Welcome to the Research Brief, where Spotlight, the New Statesman’s policy section, brings you the pick of recent publications from the think tank, charity and NGO world. See more editions of the Research Brief here.
What are we talking about this week? “Adult social care funding pressures: Estimated costs to meet growing demand and improve services in England”, the latest report from the Health Foundation.
The Health who? The Health Foundation is an independent think tank and charity, which aims to bring about better health and healthcare for people in the UK. It regularly publishes reports and policy papers looking at the state of play in the sector, and the investment needed to improve the NHS and wider health and social care services.
What’s the gist? Adult social care is severely underfunded (as if we didn’t know that already), while demand continues to rise. Billions will be needed to meet future demand on services.
Why is demand for social care going up? This is due to our ageing population and the rising prevalence of long-term health conditions. By 2040, an estimated 9.1 million people will be living with major illness, which is 2.5 million more than in 2019. The Association of Directors of Adult Social Services says that the number of people awaiting assessment for care already increased by almost 100,000 between September 2021 and April 2022 – from 204,000 to 294,000.
So how much will all this cost? To meet demand, the Health Foundation estimates we need £600m more funding by 2024-25, and £8.3bn more by 2032-33 based on current projections around local authority spend. Spending will need to increase by roughly 3.4 per cent a year until 2033 to keep up with projected demand.
The report also looks at the cost of improving the existing system, as well as meeting demand; to meet future demand, while also increasing people’s access to care and covering all their costs, the sector will need £8.4bn by 2024-25, and £18.4bn by 2032-33. Spending would need to increase by 6 per cent a year until 2033.
What state is England’s social care system in right now? It’s riddled with problems, which has a domino effect on other bits of social infrastructure, such as the NHS. A lack of social care means that patients are kept in hospital beds far too long, causing backlogs to NHS treatment and surgery. The King’s Fund, another healthcare think tank, recently summarised the social care sector’s issues, which include: limited access to services and a postcode lottery, catastrophically high costs (some people pay more than £100,000 over their lifetime), unmet need with a high reliance on unpaid carers, variable quality of care, and workforce issues (such as pay and shortages).
How is the government going to raise £18.4bn? There’s no easy answer but the Health Foundation has previously suggested ways the government could raise the money to fund social care, mostly through taxation. Suggestions included increasing general taxation, introducing a specific tax for social care, taxing wealth (such as people’s estates), and taxing older people, such as by extending National Insurance contributions beyond retirement age.
What else needs to happen? The Health Foundation has four other key policy suggestions for fixing the crisis: stabilising and sustaining the current system, such as through tackling workforce issues like staff shortages and pay; improving access to care, such as through changing eligibility criteria for publicly funded care; providing social protection against care costs, such as through different levels of government cover or support; and considering a social care cap, which would cap lifetime or annual contributions to care.
Shouldn’t social care be free, like healthcare? That’s what the Labour Party thinks. Wes Streeting, the shadow health secretary, has committed to launching a National Care Service, if the party is to win the next election. The socialist Fabian Society recently published a roadmap of what a new public service for social care could look like.
In 2019, the then prime minister Boris Johnson proposed a series of reforms to address the crisis, including introducing a cap and changes to the means test for publicly funded care. However, reform has now entirely stalled, according to the King’s Fund, with reforms postponed until October 2025. Given that a general election is due no later than January 2025, these reforms may never be implemented.
In a sentence? The social care sector has been historically neglected – but as the population gets older and increasingly ill, more and more people will require social care in their lifetime, and funding must increase by billions to meet this demand.
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