When Prime Minister Boris Johnson unveiled his plan for social care last year, which is due to come into effect in 2023, there was no shortage of criticism. The best thing in it was a more generous means test, which would enable around 50,000 more people to access state-funded care each year. The cap of £86,000 on the amount anyone has to pay for care across a lifetime was a step forward but disappointingly low – with a last-minute change introduced by the then chancellor Rishi Sunak making it far less fair for those with lower levels of housing or other wealth. The Johnson government’s plans looked like they would do little to address the other significant problems in the system – unmet need, poor quality care, the fragility of market of providers and, perhaps most worryingly, workforce issues.
The shortfall of workers in adult social care has been high for years but shot up by 52 per cent last year. Poverty pay is endemic – three quarters of care workers are paid less than the real living wage – exacerbating recruitment and retention problems and driving up hardship among staff and their families, as well as affecting the quality of care. Of the additional £5.4bn promised to social care over the next three years, only £500m was to be invested in the workforce, with £3.6bn appointed to fund the cap on care costs and £1.7bn for reform.
On top of these flaws, paying for the social care reforms through a rise in National Insurance was always unfair. It meant increasing taxes for workers, while leaving pensions and unearned income untouched, despite pensioners having on average higher incomes and lower poverty than those of working age.
Councils had already been sounding the alarm about the introduction of the Johnson reforms – especially over the changes to how people funding their own care are charged, and the expected wave of additional assessments and increased demand for care. They argued that the sector will already face £3.7bn in extra costs over the next 18 months because of inflation and rising demand. Councils said they would not be able to recruit the extra 5,000 staff needed to carry out all the extra assessments anticipated under the plans. And they claim the reforms will cost at least £10bn more over the next decade than the government’s estimates.
Should we welcome signs that the Chancellor, Jeremy Hunt, may delay or row back on the plans? Absolutely not. Social care desperately needs more funding. In 2020 the Health and Social Care Committee, chaired by Hunt, called for an additional £7bn per year to be urgently invested in it. An extra £5.4bn was never going to fix all the problems, but withholding it can only make the situation even worse. The current system is staggeringly unfair, causing misery to millions and putting unsustainable pressure on the NHS, other services and on unpaid carers. The Johnson plan represented only a small step forward. But it was progress.