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The UK social care system, which in its current form dates largely from the post- Second World War welfare state settlement, has both expanded hugely in recent decades, and by common consent is now dysfunctional in various respects. It is not without irony that Thorlby et al., (2018:3) pointed out that, whilst the 70th anniversary of the NHS was marked with much celebration, the same anniversary of social care passed largely unnoticed. The fault line established 70 years ago between health care which is provided by a national agency and free at the point of use and social care which is means-tested and provided by local government, remains a fundamental source of inequity and unfairness today.These issues include the level of national funding and how that is determined, the allocation and availability of funding among social care authorities, the individual budget decisions and choices made by those authorities and the way decisions on funding and care packages are taken for individuals with social care needs. Two very important questions that arise from this dysfunctional system, are the extent to which the rights of individuals, for example under the Care Act 2014, are being respected and, if not, what is the level and urgency of tackling those unmet needs.This report considers the academic and other material which has been produced in recent times to address these and related questions. It has been validated by the experience of the authors and contact with active professionals in the field, but is in essence a literature review. Further empirical work would be able to address in detail the problems in the national and local funding systems and the levels and types of unmet need, and consider the proposals which are being put forward currently to remedy these issues and identify those which have the greatest chance of success in terms of helping individuals in need.This report was commissioned by Access Social Care with the following aim and objective in mind:AimThe overall aim of this review was to present a picture of levels of unmet need in relation to social care in England since 2008 to the present, so as to encapsulate austerity measures and the Care Act 2014.ObjectiveThe objective was to bring together academic analysis to gain a better understanding of unmet need, with a view to informing better decision making.Main findings• The number of people with a disability in the U.K. has continued to rise in recent years, and is now around 21% of the total population, or 14.1 million people• There is also an increasing number of people with learning disabilities whothanks to medical advances are now not only surviving childhood but livingmuch longer. Their needs will call for particular attention in coming years.• The number of older, and oldest-old, people is also rising as it is in many countries. Currently there are over 703 million people over the age of 65 Between 2015 and 2030 there will be some 500 million more people over 60 in the world. In the U.K. the number of people over 85, when needs tend toincrease sharply, will double from 1.6 million by 2041.• These changes and pressures on adult social care however have not beenmatched in the last decade by increases in available resources or by clearly articulated and robustly modelled strategies for tackling these incipient challenges. Since 2010 the amount spent by councils first fell sharply and has since recovered slowly to near the same real times level, but during a decade when demand and needs have risen considerably. There is a broad consensusacross local authorities of all political stripes that social care is underfunded.• The numbers of people receiving social care has fallen by 7% between2015/16 and 2018/19.• Unsurprisingly then, many studies identify large and increasing numbers ofpeople who are not receiving the social care they need and to which they maywell be entitled under the legislation.• There is, though a dearth of studies that specifically look at unmet needs –especially for people from BAME backgrounds and LGBT groups.• ‘Need’ and ‘unmet’ need remain conceptually complex, with functional-basedapproaches to measure it remaining the default. More qualitative accounts of what unmet need means for the everyday lives of people with disabilities are missing.• Although actions are often discussed to remedy some of these identified problems there is no current plan or timetable for doing so.Recommendations.1. Immediateactionisneededtoaddressunderfundingofsocialcareespecially given the increased pressures COVID-19 has placed on the system.2. Afullandempiricallysoundpictureofthelevelsandtypesofunmetneedfor social care.3. Onthatbasisabetterandsharedunderstandingoftheresourceswhichwouldbe needed over time to move towards meeting those needs.4. Analysisoftheimpactsofthoseresourceimplicationsforlocalgovernmentand the extent to which that is viable in the current system given their other responsibilities.

Poster

People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. This study followed up men with ID who were leaving prisons in England. The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. 70% were above the clinical cut-off for anxiety and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community and many had been re-interviewed by police. Community teams need to provide better support to this very vulnerable group.

Purpose: Research has consistently shown that young people at the higher end of the autism spectrum (AS) are likely to experience increased anxiety during new social situations.The aim of this study was to explore how higher education students with AS experienced attending university in two European countries: the UK and Spain. The objective was to find out whether experiences of students with AS differed between the two countries as well as whether there were any interventions which students with AS from both countries considered might aid students? social integration and well-being at university. Method Nine students with AS were recruited to participate in a small-scale comparative exploratory study that incorporated life-history interviews. Face-to-face interviews with four students from the UK and five students from Spain were transcribed verbatim and subjected to Interpretative Phenomonological Analysis. Findings Four superordinate themes with seven sub-themes emerged from the data which were significant to both groups of students in Spain and the UK attending university. These were ?meeting new people?, ?special interests?, ?environment? and ?support mechanisms? Conclusion Students with AS need and want clear, unambiguous and structured information from academics; support to get to know others in ?small networks? such as a special interest peer group, more designated ?quiet zones? across campuses and above all, a move away from ableist notions of AS. Limitations. The study was small-scale, a larger, quantitative random controlled trial would increase the reliability of the findings.

Background People with intellectual disabilities have a shorter life expectancy but health care improvements mean that they are living longer, with the associated health difficulties. Research into ways of supporting people with intellectual disabilities who are ageing and need end of life care is short supply, and few services are provided.Method This research is a single case study that included observations, interviews with standardised questionnaires and focus groups for staff. This Discussion Paper focuses on estimating the comprehensive costs of a specialised residential facility using a standard, well-established approach.Results At £1,422 per resident week (2013 prices) our estimated cost for supporting residents at Leesdown House are likely to be slightly higher that the placement fees paid by local health trusts and social services departments. Any difference would allow the service to build up a small ‘cushion’ of funds on which to rely during periods of lower occupancy. Additional services and volunteer costs account for a further £55 per resident week.Conclusion Cost information alone should never drive care policy. However, the resources absorbed by Leesdown House generated positive results for residents’ quality of life and opportunities to make choices for themselves. This service may provide a solution to the gap in specialist service provision.