Following the government’s announced social care reforms in September 2021, JPIT’s Paul Morrison provides a guide to some of the issues involved.
What is social care?
Social care covers a wide umbrella of services to people of working
age as well as the elderly. It varies from light touch support to help people
stay active and engaged in their communities, to regular personal care visits
to help with washing or dressing all the way through to long term nursing home
care. For some, the care is simply essential for life, and for many more social
care offers the opportunity to maintain a dignified and connected life.
Good social care can transform lives, but bad or absent
social care can ever so quietly close people off and strip them of their
dignity. Both good and bad care often go unnoticed by all but very close
friends and family.
Who gets social care?
Adult social care is used by adults of any age whose needs[1]
are assessed to be significant enough to warrant support. The service is
particularly needed by people of pension age who account for two-thirds of the
800,000 individuals receiving long term care, and just under over half of all social
care spending. This does however mean that support for working age people with
disabilities or impairments forms a sizable and often overlooked component of
social care.
Why does social care need reform?
The case for change falls into three broad areas of concern[2]:
1. There are not enough social care services available to meet the need: Local authorities in England receive around 2 million new requests for help each year, and for a variety of reasons reject around 42% of them. The number of requests is steadily rising, levels of reported disability are rising, but the numbers receiving long term care are steadily falling. Other surveys indicate that 1.5 million over 65s who need and are entitled to care do not receive it. Increasingly stretched local authorities have had to spread their resources more thinly.
You only need to talk to families who have
dealt with the care system to know that the effect of this is to make it much
harder to ensure loved ones are cared for with dignity. The system can appear
to be a confusing, guilt inducing maze. Unfortunately to ensure good care families
are often required to have sufficient money to top-up the basic care packages
on offer, and/or the ability to put their case to the local authority
persistently and well.
2. Care staff have persistently
been undervalued: There are around 1.5 million people working in the care
sector. In Scandinavia, care work is viewed as a profession with progression,
training programmes, and wages at around three quarters that of a nurse’s. In
the UK care work is viewed as a low paid, low skill occupation with a limited career
pathway. By 2019 average pay had slipped back relative to other low paid jobs,
and for example is now below that of retail assistants.
The job can be difficult and demanding and given the low pay
and status we cannot be surprised that each year almost 1 in 3 carers leave the
profession (for home care workers it is nearer 1 in 2), and that recruitment is
a persistent problem.
Even if not financially rewarding, care-giving can be a
hugely rewarding job. However, when surveyed, three quarters of domiciliary
carers said that cost pressures meant they did not have time to provide
dignified care.
3. For some people care is very expensive, even to the
point of needing to sell their home to pay for it: Unlike the NHS, social
care is not free when you need it. Essentially if you have assets of over
£23,250 then you must foot the full cost of care, and may need to pay a
proportion of costs if you have assets below this threshold. The ‘housing
disregard’ means that if you need to continue living in your own home, the
value of your property is not counted in your assets, but if you move into
residential care it does then count.
Fees
for care can quickly become substantial, and the government estimates that 1 in
10 adults over will face costs of over £100,000.
What
reforms are being proposed?
The Command Paper contains 3 sections. The first about the
NHS, the second about social care and the last about a 1.5% rise in National
Insurance contributions to be branded “the Health and Social Care Levy”. The
increased tax will raise an additional £11 billion[3]
but to be divided between the NHS and the social care sector.
Changes to means tests: There is a fairly detailed
answer to the issue of families needing to pay high fees for care. It sets a
cap where once a person has paid £86,000 they will not be asked to pay any more
for their care.
The means test is also restructured, so that if you have assets
of less than £20,000, no care fees are payable; between £20,000 and £100,000 a
contribution of disposable income and up to £20,000 per year may be charged;
and over £100,000 the person must pay full costs.
The annual cost of this will be around £1.6 billion, but this
is not additional money to the sector to improve services – local authorities will
lose some fees from people with assets, but they are replaced by money from National
Insurance contributions.
Few specific commitments to social care: Ironically
for an announcement billed as ‘fixing social care’, beyond the funding reforms,
there are very few commitments to change or even provide additional funding to
social care. The paper says encouraging if familiar things about the system and
promises that a White Paper will be forthcoming, however the only money it specifically
offers the sector is £160 million per year to provide a helpline and other
support for care staff.
For context, the care system costs £23 billion a year, and
the Health Fund estimates that an additional £1.9 billion is needed to simply keep
pace with current demand. £160 million will not go far – nor does the paper
suggest it will. It is currently unclear how much of that £11 billion will go
to the NHS and how much to social care.
[1]
The criteria of sufficient need is set at what I found to be a surprisingly
high level and defined in the Care Act 2014
[2] Experts
will rightly accuse me of oversimplifying the issues. If you are interested in
more detail go to the excellent and readable Kings Fund Social Care 360 website
https://www.kingsfund.org.uk/publications/social-care-360
[3]
after taking into account increased benefit payments and costs to public sector
employers
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