Despite evidence that life expectancy may be stagnating, the century-long rise should be a cause for celebration. However, for too many people – unsure whether they will be able to afford the care they may need or plan for the future – their later years are proving to be a time of fear and uncertainty.

Now we learn there will be insufficient care home places, even if people could afford them: 71,000 more care home beds will be required within eight years – according to a University of Newcastle study – to meet the demands of an ageing population living longer, with complex care needs. But there is little hope that these places will materialise.

Residential and nursing homes are already under unprecedented pressure. By the end of this financial year, £6.3bn will have been cut from social care budgets since 2010, with local authorities facing a £2.3bn care funding gap by 2020. These severe cuts, along with rising costs and problems of retaining and recruiting staff, mean that one in six care homes is now displaying signs of financial stress, and across England residential homes are closing.

And in the coming months, the signs are that things will get worse. The Association of Directors of Adult Social Services has reported that councils will have to cut social care budgets by a further £824m this financial year alone – meaning fewer older people getting the help they need with basic tasks such as washing, dressing and eating.

The Conservatives’ policy of cutting funding and leaving people to fend for themselves is simply not working. It has left us with 1.2 million older people living with unmet care needs, one in 10 facing catastrophic costs, and relatives forced to give up work to look after them. It has also left the Tory “dementia tax” alive and well – more than 70% of people in residential care, who face the highest care costs, have dementia.

If this apathy towards finding a solution for the social care crisis continues, there is a risk not only of insufficient care beds, but of serious care failures.

In Labour’s manifesto, we set out comprehensive plans to tackle the short-term funding gap in social care, promising £1bn this year and £8bn over this parliament to stabilise the sector. But we also recognised the need for a long-term funding solution to meet the needs of an ageing population. As Andrew Dilnot made clear, this must include pooling risks – so that no one is left to face catastrophic costs alone – and raising the means-test threshold, so that no one loses everything they own.

Pre-implementation

The model of care:

• Does the new model of care align with our overriding ambition to promote independence?
• Is there clinical and operational consensus by place on the functions of the model and configuration of community health and care teams incorporating primary care, personal care providers and the voluntary care sector?
• Is there a short term offer that promotes independence and community resilience?
• Is there a method for identifying people at highest risk based on risk stratification tool?
• Are the needs of people requiring palliative and terminal care identified and planned for?
• Are the needs of people with dementia identified and planned for?
• Is support to care homes and personal care providers, built into the community services specification?
• Is support for carers enhanced through community sector development support in each community?
• Has the health and care role of each part of the system been described?
• Have key performance indicators been identified, and is performance being tracked now to support post implementation evaluation, including impact on primary care and social care?

Workforce:
• Is there a clear understanding of the capacity and gaps in the locality and a baseline agreed for current levels and required levels to meet the expected outputs of the changed model of care?
• Is there a clear understanding of and plan for any changes required in ways of working:
o thinking
o behaviours
o risk tolerance
o promotion of independence, personal goal orientation

• Have the training needs of people undertaking new roles been identified, including ensuring they are able to meet the needs of patients with dementia?
• Do we have detailed knowledge with regards to investment, WTE and skill mix across the locality and a plan for achieving this?
• Are system-wide staff recruitment and retention issues adequately addressed with a comprehensive plan, and where there are known or expected difficulties have innovative staffing models been explored?

Governance, communications and engagement:
• Is there a robust operational managerial model and leadership to support the implementation?
• Has Council member engagement and appropriate scrutiny taken place?
• Is there an oversight and steering group in place and the process for readiness assessment agreed?
• Have providers, commissioners and service users and carers or their representative groups such as Healthwatch agreed a set of key outcome measures and described how these will be recorded and monitored?
• Is there a shared dashboard which describes outcomes, activity and productivity measures and provides evaluation measures?
• Is there an agreed roll out plan for implementation, which has due regard to the operational issues of managing change?
• Is there a comprehensive & joint communications and engagement plan agreed?
• Is there a need for a further Quality or Equality Impact Assessment?

Implementation
• Is there a clinical and operational consensus on the roles of each sector during the implementation phase including acute care, community health and care teams, mental health, primary care, social care, the voluntary care sector and independent sector care providers?
• Is there an implementation plan at individual patient level describing their new pathway, mapping affected patients into new services?
• Are the operational conditions necessary for safe implementation met?
• Have the risks of not implementing the change at this point been described and balanced against any residual risk of doing so?

Post Implementation
• Is there a description of the outcomes for individuals, their carers and communities?
• Are the mechanisms for engagement with staff, users of services and carers in place and any findings being addressed appropriately?
• Is there a process in place for immediate post implementation tracking of service performance including financial impact to all organisations?
• Is longer term performance and impact being tracked for comparison against pre-implementation performance?
• Have we captured user experience as part of the process, and have findings been addressed and recorded to inform the planning of future changes?
• Are there unintended consequences or impacts (e.g. on primary care or social care) which need to be addressed before any further change occurs?
• Is there a clear communication plan for providers and the Public describing the new system and retaining their involvement in community development?