Co-published with the Women’s Budget Group.
Jerome De Henau, Anna Johnston, Sue Himmelweit, Sara Reis, Mary-Ann Stephenson and Alfie Stirling contributed. Modeling by Jerome De Henau.
NEF and WBG thank Caroline Glendinning and Fran Bennett for their comments and contributions.
This report has a separate appendix here.
executive Summary
Successive governments have done little or nothing to address the worsening situation in social care, both for care recipients and caregivers. However, since the outcry over its failure to stop the spread of Covid-19 in nursing homes, pressure on the government to deliver on its promises has changed significantly. ‘Fix’ social care. In September, the government announced plans to introduce a health and social care tax on national insurance contributions, including an extra £5.4bn in social care spending over the next three years. On December 1, the government formulated a strategy ‘people oriented”.
The strategy presents a transformative vision for care to provide ‘Support those who need it so that as many people as possible can live the lives they want.” This shift may be at the heart of building a more caring society post-COVID People with additional needs due to disability or age have equal opportunities and greater control over their lives.
The problem is that the government has failed to come up with a realistic plan to achieve this vision with a realistic amount of money.The government’s attention and much of the extra money raised is aimed at ensuring ‘By capping the cost of care, no one has to sell their home to pay for care. The £1.7bn left over three years is simply insufficient to address the multitude of other problems facing care: unmet needs due to restricted access; unsustainable demands on family and friends; or poor supplies, jobs and working conditions. Unless these issues are fully addressed, the opportunities presented by the transformation of social care will not be unlocked.
Reforming the standards of social care
We believe that the problems facing social care are rooted in a common set of causes:
- survey of economic conditions. Publicly funded social care means-tested for both income and assets. Those who do not pass the means test receive no financial help from the state in organizing their own care. It has been described as the meanest means test in the welfare state. The freeze on the means test cap means it’s getting worse over time. While the government’s latest policy will change the level of means testing and introduce caps on care costs, the caps are high and only account for out-of-pocket care.
- insufficient funds. Funding cuts have caused local authorities to reduce the number of people they support and the level of support they provide. One result is that publicly funded social care is increasingly reserved for those most in need. Another is that self-funders are being charged exorbitant fees to cross-subsidize commissioned services by local authorities.
- failed market. For those who use local commissioned services, market competition has not worked as intended. Local authorities are forced to buy short-term methods of care packages through price-based competition among suppliers. To keep costs down, employee-to-customer ratios are kept to a minimum, tasks and work practices are standardized, and labor compensation and conditions are suppressed. Quality of care suffers.
Therefore, social care reform needs to meet two main criteria. First, it must close the funding gap or the difference between the estimated income available to fund services and the cost of meeting all care needs through high-quality social care. This will require a new financial solution capable of providing comprehensive social care free of charge when needed, expanding access to social care, and improving the quality of care and working conditions.
However, investments need to drive change in social care, not more. Therefore, secondly, reforms must close the implementation gap or the discrepancy between the reality of social care provision and the vision set out in the Wellbeing Principles of the Care Act.This raises admirable aspirations for nursing, similar to the call to independent living, the purpose of nursing is ‘Help people achieve the outcomes that matter to their lives.”
Recommendations for universal quality social care services
To close the funding and implementation gap, we propose three broad policy solutions:
- Generous settlement of new funds. In our core scheme, the cost of additional care under the Common System is £19.6 billion per annum. At the same time, raising the wage rate to a real living wage would require an additional £12.3 billion. This should be a priority.
Our proposal is more expensive than many of the other more incremental reforms proposed in the current debate. Unlike other proposals, however, we combined the costs of all reforms to assess how much it would cost to address these issues in one round, rather than tackling each issue in isolation. And income can be increased.
In addition to this urgent priority, transformative care systems will expand services to a wider group of people with intermediate care needs, while improving the quality of care through higher levels of training and skills. This in turn requires higher wages, bringing UK nursing staff wages more in line with those in the Nordic countries, at around 75% of nurses’ wages.
- Expand the role of local authorities. We recommend that local authorities should work with people in need of support and their families to develop and implement a long-term strategy to transform supply in line with the wellbeing principles in the Care Act. This means placing the principle of co-production at the center of social care. Achieving this goal will involve (1) a shift in the organizational nature of provider organizations receiving public funding from for-profit to provider, and (2) a step-change in relationships with local governments and provider organizations. Instead of short-term, cost-driven competitive tenders, local authorities should turn to cooperation and strategic partnerships to achieve common goals.
- A new state agency to drive improvements. The creation of a new national agency will work with local authorities to transform the way social care is delivered. It will set and enforce high standards for quality of care and work, and share and disseminate local good practice. A reformed Care Quality Commission (CQC) should go hand in hand with a new body to oversee the workforce.
Photo: iStock
