Social care - too costly not to act

Reform of social care in Britain has been too long delayed – by decades, with no end in sight. And the longer things stay as they are, the more important it becomes. It’s necessary to restate the reasons for change, though that alone is not enough.

Social care is a broad term; picking on one aspect alone masks the size of the problem. The first thought is that this is about looking after the non-medical needs of older people in care homes. But it also includes people living in their own home with support, working age adults and children. None of them are served well by the way care is organised and provided across Britain.

Care workers suffer too – they know too well that things should be better. They experience poor pay, with low job security in a sector where employment is fragmented. Public sector provision has declined, and what remains is underfunded. Too many private care providers are either inadequate or put the profit demands of their owners first – or both.

The impact of inadequate social care on the NHS is frequently mentioned, and it cannot be underestimated. Far too many patients can’t be discharged from hospital as soon as they are medically stable. This all takes time and diverts NHS resources.

Delay

More important is the impact of delayed discharge – often for weeks – on patients. It results in far worse recovery, both short and long term. Inadequate care during recuperation is known to create further medical problems later on.

Care provided at home is the best option for most conditions – not only for recovery but also for long term outcomes. For working adults with chronic conditions, care at home can make the difference between becoming socially isolated and not. For some, and for the parents of children needing care, adequate support can keep them in work.

The notorious 15-minute care visits may have ended (though Warrington was using them at the start of the year), but provision is patchy and often poor. Local council budgets are under pressure, even where they try to prioritise social care over other services. Funding allocated to social care has dropped over the past decade – and that looks likely to continue.

Many people eligible for care at home don’t receive it, and give up trying to secure the help they need. And local council support for occupational health assessment and equipment also suffers from underfunding, leading to delays. These factors contribute to poor outcomes.

Some councils have completely contracted out their front-line care services. Others rely on private companies in part – for example, when they can’t recruit and retain enough workers. And for some unfortunate people, the benefits system requires that they directly engage care support – adding to their stress and strain.

The cost of care, even part time and in your own home, can be crippling. Those few people who can afford it will be able to manage by paying for all of their care themselves. But for the great majority, that’s not an option – certainly not in the long term.

Frozen

The limits on personal savings above which councils will pay for part or all of care needs have remained frozen since 2010-11. Inflation since then is about 40 per cent. No wonder the proportion of people receiving full or partial care support is diminishing. Dealing with this problem of contributions has delayed social care reform by decades.

After the 2019 general election Boris Johnson said that his government would “fix social care” – it didn’t even start to tackle the problems. The pandemic exacerbated them, but was not the cause. Since then, governments have repeated the political manoeuvrings of the past 20 years without getting any closer to an answer.

Jeremy Hunt has twice kicked proposals down the road – once as health secretary and again as Chancellor of the Exchequer. The health and social care levy was announced by Johnson in September 2021 as an extra tax on individuals and employers – £12 billion a year ring fenced for those purposes.

From the outset, the emphasis was on health care in the wake of the pandemic. But with the promise of the extra money, nothing more happened about reforming social care funding. And a year later, Kwasi Kwarteng, during his short term as Chancellor of the Exchequer, cancelled the levy.

Local councils talk about a funding gap for social care, not maintaining levels. Governments have offered extra cash at times. But these announcements are often all smoke and mirrors – counting money already committed. And, under other pressures, councils don’t always spend on social care what extra they have.

‘Life expectancy has risen steadily in Britain for many decades, at least until recently. That’s something to celebrate…’

A long-term plan for reform of social care funding is needed – one that no government or council can afford to ignore. The Dilnot Commission, appointed by the coalition government in 2010, reported a year later with such a plan.

The proposals were to cap lifetime care costs and to raise the means-tested threshold considerably. This was designed to give certainty and stability to the sector. The report was praised by the government…then buried.

Some say the problem of social care is intractable because the population is ageing. No – that is to accept that people are to be left uncared for.

Life expectancy has risen steadily in Britain for many decades, at least until recently. That’s something to celebrate, and an imperative to improve care rather than put off reform. So too with disabilities that would in the past have made life much shorter.

Manageable

Governments say that social care is unaffordable, which is in effect what happened to the recommendations of the Dilnot commission. Yet that report estimated the direct cost to the state would be around 0.25 per cent of GDP – a significant amount, but manageable. The knock-on costs of inaction on the NHS, and the benefits of getting those needing care or their families back to work, are left out of the equation.

And while there’s deadlock on care costs, nothing is done about any other aspects of care – or the woeful levels of pay and uncertain employment.

What’s the answer? The Blair government proposed a National Care Service. Inspired by the NHS, it might have been a small step in the right direction. But anything like that would still have to deal with the questions of payment by those in need of care and potentially unlimited care costs, as well as employment conditions in the sector.

And a national care service can’t be implemented as an add on to the NHS either – which has plenty of its own challenges to deal with.

In Scotland, the SNP-led administration has proposed its own National Care Service. But that seems ill-thought out, and has been deferred. Funding is not assured and councils see it as a purely centralising measure (as with several other aspects of SNP policy).

Care workers in the sector, where organised, have understandably concentrated on securing decent pay and conditions. It’s a sector where skills are not recognised and casual work is commonplace – with chronic staff shortages across the country. Yet they know best where the shortcomings are and how they might be put right.

In August, the TUC set out the case for changes in conditions for the care workforce. That’s essential, but needs reforms to the structure of the sector to go alongside it. This is for the whole class to take up, not only workers in the sector. Otherwise the next 13 years will see as little progress as the last 13.

The Dilnot proposals might not be the answer, but they are the best place to start. No other policies since then have looked at the needs of the whole sector. Parliamentary parties and local councillors are too concerned about whether they will be elected again rather than about what needs to be done to reform social care.

It’s in the interest of the whole of the working class of Britain to shout loudly for reform – and to trust no one until something workable is on the table.