England & Wales Finance, Health and social care, Public health

A new deal for social care


“Adult social care has been ‘unfinished business’ for what now seems forever”, writes LGIU’s head of briefings, Janet Sillett. This blog addresses the chronic problems that undermine adult social care and discusses how the pandemic represents a pivotal moment for reform.

The LGIU had just started a project on ideas for local government and care when the pandemic struck. Now, as we are hopefully going into a transition before recovery, we are returning to these thorny issues, and social care is at the top of the agenda.

Adult social care has, of course, been ‘unfinished business’ for what now seems forever. Since the 1990s, successive UK governments have committed to reforming the system, particularly the funding of care, but nothing radical has changed, despite Commissions, including a Royal Commission, reviews, green papers, white papers, and numerous expert reports. The UK government’s proposed green paper has been delayed now for several years. Adult social care suffers from chronic underfunding and is now more than ever in need of a new sustainable funding mechanism.

The House of Commons health and social care select committee’s recent report on social care paints a bleak picture of a system on the brink of failure. The HSCSC heard evidence that people were not getting the care they need, staff were under pressure and feeling under-valued and under-recognised, resulting in a high turnover while providers often struggled to operate. Coupled with demographic change the HSCSC concluded the system was at real risk of collapse.

Covid-19 has exposed and exacerbated the failings of the social care system. Social care was never going to be able to withstand the enormous shock of the virus without there being huge challenges – both home and domiciliary care were fragile before the outbreak. The sector had little resilience to major disruption. Increasing provider failure was likely. The huge commitment of those who work in social care has meant the system hasn’t collapsed, but it is a system that is at risk.

What are the critical areas that need urgent reform and does the government’s health and social care white paper have the answers? It has many welcome proposals for change, including for much stronger collaboration (though there are questions about how it works at the local level and where decisions will be made), but it is silent on the key issue of sustainable funding. Without the funding issue being addressed can the positive changes in the white paper be achievable?

How much longer can the government put the green paper off? It isn’t like there are no ideas for reform – the King’s Fund says that ‘in the vacuum caused by the ongoing absence of the green paper, a series of parliamentary committees and other bodies have argued that reform is urgently needed and outlined proposed reforms. Many of the reforms involve some variation on free personal care, echoing the Sutherland commission in 1999’. They highlight that the calls for radical change are not limited to left-of-centre bodies such as IPPR: its advocates now include (some) fiscal conservatives.

How personal care is paid for is not the only outstanding issue. The care workforce has been essential in the pandemic but is seriously underpaid, with insecure jobs. Low pay, inadequate training and lack of status have to be addressed and working conditions improved.

Closer working between health and care has long been a mantra of governments and the sector – with some successes, but Covid-19 has highlighted the differences in how social care is regarded centrally compared to the NHS. Certainly, at the height of the first wave of the pandemic, care was the Cinderella service. It is nonsense that the interdependency of the two services is hardly recognised. The select committee recommends that the UK government should introduce a ten-year plan for social care, in the same way as one is produced for the NHS, subject to similar levels of planning and, through that, a strategic approach developed to address some of the fundamental issues of pay and conditions.

Social care has been, and remains, high profile during the pandemic crisis in ways it has not been previously. There has been a groundswell of support for reform. If not now, then when?

This blog was originally published by Social Care Today.


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