The UK government has published details of how it plans to reform adult social care in England. On December 1, in the House of Commons, Care Minister Gillian Keegan introduced an “ambitious 10-year vision”, which was first promised four years ago and is entitled People at the Heart of Care.
The white paper lays out how the government intends to spend the funds raised by the new health and social care levy announced in September. Much like the £86,000 cap on lifetime care costs, on which the House of Commons voted in November, however, it has already proven controversial.
In 2019, Boris Johnson promised, in his first speech as prime minister, to “fix the crisis in social care once and for all”. And Keegan was emphatic that the government is determined to get it right. “After all,” she said, “we cannot be serious about levelling up unless we are also serious about social care.”
Keegan’s Labour counterpart, Liz Kendall, and former Tory health secretary Jeremy Hunt, among others, were unimpressed. The plan, they claimed, fails to deal with immediate pressures on the social care system and in particular on its workforce. In the long term, meanwhile, it proposes little that is new. Crucially, the white paper is vague on key details and the government’s budget for it falls far short of what’s needed to make it happen.
The broad aims of the plan – to give people “choice, control and support to live independent lives”, through care and support that is fair, accessible and tailored to their needs – are not new. These basic principles have been widely discussed since at least 2005.
The specific proposals outlined cover similarly familiar territory. It offers modest new funding to explore ways of tackling major and longstanding care workforce issues, including the need for upskilling and better working conditions, but nowhere near enough. In many areas, services similar to those proposed existed in various forms before the austerity-induced cuts of the 2010s and the havoc wrought by the pandemic.
Keegan says the new plan addresses past governments’ failures to invest in preventative services or to focus on wellbeing. The new funds are being allocated to several things that will make a difference: greater uptake of technology and digitisation (£150 million); a practical service to make minor repairs and changes in the homes of people who receive care; enhanced housing options for supported living (£300 million); support for unpaid carers – family members, neighbours and friends – who provide invaluable informal care, and whose rights to support under the Care Act 2014 have yet to materialise in practice (up to £25 million).
Elsewhere, a campaign and new website are planned to help people find out more easily how to get the care they need. Finally, to tackle longstanding problems with vacancies and recruitment, £500 million is set aside for care workforce training and development.
While welcome, all of this is significantly less than the amount the House of Commons Health and Social Care Committee called for in 2020. Hunt, who chairs that committee, said £7 billion would only be enough to “meet demographic and wage pressures, as well as the catastrophic care costs faced by people with dementia or other neurological conditions.”
For Hunt, the government’s new plan thus represents “three steps forward and two steps back”. As an investment, it falls far short of what is needed to fund local authorities’ core responsibilities or to tackle the now urgent care workforce crisis.
In 2019, the House of Lords Economic Affairs Committee put the cost of reforming social care at £8 billion a year. The total allocated here, over three years, however, is £5.4 billion, £3.6 billion of which is already earmarked to fund the care costs cap and more generous means testing.
Unpaid carers, of whom there are an estimated 13.6 million, get mere crumbs from the table: how far will £25m go to improving the support they get? Some disabled and older people may get modest and much needed extra help to live independently at home. Conversely, the unmet need and pressures spilling over from social care into the NHS lack the attention they urgently require.
Crucially, despite everyone from think tanks, care sector organisations, charities concerned with older and disabled people and carers and parliamentary committees long emphasising the need for a radical overhaul of the system, this plan suggests the government does not appreciate the urgency.
Workforce shortages alone amply demonstrate this need. Even before the pandemic there were upwards of 124,000 vacancies. By 2030, projected shortages (due in part to an ageing population) are set to rise to 627,000 care worker vacancies in England alone. This plan does little to address either the immediate problem, for this winter, or the longer-term issues of low pay and poor working conditions.
Since 2010, the UK’s Conservative-led administrations have had a mixed record on social care. While the Care Act 2014, under David Cameron’s Coalition government, was undoubtedly a high point – putting fairer care funding recommendations, new rights for carers and the core principles of wellbeing and prevention into statute – its reforms were inadequately funded. And subsequent administrations delayed many of its key provisions.
The government’s new vision is one almost everyone else has long been signed up to. But few think the plan provides adequate detail or funding to make it a reality. Care is the crucial underpinning of all our everyday lives. Merely tinkering with the system, as this long-awaited white paper does, leaves me disappointed and angry about what could, and should, have been offered.