Unfinished business

By Ann McGauran | 04 May 2021

Early last month, well within his first 100 days in office, President Joe Biden announced his $400bn plan to expand home and community-based care.

Biden’s fast action has thrown Prime Minster Boris Johnson prevarications with laying out a long-term plan for social care into even sharper relief – a point made by a number of speakers at last week’s Association of Directors of Adult Social Services (ADASS) virtual spring seminar.

Mr Johnson’s words on the steps of 10 Downing Street on forming the Government in July 2019 were that ‘we will fix the crisis in social care once and for all with a clear plan we have prepared’. But the country is still waiting for deeds and cash.

Fast forward nearly two years, and outgoing ADASS president James Bullion spoke out angrily ahead of the spring seminar on what he said was the failure by successive governments to sort out the care system. Failure to reform had led to countless avoidable care home deaths during the pandemic, he believes.

Secretary of state for health and care Matt Hancock pledged at the seminar that the Government ‘will be bringing forward proposals later this year’ setting out reforms that are needed for the long-term future of social care. The COVID-19 crisis had hit social care hard, he acknowledged.

But there’s no more time to wait for reform, said ADASS’s new president Stephen Chandler, who told delegates that society had, over the last 12 months, ‘learnt so much about the difference high quality compassionate care and support makes to millions of individuals’ and families’ lives every day’. 

Former health secretary Jeremy Hunt, who is now chair of the Health and Social Care Select Committee, said it is ‘now or never’ for meaningful reform. Social care, he said, was ‘going to get something like the [NHS] ten-year plan, but the more noise we make the better the chances of having something substantive in that plan’.

If a tax rise is needed, he said he would support that, adding: ‘Which MP from which party is going to oppose any kind of tax rise to support the [social care] system?’

Caroline Abrahams is co-chair of the Care and Support Alliance of 80 charities campaigning for better social care. On reform, she said: ‘You can’t do it if you haven’t got the dosh – and as far as I can see you haven’t got the dosh.’

She said it seemed the Government is ‘thinking about a cap on catastrophic care costs’. But what older people are more concerned about are problems accessing care, she told delegates, and  ‘a care cap is not enough on its own’.

Sally Warren is director of policy at the King’s Fund and a former director of social care at the Department for Health and Social Care (DHSC). She highlighted how the small size of the DHSC adult social care team as the pandemic hit has left the Department ‘learning lessons about capacity’.

Going into the pandemic the DHSC had the smallest team working on social care for about 15 years, she said. ‘We had about 50 people working on adult social care, so I think one of the things they learned is that they didn’t have enough capacity and capability to understand what was going on, and they are now expanding the team to closer to 300.

‘What that’s meant is there has been a big influx of people new to the sector and the policy area coming in over the last 12 months, so [there has been] a really steep learning curve, and then doing all of that learning about the sector in the context of a pandemic.’

The DHSC has suggested a ‘number of small steps in the Health and Social Care Bill around adult social care about data collection, payments to providers, the Better Care Fund’ and other issues. But she added: ‘This does not at all cohere to a vision for social care for me….. I want to see a much clearer articulation of what the vision is.’

 As someone who has negotiated many spending reviews with the Treasury, she reminded delegates that the public finances are ‘going to be in an astonishingly difficult situation in the next few years. So getting public funds is going to be highly competitive’.

There is a real challenge for the sector ‘about how we collectively have a unified voice to really push the need to invest in social care, and why that is an investment and not a cost’. There is no money to have a ‘Beveridge moment’ in one go, she concluded.

The Prime Minister met the chancellor recently with the intention of starting intensive work to solve the crisis. But even with the Queen’s Speech around the corner, there is no certainty that Mr Johnson’s ‘clear plan’ for reform will be one of the more than 25 bills in the legislative programme. The wait for action drags on.

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