As Prime Minister, Boris Johnson said he would fix the crisis in social care once and for all. Credit is due to the Government for taking the first steps on the road to reform and for its initial efforts in seeking to prevent the unpredictable and catastrophic costs which people face for their care.
However, as the Levelling Up committee’s inquiry has found this week, the government should be under no illusions that it has come close to rescuing social care or has met the ambitions of Johnson’s words.
Our inquiry has revealed one clear message: the adult social care sector does not have enough funding for now or the longer-term.
Covid-19 has wrought damage on the sector and exacerbated the underlying structural challenges of rising demand, unmet need, and difficulties in recruiting and retaining staff.
With rising inflation, the social care system is now unable to escape the trap of rising prices and knock-on cost pressures on social care providers. While we welcome the increases in the National Living Wage and the National Minimum Wage for social care workers, this is a cause for concern.
Through the Health and Social Care Levy, the government is able to raise additional funds but the reality is that the majority of this funding is going to the NHS, meaning that the money allocated to social care will barely touch the sides.
Money going to adult social care is also, regrettably, targeted only on reforms rather than attempting to tackle the overwhelming cost pressures facing the sector. There is also evidence that the government has underestimated the costs of its new charging reforms (its proposed cap on the amount anyone in England will need to spend on their personal care over their lifetime).
Kemi Badenoch MP, former minister for local government, faith and communities, told us that adult social care has the funding needed to meet “here and now” challenges. Given the compelling evidence the committee received on the immediate need for additional funding, we strongly disagree with the former minister’s view. Indeed, we call on the government to allocate additional funding this year through the adult social care grant, to cover inflationary pressures and unmet care needs.
Local authorities spend most of their budgets trying to meet their social care duties, so the government should provide a multi-year funding settlement to give greater certainty and to help shape sustainable local care markets. If the next Prime Minister is serious about levelling up, they should also make a concerted effort to tackle the unequal geographical distribution of funds for adult social care so that funding is better matched with need.
We examined the government’s recent white paper, People at the Heart of Care, and concluded that the government currently has nothing more than a vision, with no roadmap, timetable, milestones or measures of success. To help turn its vision into reality, we’re calling for the publication of a 10-year plan explaining how the paper’s aims will be achieved.
A key factor in determining whether a person will need care and in helping people live independently is their housing. The government’s proposals around housing in the white paper were well received, but it must ensure that local authorities have needs-based plans in place for a wide range of specialist housing options for older people and disabled people, and that health and care is integrated with housing more closely. We need to understand that most people’s preferred option is not a care home – most people who receive care do so in their own home.
More needs to be done to value the highly skilled workforce and address systemic difficulties around recruitment and retention. We call on the government to develop a 10-year strategy for the adult social care workforce and take concrete action to improve pay and progression.
The reality of our broken adult social care system is that it is held up by unpaid carers doing vital work out of love and pride. The cost to these carers can be financial, physical and emotional. In this context, £25m over three years is a totally inadequate amount of funding to allocate to support carers, whose contribution to the UK economy is estimated by Carers UK at £132bn a year.
In October 2020, the Health and Social Care Committee estimated a funding gap of £7bn to cover demographic changes, uplift staff pay in line with the National Minimum Wage and protect people who face catastrophic social care costs. We have not yet received an updated estimate of the funding gap taking into account immediate pressures; £7bn was just a starting point and the full amount needed is likely to be tens of billions.
Whatever the precise estimate, the NHS and adult social care provision should not be pitted against one another for this funding. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from – from allocating a higher proportion of levy proceeds to social care, or from central government grants – in our report we are clear that the government urgently needs to allocate billions more to adult social care every year.
Ultimately, whether it relates to immediate cost pressures or wider structural issues in the sector, the fundamental problem is that there is a large funding gap in adult social care that needs filling. Those who need care, alongside their loved ones and their care workers, deserve better.