The 2019 Conservative manifesto was clear: “It is a basic, compassionate Conservative belief that we should care for those in need… We need a long-term solution for social care.”
The last six months have made any hope that this would translate to an ambitious plan feel like a distant memory. Last Autumn, Boris Johnson’s headline policy proposal – a cap on social care costs – was delayed until 2025.
Now, £600m of a promised £1.7bn of social care funding has been held back – including £250m of the £500m that had been promised to support and develop the social care workforce, such as through training. This reduction in funding and ambition will hit workers and service providers alike. Social care in its current state is a poorly-paid career, with little opportunity for training and progression. One in ten social care posts were vacant in June 2022, and staffing shortages have risen sharply.
A £500m investment in training was never going to be a silver bullet. But the government has now chosen to reduce even that small measure of progress. With 1.6 million people employed in the social care workforce in England, the remaining budget amounts to just over £150 per person, spread over three years. This is not a strategy that will make adult social care an attractive, highly skilled and resilient sector.
The consequences of allowing a capacity crisis to continue in our under-resourced social care system will be severe. Most obviously, and importantly, this will directly affect the great many people who draw on social care services. The grave lack of staff is a key reason for high levels of unmet care need in the UK – the charity Age UK estimates that 2.6 million people in England aged 50 or older need some kind of help but are unable to get it.
There will also be consequences for the NHS, as it struggles with its historic backlog, including a waiting list of 7.2 million people. At the start of the year Rishi Sunak pledged the fastest improvement in NHS waits in history. But in practice the NHS is struggling to increase activity and achieve this. Indeed, fewer patients were treated in the between February and December 2022 than in the same period in 2019.
The NHS’s problem is this: the flow of patients through care pathways is blocked. And one of the biggest blockers is the inability to discharge patients from hospital to social care. Nearly four in ten delays to discharge from hospital are due to patients waiting for social care services. Or in other words, the lack of staff, space and capacity in adult social care is preventing the NHS’s recovery.
And what is too often ignored is that a weak social care offering causes economic damage too. This happens through two main routes. Firstly, if the state cannot provide care, at least some of that is picked up by family and friends, mostly women. Unpaid care is incredibly hard to balance with paid work. Carers UK estimates that on an average day, 600 people quit their job to provide unpaid care.
Secondly, unmet care makes it harder for people to participate in the economy, even though they would like to and would benefit from this. Research by the Institute for Public Policy Research’s Commission on Health and Prosperity recently showed that, as of 2020-21, more than a third of requests to local authorities by working age adults for social care led to “no further action” – code for “rejected”. Councils have neither the staff nor the funding to meet growing demand.
That means hundreds of thousands of people are not getting any care at all – let alone at the level and quality they need to lead flourishing, independent lives. That is an obvious barrier to them finding and keeping high quality, meaningful work.
It is surely this economic dimension that most clearly exposes the incoherence of the government’s approach to social care. Last month, at the Budget, the Chancellor announced a major and welcome expansion in childcare based on a universal model. He justified this expansion by the need to get people back to work, among other reasons.
Exactly the same logic could have been applied to adult care: a new, long-term vision for better lives and a stronger economy. Instead, this government has allowed its vision for adult social care to fade away, leaving merely the dimmest shadow of the bold reform it offered in its manifesto in 2019.
[See also: Jeremy Hunt didn’t fix anything]