OPINION: The Government's social care plan - fix or fiddle?

File photo dated 20/4/2021 of Boris Johnson who is hoping to be Prime Minister for another decade as

Prime Minister Boris Johnson - Credit: PA

Now the initial political noise surrounding the Prime Minister’s announcement about Social Care on September 7 has subsided it’s perhaps time to reflect.

Has Boris Johnson ‘fixed Social Care’, or is he now en route to it as he promised in 2019? Or have the promises and media statements merely been cover for political fiddling on one aspect only, important though it might be, and ignoring so many of the equally important and interconnected issues?

Let’s remind ourselves what Social Care is.

It’s what an advanced civilised country ensures for its more disadvantaged people, whether through disability, long term disease, fragile mental health, frailties of ageing or the life crises we all experience. It’s about the family members, unpaid carers and paid workforce who offer the support and assistance. The approaching 10 million of us adults at any one time in England in one role or another.

It’s also about the way care and support is experienced – respectful, individualised, joined up between services and as skilled as it needs to be.

This should be the starting point for any vision and joined up policy, funding and practice.

Perhaps that is what we will see in the Health and Social Care Secretary of State’s ‘White Paper for Adult Social Care’ now promised ‘later this year’, and the Chancellor’s forthcoming Spending Review & Autumn Budget.

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What the Prime Minister actually told parliament was that ‘the state should target its help at protecting people against the catastrophic fear of losing everything to pay for the cost of their care, and that is what this government will do’.

That’s not about Social Care. It’s about protecting people’s wealth and future inheritances.

The cost of this would be the 1.25% increase in national insurance, perversely weighted towards lowest paid people like care staff, as well as employer costs impacting on the financial sustainability of struggling care providers. 

The greater focus of the media was predictably more about the NHS, its understandable need for more investment in the context of Covid. But then so was 85% of the Health and Social Care levy income to the Treasury going to the NHS.

Significantly Social Care was, yet again, portrayed more as a support service to the NHS. Not about the far greater numbers of people living in their own homes in the community of all ages needing to receive a service, deemed failing to be eligible, or receiving one of insufficient or inadequate quality. Places where personalised support and preventative investment would much more sensibly be targeted through local government, and voluntary and community organisations. 

Surely this should be the starting point underpinning any announcement about Social Care?

So we heard or read nothing which addressed:

- The two million requests for care which have been turned down by Councils according to Age UK in the last two years.

- ‘Younger’ people, meaning anyone over 18 and mostly before their late 70s. Only people already in a care home or ‘delayed’ in a hospital bed needed by someone else seem a priority to the government. Indeed nothing about people with disabilities and other needs for care or support of all ages. Indeed, the latter are source of more than 50% of national expenditure on Social Care and the area of greatest demand and cost pressure on local Councils.

- The underpaid, insufficient and so often undervalued workforce in Social Care receiving only passing reference.

- The multiple organisational fragmentation of Social Care, most of it provided in the private sector, hugely varied in size and quality, and in too many cases with dubious ownership arrangements or financially unsustainable. 

- The £8 billion that Council political leaders of all parties and Directors of Adult Social Services say is the present funding gap, the £1.5 billion a year more needed to stabilise care providers (in a similar way to hospitals struggling to meet demand & costs), or the £1.1 billion needed annually for inflation, more people ageing and the national living wage.

- Indeed we heard that only £5.4bn of the £36bn from the health and Social Care levy, spread over three years would be spent on Social Care, the rest on the NHS. Almost all of this would be probably be spent on funding the ‘Social Care cap’ on care costs from October 2023, helping people who would previously pay for their own care.

So the answer to the question at the beginning of this ‘Opinion’ piece – ‘Fixed’ or ‘Fiddled’ must surely be obvious.

To date we have heard nothing from the Prime Minister which ‘fixes Social Care’. Maybe we will later this year? We have heard only of a plan to cap care costs. This was already legislated from when David Cameron was Prime Minister following the ‘Dilnot Commission report’, and then abandoned by the government in 2015 before implementation. Am I wrong to fear that we will continue to wait?

But sadly too, I hope this ‘Opinion’ piece will enable readers in Suffolk and North Essex to appreciate more fully the position of Councils, their staff and social workers when they hear: ‘the request’s not possible’, ‘you will have to wait’ and ‘I cannot say when’. This is too often the reality of Social Care in 2021 amidst personal distress, anxiety and despair while we all await the government’s ‘fix’. 

Brian Parrott is a former Director of Social Services and NHS Trust Chair. He is currently a trustee of two Suffolk voluntary organisations