By any standard the announcement of a new plan for social care, along with a brand new hypothecated tax to help fund it, ought to be a very big deal in the tortuous history of social care reform. First the good news. For the first time since 1948 there will be a limit on the financial liabilities of individuals for their care costs. This is a genuine extension of the welfare state which subsequent governments could improve and why the Treasury has resisted it for long.
More money is promised to pay for it. Some will benefit, especially from the more generous means test threshold. But we’ve been here before. The coalition government accepted similar proposals in 2014, it passed the legislation and found the funding, only for the Cameron Government to get cold feet within weeks of its election in 2015. So rather than a bold first step in reform, this is no more than winding back the clock to where we would have been five years ago. Had these proposals been implemented as planned, we would be having very different conversations now about the needs of older people, disabled people and carers. And given the intense political controversy over the plans, no one can guarantee that as 2023 approaches, this latest attempt at reform will get over the starting line.
Whatever the superficial gloss of the ‘Build Back Better’ plan, it is the looking at the numbers where it quickly loses its sheen. It’s clear that the lion’s share of the cash goes, as ever, to the NHS to tackle hospital waiting lists. There is little detail about the £5.4b promised for adult social care over the next three years other than a big chunk of it is for councils to pay a ‘fair rate’ to care providers and reduce the cross-subsidy from those who self-fund their own care (a move that is fraught with risk for councils and care providers alike). There will be implementations cost too. £500m is for workforce development, again over three years – welcome but barely covering the sides of what needs to be done. But there appears to be no new money to deal with lengthening waiting times for social care – 300,000 people are waiting for assessments, support or care reviews according to the latest ADASS survey; or the backlog of unmet needs, rising costs & and the imperative to do something about better pay and conditions for care staff. With mandatory vaccinations for care home staff on the way, the workforce crisis is deepening & still there is no national workforce strategy.
The Government has made it clear that these pressures must await the outcome of the forthcoming Spending Review but analysis by the Institute of Fiscal Studies of the implications for non-protected spending departments does not augur well for local government. Many councils will once again contemplate the grim option of further council tax and precept rises. Successive governments have been highly proficient in paying lip service to the integration of health social care whilst treating the financial needs of the NHS & social care totally differently. This is an abject failure in joined-up policy-making.
The pros and cons of the new health and care levy have been examined elsewhere and although some have welcomed it as a new funding stream, there are downsides. As well as being regressive, it will represent the seventh funding stream for councils’ social care budgets, adding to the tangle of the council tax, the social care precept, business rates, the NHS funding, government grants and user charges. This is not a sensible way of funding an essential public service. It adds to the complexity of the budget process & makes it impossible for citizens to understand who is accountable for local spending & outcomes. A further worry lies in the small print of the draft legislation indicating that the Treasury will decide how the proceeds of the new levy will be shared out between the NHS and social cares.
The government has a plan for asset protection but still does not have a proper plan for social care. The Government has acknowledged as much by promising a new White Paper on social care reform - and another one on integration with the NHS (though unless a big shake-up is on the cards it is not clear what this will add when integrated care systems are already developing and guidance aimed at local government too is mushrooming). No wonder so many involved in social care are so deeply disappointed.
Richard Humphries is a trustee at the Association of Directors of Adult Social Services (ADASS) and a senior advisor to the Health Foundation and Newton Europe