From the reporting of last week’s announced reforms to the
social care system in England, you might be forgiven for thinking that the key
issue was National Insurance contributions, or broken election promises, or even
grand political gambles. Fascinating as this is (for political nerds like me at
least) it is a serious problem that in the one week when social care is at the top
of the news agenda, remarkably little attention has been given to those who need
its help or do the hard work of delivering care day to day.
What is even more troubling is that the Command Paper presented
to Parliament introducing the changes to social care goes into huge detail on
the tax issues (including a section on the rather niche issue of freeports)
without telling us much about how the extra money will improve the quantity or
standard of care available to families in need.
Huge demand, but often overlooked
Around two million new requests are made to local authorities in England for social care each year. However, despite its huge scale and importance, social care has never had the recognition, funding or public support afforded to the NHS. Perhaps this is because unlike the NHS only one in seven of us have direct contact with social care services any given year[, or perhaps it is because it provides unglamorous care we hope we will never need ourselves, to people who we would prefer not to think about.
For whatever reason, social care has been politically easy
to forget. The Dilnot
Report from which the main ideas for the current reforms are drawn was
published over a decade ago, and was commissioned because by 2008 the social
care system had been widely regarded as increasingly inadequate for a decade
before that. The report was widely welcomed, but despite frequent political promises
to “fix social care”, the reality of the next decade was that the sector was
forced soldier on in the face of increasing need and dramatic cuts in funding. The
Covid pandemic then threw fresh attention on the challenges faced by the system.
Need for reform
The case for change falls into three broad areas of concern.
First, there are not enough social care services available to meet the need. Secondly,
care staff have persistently been undervalued and poorly paid. Finally, for
some people care is very expensive, even to the point of needing to sell their
home to pay for it.
The government’s reforms focus on addressing the third of
these concerns. It has changed the system for paying for care, introducing a
cap on how much people will have to pay for their care costs, funded through tax
increases. Broadly this is better for those with assets of £20,000, but for
those with less, very little changes. For those with large amounts of savings
or assets, perhaps a property in an expensive area, the system provides
assurance that this wealth will be protected. I understand why that is
important for many, and depending on how this assurance is paid for, it could
However, there are many other injustices about the social care
system which warrant attention. More than 1.5 million people need and are entitled
to care but are not receiving it – leaving many people who could thrive if only
their care needs were met. Workers are often poorly paid and not treated fairly,
and not all care is of the quality people deserve. Women disproportionately
bear the burden of care, both as low paid workers and as unpaid carers taking
up the stain caused by an inadequate care system. There are racial injustices
as ethnic minorities report less access and satisfaction with the care system,
and carry out a greater proportion of low paid care work. I could go on.
We do not yet know how much money these reforms will provide
for the social care system, but even if it was the entire £11 billion that will
be generated by the planned tax increases, it would still be £15 billion short
of spending the same proportion of national income on social care as in Scandinavian
countries. Beyond the funding reforms, there are very few commitments to change
or even provide additional resources to social care. Changing means tests and providing
a one-off above-inflation funding increase is certainly not going to be enough
to “fix social care”.
either as a person receiving care or a family member helping with arrangements