Wes Streeting, the new health and social care secretary, has one of the toughest jobs in government. With hospital waiting lists of about 7.5 million patients, the NHS must be his first priority.
But this should not be at the expense of care and nursing homes. Despite endless commissions and reviews over the past 40 years, successive governments have left social care underfunded, under-staffed and locked into an inequitable system. While the NHS is free at the time of use, care-home admissions are means tested.
As The King’s Fund healthcare charity put it so succinctly: “The difference is huge. No one is asked about their house value if they need medical treatment for cancer, yet, if they need social care because of dementia, that is exactly what happens. This level of means testing sets England apart from many other progressive, developed countries such as Germany, Japan and Denmark.”
This is why Hartford Care Group, which runs 19 care homes, is campaigning for better public education around paying for social care, and the appointment of a visionary minister for care and nursing homes to eliminate means testing and the financial insecurity riddling social care. More than 370 care homes in England closed in 2023.
The Department of Health and Social Care estimates that one in seven residents pays more than £100,000 for care. Means testing results in thousands of families selling their homes. People with assets of more than £23,500, including property, savings and investments may be liable for all care-home charges.
The Office for National Statistics reported that of the 372,000 people living in care and nursing homes in 2022-23, more than a third were ‘self-funders’. The rest were supported wholly or partly by local authorities or by the NHS if they had complex, long-term health problems.
Kevin Shaw, chief executive of Hartford Care, says: “There are strategic, far-reaching national campaigns to help people understand the importance of pension savings, but nothing exists to provide clarity on care-home placements and provision. All too often, information simply comes too late.”
We believe that there is a huge opportunity to transform social care for the better. Not least, because of the dedication and compassion we see from our staff every day to create a home away from home
In a national survey of 2,000 UK adults commissioned by Hartford Care, 49% of respondents said that they had no savings for later life care. Those aged 30 to 59 were the least likely to save.
Hartford Care has a simple solution for care and nursing homes. Shaw explains that all workers could begin making additional national insurance (NI) contributions early in their lives – in their 20s, perhaps. Whereas existing NI payments are used to fund the NHS and state pensions, the extra contributions could be used for late-life care.
He adds: “If I took out a mortgage now, I could get insurance for, say, £140,000 for £5 per month over 30 years. A state-run, care-home insurance scheme could work in exactly the same way.
“Tax free, it would have the government seal of protection. I’m sure most people would contribute willingly if they were properly informed about the cost of and the challenges facing social care.”
Bureaucratic red tape is another multi-million pound bill. English care homes must register with the Care Quality Commission, the independent regulator of health and social care services.
Registered care homes can accept self-funding residents as well as those funded by local authorities and the NHS. But some local authorities refuse to pay care homes unless they have had a CQC inspection — even, remarkably, if they are CQC registered.
Hartford has been waiting for more than 12 months for the CQC to inspect its two new £20m homes.
Shaw says: “These two homes are running at only 50% occupancy for want of CQC inspections — local authorities are a big chunk of our business. “This has left us with 132 empty beds even though we pay the CQC about a quarter of a million pounds in registration fees. In my three years at Hartford Care we’ve had only two CQC inspections. This is at a time when local authorities are screaming for places.”
The 1.2% rise in employers’ NI contributions will add millions to care homes’ NI bills. The NHS is exempt from the new charge, but GPs, care homes and hospices are liable. Setbacks for future residents include the scrapping this year of the government cap restricting the amount a person could pay for their personal care to £86,000.
So where do we go from here? The government has promised to “grip” the social care crisis, which means closing the widening gap between the population’s need for support and the availability of publicly funded care.
It could do so by adopting Hartford Care’s vision for care home charges to be met through additional NI contributions. Home-care provision could then keep up with the needs of a population that is both ageing and increasingly susceptible to multiple long-term conditions.
The life expectancy of older people with learning disabilities is increasing, adding to the pressure — as is the number of people with Alzheimer’s, including those under 65. In April 2024, the Nuffield Trust, the independent healthcare think-tank, reported a decline in the total number of beds in care homes per 100 people aged 75 and over, from 11.3 in 2012 to 9.6 in 2020 — a 15% fall.
The shortfall is projected to reach 64,000 by the end of 2024. Thousands of patients who should be in care homes are blocking beds in NHS hospitals, resulting in longer wait times for other NHS patients. The government has allocated an additional £600m to social care, but Shaw says, ”This isn’t enough.”
No one will blame him and others in social care for looking on with envy at the additional £22bn NHS funding. But the King’s Fund argues that social-care reforms should look beyond funding.
It says: “The fundamental need is to make the system fairer, with more people able to access care that is, at least in part, funded by the state. This would be the mark of a more decent society.”
Shaw concludes: “We believe that there is a huge opportunity to transform social care for the better. Not least, because of the dedication and compassion we see from our staff every day to create a home away from home for every single resident of the Hartford Care family.”
