Medical leaders are warning that we are facing a ‘ticking time bomb’ in social care as chronic underfunding, severe staffing shortages and a growing elderly population means that many in the future will not get the care and support they need.

In a report published today¹, the BMA says that people living in poorer areas of the country, many of whom already have a greater need for support than more affluent areas, will see their health and wellbeing worsen in the coming years unless there is wholescale reform to the social care system. 

Without this help, the BMA warns that we will see huge gaps in care available to people, meaning that the most vulnerable are more at risk of seeing their health worsening and requiring care in the NHS.

Commenting on the report, chair of the BMA's committee on community care Dr Anil Jain said:

“This country is facing an unprecedented crisis in social care. Years of chronic underfunding, severe workforce issues, and a fragmented system mean we cannot adequately meet the growing needs of the population.

“This situation has been exacerbated by the pandemic, and government proposals to shape the future of social care have fallen significantly short of what is needed.

“Serious underfunding of local authorities means many have their hands tied unfairly. Those living in the most deprived areas, many of whom have greater need for support, will not get the same access to the services they need. Complexities around the means tested provision of care too have led to a system of unfairness, which is worsening health inequalities across the country.

“It is alarming that we could see up to 500,000 vacancies in social care by the end of 2030. This, alongside an ageing population, means that we are effectively facing a ticking time bomb. The Government must act now to effectively remunerate and value care workers to ensure that there are enough staff to look after all those in need of social care in the future.

“The current social care system is deeply flawed. As doctors, we are concerned that the Government proposals to fix are not sustainable and will risk seeing the health of some of the most vulnerable and elderly populations worsening. The system needs urgent reform if we are to meet the challenges of the future.”

The report outlines several key areas which are contributing to this crisis and recommendations from the BMA.

Chronic underfunding:

• Government cuts to funding for local authorities have been cut by over half (55%) between 2010/11 and 2019/20².
• Reductions in central government grants are disproportionately impacting areas of higher deprivation with the most in need failing to get the support they need³.
• A lack of long-term funding in favour of short-term initiatives and one-year spending reviews has hindered local authorities’ plans for longer term planning and budgeting beyond the financial year.

BMA recommendation:

• Increase long-term additional funding beyond the Health and Social Care Levy to maintain the social care system in the long term.
• The BMA estimates that a further £7.9bn a year in social care funding is needed by 2024/25 to keep up with cost pressures and demand, and to pay social care staff the national living wage⁴.

“The current funding system to support older and disabled people is failing to deliver the quality and continuity of care needed for the 21st century. Despite the 2014 Care Act introducing a national system of eligibility, local variation is still leaving many older people without any support” - Louise Brady (Clinical Development Lead, The Royal British Legion)

Staffing issues:

• Severe staff shortages mean there are not enough staff to care for the needs of the ageing population with projections indicating that vacancies in adult social care could rise to almost 500,000 by the end of 2030⁵.
• The social care workforce receives the lowest wages of almost any sector in the UK with almost a quarter (24%) of the social care workforce employed on zero-hour contracts, rising to 41% in London⁶.
• Staff shortages in the social care system have resulted in a sharp increase in the number of people providing unpaid care to loved ones. Approximately 350,000 young people aged 16–25 in England and Wales provide unpaid care⁷.

BMA recommendation:

• Ensure social care workers are paid the Real Living Wage, as a minimum, to improve the status of carers and curb the current high rate of turnover in the sector.
• Introduce a standard work contract and improved training opportunities for social care staff with the option for every care worker to move onto this new contract.

“I would love to see the phrase “young carer” disappear from use with adult professional carers taking over this role from the children. We shouldn’t be praising and giving awards to these children, we should be protecting them.” - Dr Angela Dixon (General Practitioner, NHS Lanarkshire)

Means-tested provision of care

• Social care is not free for everyone in England as people may be cared for by family and friends without payment for the carer (informal care), or through services they or their local authority pay for (formal care).
• The BMA argues that this approach to provision perpetuates inequality and unfairness as complexities around determining eligibility for publicly funded social care services create a complicated system that is confusing and leaves many disadvantaged.

BMA recommendation:

Provide free personal care at the point of need to ensure that social care can be accessed by all those who need it and abolish the unfair system of means testing.

“The idea that those with a diagnosis of dementia are not deemed to have a condition with parity with other long-term/chronic conditions which receive health funding is discriminatory. Their needs should not be categorised as “social” and therefore not meeting funding criteria.” - Sue Gallagher (BMA Patient Liaison Group)

Ends

Notes to editors

1. BMA 2022. Who cares? The need for real reform for social care in England
2. National Audit Office, 2021. The adult social care market in England
3. Housing, Communities, and Local Government Committee, 2019. Local government finance and the 2019 Spending Review
4. The Health Foundation, 2018. Social care funding options: How much and where from?
5. King’s Fund, 2018. Staffing shortfall of almost 250,000 by 2030 is a major risk to NHS long-term plan
6. The Health Foundation, 2020. The adult social care workforce in London
7. Brimblecombe et al, 2020. The high cost of unpaid care by young people: health and economic impacts of providing unpaid care

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.