Social care is being disfigured by a crazy paving of fault lines driven by rising demands, financial constraints and complex structures that straddle state and private support. The cost of wrapping our arms around the vulnerable is rising and experts believe an extra £7 billion a year, on top of its annual £22.2-billion government funding, is needed to stabilise a sector that has been badly damaged by the pandemic.
The plight of care homes, where the COVID death toll has been at its most concentrated, have become a totem of the malaise of social care. Prime minister Boris Johnson has pledged to “fix the crisis in social care once and for all”, yet provision was conspicuously absent in the chancellor’s March Budget and many feel it will take considerable ingenuity to fulfil Johnson’s promise.
Social care does not lend itself to easy fixes: 1.1 million people work in adult care, but they are propped by more than five million unpaid carers (they may receive a carer’s allowance) looking after family and loved ones. The financial profile is also confused, with families paying £10.7 billion for a range of care and the sector featuring 25,000 private businesses.
It is an arena where low wages dominate; almost 30 per cent of the workforce move jobs each year and vacancies stand at 122,000 or 7.8 per cent compared to 2.8 per cent across all industries in the UK, according to The King’s Fund think tank.
“Social care was in a bad state before the pandemic and it has been weakened further by it,” says Caroline Abrahams, charity director at Age UK. “There is a huge workforce shortage and there’s arguably a crisis in confidence among the public about care homes.
“There are also significant numbers of old people who are trying to manage without the support they need with basic things like eating, drinking, taking a shower and getting dressed, and those people are more likely to fall or get ill and need NHS care. Social care is often portrayed simply as being about older people, but it is a much wider issue than that and half the spend goes on younger adults with complex care needs and disabilities.”
Complex care needs
Greg Allen, chief executive of Future Care Capital (FCC), an independent charity shaping the future of health and social care, adds: “The sector consists of a patchwork of regulators, policymakers, commissioners and providers. People often think of social care as the elderly and frail in care homes, but it spans children, young people, people of working age, and disabilities, and each facet faces different challenges.
“Successive governments and policymakers haven’t found a solution, but this government and others that follow cannot ignore social care because it will implode as a system.”
FCC advocates a care covenant, similar to the UK’s military covenant, which establishes mutual expectations and responsibilities of citizens and the state around care provision. It also wants to see more detailed research and data deployed to help design services that are tailored to evolving demands.
“We need to raise the debate to look at this from different angles and see it as a bigger societal issue,” says Allen, who has worked at board level in the NHS. “The pandemic has opened the public’s eyes not only to the amazing care delivered in homes, but that social care is not just about care homes. Perhaps the pandemic is a catalyst for better understanding and developing better options.”
Danny Kruger, Conservative MP for Devizes, recently petitioned health secretary Matt Hancock to explore systems used in Germany and Japan, which involve social insurance to spread costs, while promoting new models of care that compensated family members who give up work to perform care and fund semi-professional domiciliary care workers drawn from the local community.
A public conversation
Kruger’s creative approach is echoed around healthcare as public anger continues to rise about the number of families forced to sell their homes to pay for care. The government’s recent healthcare white paper, addressing some of the wider concerns, promises greater integrated care at local level and the use of technology to widen the range of at-home care options.
“The pandemic has made a lot of people realise that even if you’re really responsible, and you do all the right things, stuff can happen, which can hold your life below the waterline,” says Anita Charlesworth, director of research at the Health Foundation, an independent charity.
“Lots of people assume the state will be there for them if anything happens to them or a loved one, so it is a deep shock when people find out that is not always the case. We do need a big public conversation about social care because we have not worked out what our individual responsibilities are for those we love and where the state should be supporting us.”
The Health Foundation wants the government to invest to stabilise the current system, improve access to care, protect the public from ruinous costs and explore alternative revenue-raising options.
Unmet need
“Investing in social care has a very big price tag and often the political gain doesn’t look that great. It’s the right thing to do and it’s the long-term decent thing to do, but there’s often not a lot of short-term political mileage in it,” adds Charlesworth.
“The reality is there is unmet need, a lot of providers are not sustainable and care staff work under really poor terms and conditions, while individuals can be exposed to catastrophic costs.
“I believe the government will do something because the downside of not acting on an unambiguous and bold commitment would be very difficult. The question is how wide or narrow the support package will be. The concern is that if it is not big enough then more people will exist in the silent misery of unmet need.”
Carers UK, a membership charity representing the one in eight adults who are unpaid carers, wants to see ambitious reform that includes legal rights for paid leave and flexible working for carers along with greater government recognition of their role in social care.
“We have waited years, more than a decade, for a plan for social care and the pandemic has highlighted that wholescale change needs to happen now if it is to be fit for purpose in the future,” says chief executive Helen Walker. “The demand for formal care has increased. If we ignore social care for much longer, families’ lives will deteriorate and the economy will feel the hit too.”
Age UK echoes the call for urgent social care reform. Abrahams adds: “If we continue as we are, then everyone’s experience of it will get worse, and we will get more scandals to do with poor care, and that will put extra pressure on the NHS when it can least afford it.
“I’m optimistic they’ll do something, but I’m worried they’ll do enough. If we’re going to get social care reform and refinancing, then it requires the prime minister to exert his political power over the Treasury.”
