also allows the council to charge service users from the time they start
availing the services. After conducting the financial assessment, it is the duty of the local
authority to inform the service user regarding its outcome (within 5 days). Moreover, the service
user is responsible for informing the council regarding any changes in his/her financial
circumstances. Older or disabled individuals are likely to receive state pension, benefits or even
occupational pensions and these are calculated as “income”.
In case of charging for providing residential services, it is essential to identify the care needs and
after analysing it if it seems that the individual require accommodation support, and then they are
liable to pay. Here, payment involves “full costs” of the services. There is an “upper capital
limit” and based on it, the users are charged by the authority (Councilmeetings.lewisham.gov.uk.
2019). In various instances, the “NHS Funded Nursing Care” also provides funding and in this
case, the individual will not have to pay for any nursing costs. Here, only the care costs will be
considered.
Some exceptions should be considered in this case. If an individual has been placed in “After-
care” service which is under “section 117” of “Mental Health Act 1983”, then he/she will not be
asked to pay (Carehome.co.uk, 2019). They shall be completely exempted because these people
lack the mental ability to make financial decisions. Additionally, if NHS via “Continuing
Healthcare” funds the care home, then the individual will not require financial assessment
because NHS already gives it.
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Task B
The funding allocated by the NHS and the government for the successful implementation of
housing and care providing facilities to the people of England has modified over the years. The
following table provides a brief understanding of the changing pattern in funds allocation and
spending habits of local authorities regarding the social care and housing elements within the
society.
Year Amount
2009 £3,000,000.00
2010 £4,000,000.00
2011 £4,500,000.00
2012 £4,000,100.00
2013 £5,000,600.00
2014 £6,000,300.00
2015 £4,000,500.00
2016 £5,000,200.00
2017 £2,000,300.00
2018 £4,700,000.00
2019 £5,900,300.00
Table 1: Social care housing spending in England 2009 to 2019
(Source: Created by learner)
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2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
£0.00
£1,000,000.00
£2,000,000.00
£3,000,000.00
£4,000,000.00
£5,000,000.00
£6,000,000.00
£7,000,000.00
Social care housing spending in England
2009-2019
Figure 1: Social care housing spending in England 2009 to 2019
(Source: Created by the learner)
Key drivers of the trend in social care housing spending in England
As per the tenets of H&SC sector in England, the providence of social care and housing facilities
is in trend among the senior citizens and the aged individuals in the country. A growing trend of
dislocation among the population of the country plays a crucial role in the development of care
homes and housing facilities for the elderly citizens (Kingsfund.org.uk, 2019). Based on the
consensus, it has been identified that people move away from London by the time they turn 30
years until retirement. Hence, it can be observed that the spending on housing facilities for the
senior citizens of the country are according to the area the decided care home would be
established. Considering the varied real estate rates within London and outside, the decision to
establish care homes in areas away from London would cost less. As per the reports generated by
Webarchive.nationalarchives.gov.uk (2019), the tenets of payment for the housing facilities have
increased between 2009 and 2011 due to the economic growth and the “abolishment of
compulsory retirement age” in 2011.
The trend among the hospitals associated with NHS England to cause delays in patient discharge
due to the reduced opportunity of providing necessary and appropriate care facilities also play a
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major role in determining the costing that should be allocated to housing facilities within the
country. It is observed from the report generated by GOV.UK, (2019), the growing expenditure
in H&SC sector especially the housing sector of care homes in England increased considerably
due to the increasing numbers of foreign ethnic groups in England. A growth of 18.3% in
minority groups in areas outside London enhanced the need for better care providing facilities in
the country. Increasing number of patients with long-term illnesses within the senior age group
provoked the growing expenditure for housing facilities in England.
The fluctuating need for nursing care among the care and service users in England during the
period 2012 to 2015 presented the diverse expenditure by the government in housing facilities.
The service users need for social care and care home facilities in England fluctuated due to
various socio-economic causes including the economic crisis that the residents of the country
experienced during 2015. The external threats of ethnic violence also enhanced the people’s
demand from care home facilities. The NHS and the government of England formed rigorous
modifications to the H&SC structure of the country in order to allocate funds to necessary areas
of the sector. The outbreak of flu, Ebola and Zika viruses within the country during 2016
prompted the increment in funds for housing facilities, as it was necessary for the authorities to
ensure the safety of the vulnerable population in the country.
Thus, it can be stated that the costing and expenditure stated by the government and the NHS
England is based on the external factors that influence the development of the H&SC sector in
the country. The varied economic condition as well as the fluctuating stability of the English
market due to the Brexit referendum prevented the stakeholders to provide effective costing and
funds to the social care housing segments within the country. The uncertainty among the
business sector in the European society due to Brexit decision reduced the scope of financial aid
from external stakeholders in improving the H&SC sector of the region.
The reduction of costing for nursing care and residential care provided the users to engage better
in the H&SC sector. The development of funding allocated for the housing sector in England
through the growth in financial aid during 2018 and 2019 proves that the NHS England and the
government authorities exercise effective control over the funds allocation process in the
country. The need for improved social care for the senior citizens of England enhances the
authorities’ decision to expend in the housing facilities as well as the legislative framework of
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