The problem for individuals
Everyone agrees that people needing social care, in their homes or in residential settings, face real problems. At present 1.6 million people who have been assessed as needing care are not getting it. Many more are getting only enough to keep them safe and alive.
The possibility of needing care is one of the biggest financial risks which most people experience. Nobody can tell whether at the end of their life they will need twenty years of residential care, or no care at all. At present, if you need care, you are expected to pay for it until your wealth is reduced to £23,250. For many people this involves selling their house.
The problem for providers of care
Providers also face problems. Adult social care is provided by 17,000 private firms, but paid for by Local Authorities. This care represents 40 percent of Local Authority budgets, and an ageing society means growing numbers of people in need. However since the Conservatives came to power in 2010, central government funding to Local Authorities has been cut by 37 percent (the biggest cut of any part of government). Inevitably, social care budgets have been squeezed, while many popular but non-statutory services have been cut altogether. Most care providers subsidise Local Authority funded residents by charging higher prices to those who are paying their own costs.
Although care work is skilled and complex, it is generally poorly paid. One and a half million people work in social care, but there was already a shortage of staff before Covid and Brexit led to people leaving. Skills for Care reports over 100,000 vacant posts. When they can’t recruit staff, care providers have to cut their beds. The overloaded NHS then fills up with people who can’t be discharged because there is nowhere for them to go.
Vacancies also put increased pressure on those who remain. The combination of heavy workloads and poor pay means that nearly 30% of workers leave or move each year. Workers get insecure employment and care recipients get more change and uncertainty.
Does the plan help individuals?
The government’s first announcements this Autumn focused on the cost to individuals, and particularly the need to sell one’s home to pay for care costs. The plan is that nobody should have to pay more than £86,000 for their care, however much they need (though it later became clear that some will still end up paying more). However, most people’s only major asset is the value of their home. So the cap only solves the problem for the relatively rich.
The government’s solution is to allow people to raise the money with a loan from the Local Authority, repayable on death. So people can keep their homes while in care, but will not be able to pass it on to their children (which is one of the main reasons many people want to hold on to a home they can no longer live in). Furthermore, since house prices are much lower in the North, the impact will be greater there, in the constituencies which the Conservatives won from Labour in 2019. That is why they faced a (modest) rebellion on this from their “Red Wall” MPs.
Does the plan improve services?
The plan proposes to raise money for health and social care through a new tax, the “Health and Social Care Levy”. This is to raise about £1 billion for specific improvements: integrating health and care strategies, introducing new technologies, improved training for staff, practical modifications to homes, support for unpaid carers, a website and better planning at Local Authority level.
But not yet. At first, the money will be used to help clear the NHS backlogs created by Covid-19, and it will only gradually be moved into Social Care. Many people doubt that the transfer will ever happen. NHS budgets have been severely stretched since 2010, and the transfer is only planned to happen after the end of the current Parliament, and today’s promises may not be honoured by their successor.
The mechanism for raising the money has also been criticised. The new “levy” will be a tax like National Insurance, of 1.25% on earnings up to £50,000 pa, and a similar sum for employers. Earnings over £50,000 a year will be exempt from this tax, so the burden will fall more heavily on lower earners. Someone earning £100,000 will pay the same as someone earning half that.
The elephant in the room
Adult social care is in crisis, now, as anyone who has experienced an elderly relative in need of care, or who works in the service, knows.
The government’s plans will make some improvement for some (generally richer) individuals, and may improve the quality of services in the long term (but not immediately). But it is silent on the biggest issue: that Local Authorities do not have enough money to pay a proper price to the care providers, who in turn cannot afford to pay staff properly.
Failure to solve this problem means that people who need care do not get it, or only get minimal care. Staff are overloaded and burned out, and unable to provide the quality of care that they know their clients need. Providers struggle to keep their businesses afloat, and are cutting back on bed numbers. The NHS, already struggling to cope with demand, is unable to discharge patients because there are no care places for them to go to. Local Authorities close “optional” services, like libraries and swimming pools, and cut back on road repairs, to pay for social care.
It is not surprising that the government’s plan has been heavily criticised by people working in the field and by organisations representing older people. As people live longer, with more complex health needs, the demand on the service is bound to grow.
This “plan” that we were promised two years ago is a small, slow step forward that goes nowhere near solving the problem.
All of us get old in the end, and one day most of us will need some of these services. It still doesn’t look as if we can be sure they will be there.