After years of waiting, this autumn is seeing a flurry of documents which, taken together, make up a government plan for reforming social care.
With Build back better: our plan for health and social care and the 2021 Spending Review both announced, and a White Paper rumoured to be making an appearance within days, social care reform will be the hot topic of discussion at this year’s National Children and Adult Services Conference.
This week, The King’s Fund has published its own vision for social care in which we argue for an ambitious and attainable set of reforms. A radically realistic White Paper would have at its heart four core principles.
- Availability: access to the right services, in the right place.
- Personalisation: all care is personal to the needs, wants and ambitions of those who are drawing on it.
- Quality: all care is high quality, and delivered by properly trained staff, fairly paid for their work.
- Eligibility: everyone can get the care and support they need to live a comfortable and independent life, with the costs of care shared between the state and, if they can afford it, the individual.
Given the current starting point for social care – high levels of unmet need, high vacancy levels in the workforce, providers and commissioners struggling to fulfil their duties – it would be wrong to expect a leap to a better system in one single bound. It’s going to take time. What is needed is a clear vision of the type of social care society wants – and a mapped-out journey of how to get there, step by step, so we stay on track.
If we accept that reform is a journey towards a future vision, two key questions emerge for the White Paper. Is the White Paper’s vision the right one – is it what people who draw on social care want to see? And is there enough pace and ambition in making those first few steps towards it? Given the small pot of money associated with wider system reform – less than £2bn over the next three years once the money for funding reform is excluded – it feels like the ambition and pace will almost inevitably be a disappointment and the first steps on the journey to the vision will be too small and slow.
Supporting the social care workforce will be the totemic issue on which many people will judge that sense of ambition and pace. A £500m workforce reform fund initially sounds good – but £500m over three years for a workforce of close to 1.5m people? It starts to stretch pretty thin. And it fails to tackle one of the biggest issues – pay. A White Paper without a serious commitment to better rewarding staff will fail a key test of credibility and fail to solve one of the biggest problems facing the sector – how to attract and retain people with the right skills, experience and values. Recruitment campaigns and wellbeing support of course help – but risk playing at the margins unless something more fundamental is done too.
On the Spending Review, once the tables in the annexes are studied, it’s clear that the settlement for local government is not enough. It washes out at a like-for-like 1.8% increase in spending power when social care cost pressures – demographic change, wages, National Insurance Contributions and energy costs – are rising at a much higher rate. There will be some very tough choices ahead if local government is to balance the books.
Taken together, the commitment to a capped-cost model and an extended means test is a good step forward in reforming how the cost of social care is shared between the individual and the state. We now have more detail from government, and with less than two years to go until the new system goes live, detailed planning for implementation can start in earnest. The change the government has announced to how the cap works is deeply disappointing, reducing the protection from catastrophic costs offered to older people with lower wealth, and to working-age adults.
A second White Paper – on better integration between health and social care – is also rumoured to be landing on our desks next month. This one has prompted much less public debate and discussion. It should avoid the lure of a structural, one-size-fits-all fix and instead ensure that the levers we have across the system – be they financial incentives, workforce development, leadership, performance management and more besides – are aligned to support local leaders to deliver joined-up care that meets of the needs of their local communities. This might make for less sexy headlines but it will make for better policy and delivery.
Every day, people who draw on social care see the reality of services under enormous strain. Their expectations have been raised by the promise of a better system. This time, let’s hope they are not disappointed.
Sally Warren is director of policy at The King’s Fund