Plans to reform adult social care fall short of promises, say critics
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2980 (Published 02 December 2021) Cite this as: BMJ 2021;375:n2980
The government’s long awaited proposals on adult social care have been criticised for failing to tackle the current high levels of unmet need and workforce shortages.
The white paper for social care reform, People at the Heart of Care,1 sets out how £1bn (€1.18bn; $1.33bn) for system reform will be spent over the next three years:
At least £300m to increase the range and amount of supported housing available
At least £150m allocated to new technology and digitisation to support independent living and improve the quality of care
At least £500m towards improving training and qualifications for the social care workforce
A new service to make minor repairs and changes in people’s homes to help them remain independent and safe in their homes, as well as an increase to the upper limit of the disability facilities grant for home adaptations such as stair lifts, wet rooms, and home technologies
£70m to help local authorities improve the delivery and standard of care
Up to £25m to kickstart a change in the services provided to support unpaid carers and increase access to respite services, and
A national website to provide information for the public on social care, along with £5m to pilot new ways to help people access the care and support available.
Announcing the plans in the Commons, Gillian Keegan, minister for care, said, “The lives of millions of people will be improved by our plans for social care supported by significant investment for system reform to deliver the person centred care we need.”
But the shadow social care secretary, Liz Kendall, said, “Ministers have utterly failed to deal with the immediate pressures facing social care as we head into one of the most difficult winters.” She said that the plan would not deliver extra staff and that another 500 000 care workers were needed by the end of the decade.
Danny Mortimer, deputy chief executive of the NHS Confederation, said that the plan was not ambitious enough. “The government must act now to support the social care sector and its workforce,” he said. “To stem the haemorrhaging of staff, one immediate measure should be to offer a £1000 retention bonus to each worker, as well as to add care workers to the shortage occupation list.”
The spending plans will be funded by the increase in national insurance contributions from next April.2 Of the money raised by this health and care levy, £5.4bn will be spent on social care over the next three years, with £1.7bn earmarked for improving services. The remaining £3.6bn will fund the more generous means test for receiving local council support and the new £86 000 lifetime cap on care fees. Further details on how the remainder of the £1.7bn will be allocated over the three years will be “confirmed in due course,” the government said.
“Barely enough”
Think tanks said that the white paper fell well short of what was needed to deliver the prime minister’s promise to “fix social care once and for all.”
Hugh Alderwick, head of policy at the Health Foundation, commented, “The funding provided by government for social care over the coming years is barely enough to meet growing demand for care—let alone improve and expand the system and provide care to more people who need it.”
He said that the high levels of unmet need and workforce shortages would need additional funding of around £7.6bn in 2022-23, rising to £9bn in 2024-25, over and above that provided for in the spending review.
Sally Warren, director of policy at the King’s Fund, said that the overall vision was the right one and if delivered could significantly improve the experience of people receiving care and those working in the sector. “However, the steps outlined don’t go fast or far enough to achieve this vision, and the funding allocated to deliver it is insufficient,” she said. “In particular, although there are some welcome commitments on training and skills for staff, there is little to tackle poor workforce pay and conditions and high vacancy levels in the sector.”
And Natasha Curry, the Nuffield Trust’s deputy director of policy, said, “There is a question about how thinly the funding committed to these proposals will be stretched. The money allocated must fund the cap on costs and higher means testing, as well as make care fees fairer and support providers of care at risk of collapse.
“Beyond the initial three years of the levy, it also heavily banks on the actions of future governments and the assumptions that funding raised can be diverted from the NHS to social care.”