Spring budget: cash for social care and a green paper on future fundingBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1281 (Published 14 March 2017) Cite this as: BMJ 2017;356:j1281
- Correspondence to: C Ham
The spring budget delivered £2bn of new funding for social care over three years from 2017‑18 and a commitment to publish a green paper outlining options for future funding. The government’s decision to find additional resources reflects the huge pressures facing social care in England, which the Care Quality Commission described as near “tipping point,”1 and the effect of these pressures on the NHS. These resources will go some way towards stabilising social care, even though they fall short of the sums independent commentators have argued are needed to bridge the expected funding gap by the end of this parliament.2
The announcement of a green paper, planned for the autumn, fulfils the prime minister’s commitment to explore ways of making the funding of social care sustainable. Several options are likely to be considered, including compulsory social insurance as used in countries such as Germany and Japan; acting on the recommendations of the Dilnot report to introduce a cap on care costs, which was included in the Care Act 2014 but has yet to be implemented; and the development of private insurance and savings products such as a care ISA. The only option explicitly ruled out is the so called death tax, proposed by the last Labour government, under which care costs would be recouped from the value of people’s estates.
New funding for social care is very welcome, and it should provide some reassurance to hard pressed local authorities and care providers, which have been exiting the market in increasing numbers. Among other things, it will help cover the cost of the national living wage in 2017-18 and will shore up the provision of home care, where waits for care packages explain a 51% rise in delayed transfers from hospital in the past 12 months alone.3 Most importantly, new funding will provide some relief for older and disabled people needing care and their families, who have experienced deep cuts in services since austerity began to bite in 2010.4
National NHS leaders expect that extra spending on social care will free up 2000-3000 hospital beds and enable the NHS to get back on track in delivering the four hour emergency department waiting time target and other government priorities.5 The logic here is that enhanced provision of social care will reduce delayed transfers of care and release beds for use by patients waiting for admission from emergency departments or for planned surgery. At a time when local authorities are facing severe financial challenges and competing claims on their budgets, rigorous oversight will be needed to ensure that the new funding reaches social care.
Work on the green paper will be able to draw on at least four independent reviews and 12 white and green papers over the past 19 years. Previous failure to act on these reviews does not bode well. Paying for social care remains the last major risk for which insurance, either public or private, is not available, with predictable consequences. Publicly funded care has become a threadbare safety net for relatively poor people with the highest needs, and privately funded care may incur catastrophic costs for people requiring long term care. Add to this the way in which people who pay for their own care currently subsidise people receiving council funded care, and the argument for a more equitable approach to funding is compelling.
The unwillingness of successive governments to increase public funding has been a major obstacle to reform and explains lack of progress in finding a sustainable solution. A notable, albeit partial, exception is Scotland, where the devolved government has found funds to support a more generous system of paying for personal care for people assessed as needing it, with people admitted to residential care being expected to contribute to their accommodation costs. Scotland has not been affected to the same extent as England by rising delayed transfers of care in hospitals, suggesting that its distinctive approach has helped it meet growing demand more successfully, as well as being beneficial for people needing care.6
A sustainable solution in England must bring together funding of the NHS and social care to make it easier to deliver the integrated health and care services required by an ageing population for which frailty and multimorbidity are among the greatest challenges. One way of doing this was outlined by the Barker Commission, set up by the King’s Fund.7 The commission proposed that there should be a single, ring fenced health and social care budget funded by increases in taxes and national insurance contributions and by redirecting some of the funds currently used to pay for universal benefits for older people.
Criticism of the government’s plans to increase national insurance for self employed people in the spring budget suggests that any proposals to raise taxes and national insurance will face resistance, but hard choices are necessary if social care funding is to be put on a sustainable footing. The alternative—short term fixes to deal with recurrent crises—is simply not credible if the government is committed to finding a long term solution. The additional funding provided in the budget has bought some time, and more fundamental changes should now be pursued with urgency.
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.