Social care is set to be a central theme in the forthcoming UK general election. In the first electoral debate, held on June 4, 2024, Labour leader Keir Starmer promised a full plan to be published within the party’s manifesto. Sunak was altogether vaguer on what the Conservatives aim to do.
Whomever ends up in govermnent, adult social care will be one of their biggest challenges. Since the financial crisis of 2008, the problem of how to provide it to an ageing population has reached a critical level.
In England alone, 2.6 million people over the age of 50 cannot currently access the care they need. The devolved governments of Scotland, Wales and Northern Ireland all spend more per capita on social care than the Westminster government spends in England.
And yet, as government funding for social care has declined, recipient numbers have dwindled there too.
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Care professionals face a medley of work-related challenges, which undermine their capacity (and therefore the capacity of the state) to provide care. Adult social care providers say low pay, high pressure and staff burnout are driving care workers out of the profession – or at least leading to high staff turnover.
Most councils no longer provide care themselves, but contract with private providers, which are racking up high levels of debt. Care homes face closure, while private providers are exiting the market altogether. Councils, meanwhile, for whom care remains the biggest expenditure, are going bust.
Ever since the welfare state was established in 1948, Britain’s elected leaders have grappled with how to pay for and deliver social care. Research shows that central government austerity policies, implemented in the wake of the 2008 banking crisis, in particular, have driven a shift in the level and quality of care provided by the government. Community groups and unpaid carers have had to step in to fill the gaps left by insufficient funding.
The state of care
Across the four nations of the UK, narrowing eligibility, reduced staffing and delayed assessments for care have seen ever fewer people access the government-funded care they need.
More and more people are being kept in hospital when they could be discharged because they can’t get the care they need in the community. On January 9, 2022, of the 17,303 patients in English NHS hospitals ready to leave, only 4,907 were discharged.
One of the primary reasons experts point to is the lack of staffing. A recent report from the Care Quality Commission found that over half of the 1,900 providers of adult social care surveyed struggled to recruit staff, while 31% had challenges with worker retention.
Working conditions are largely to blame here. The social care sector has some of the highest levels of absence due to stress and mental ill-health, a situation significantly worsened by the pandemic.
Care workers are often paid less than the living wage. Most of those who do home visits – 75% – are not recompensed for the time they spend travelling to homes, which can make up nearly a fifth of their working day.
Meanwhile, recent reports highlight that many UK carers are being threatened with prosecution by the Department of Work and Pensions for making slightly more income than allowed.
The costs, meanwhile, to families and the local authorities which pay for people’s care, continue to rise. The weekly average (adjusted for inflation) of the cost of residential and nursing care in England has risen for both working-age and older adults.
In real terms, the average weekly fee which local authorities pay for working-age adults has increased by £135 since 2015/16, while the average weekly fee for working-age adults has increased by £172.
How did we get here?
In sum, care is getting worse and more expensive. The question is how this has happened.
In 2010, the Local Government Association (LGA) proposed reform to the law governing adult social care. Despite the LGA’s call for “a better alignment” between policy, resources and the law, the subsequent 14 years have been largely marked by stagnation.
Successive Conservative governments have announced new social care initiatives only to immediately revise them before they were even implemented. They have also moved social care from one government department (the Department of Local Government and Communities) to another (the Department of Health and Social Care).
This political indecision has come within the wider programme of austerity measures implemented after the banking crisis of 2008 left the UK’s economy and state services in tatters. Funding for adult social care has been severely affected.
The legal duty to provide adult social care in England lies with local government. However, in the first five years of Conservative rule, local authorities shouldered the largest reduction in central government funding – over 50%, between 2010–2011 and 2015–2016.
This dramatically weakened state-provided care services. At the same time, need only increased.
In 2014, with broad political consensus, the Conservatives introduced the Care Act. This made care funding means tested, meaning that an applicant’s income, savings, investments and property would be taken into consideration.
The legislation also implemented a cap on charges for residential care, intended to protect people’s assets. However, this cap has been repeatedly postponed, due to the magnitude of the financial pressures surrounding adult social care, and is now scheduled to be introduced in October 2025.
Three years later, in 2017, then prime minister Theresa May announced plans, dubbed the “dementia tax”, for elderly people with assets totalling at least £100,000 to pay for their own care. The idea was strongly criticised as a mechanism by which people could lose much of their assets.
May acted to quell these concerns with promises to consult on a cap for care costs, an approach which would see those with most assets lose the smallest proportion of these.
Under May too, however, social care policy proposals were repeatedly delayed before being indefinitely postponed. This created a political vacuum. People in need were left waiting.
Then, in 2019, on day one of his premiership, Boris Johnson said he had a “clear plan” to fix social care. It took him two years to share that the plan was to pay for social care via national insurance and taxation.
This would have shifted the costs on to younger generations who themselves face a distinct set of financial challenges. Social work expert Jon Glasby quipped that Johnson’s plan wasn’t very clear, wasn’t really a plan and wouldn’t fix very much.
That same year, local councils were granted permission to increase the social care precept, a local tax ringfenced for social care. But the funding this provided was unequally distributed across the country. It also didn’t even come close to meeting the need. In 2019, English councils alone needed an additional £4 billion each year to meet social care needs.
Since the 1990s there have been at least 12 white papers, green papers, visions and major reviews. The fact that no government, to date, has come up with solutions commensurate to the looming needs of an ageing population, should give all campaigning parties pause in the run up to July 4.