Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: The social care white paper provides few solutions to an urgent crisis

BMJ 2022; 376 doi: (Published 19 January 2022) Cite this as: BMJ 2022;376:o107
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}
    Follow David on Twitter @mancunianmedic

Last September, the response from policy experts to the government’s Build Back Better: Our Plan for Health and Social Care1 was one of disappointment and frustration. It had been trumpeted as a plan to “fix social care.” It did no such thing.

In response, the health secretary, Sajid Javid, briefed the media that the forthcoming white paper on adult social care would contain radical and detailed plans that went much further. When People at the Heart of Care was finally published on 1 December,2 it fell well short of anything radical or transformative to tackle a social care sector facing an existential crisis,3 with serious implications for the lives of people needing care and for the NHS itself.

Since 2010, Conservative led governments have cut local government and social care budgets, ditched a commitment to legislate implementation of the Dilnot Commission on social care funding, and presided over a fall in the number of adults receiving social care and a growing market failure in care home and home care provision. The social care workforce now has around 100 000 vacancies, with staffing gaps even worse than those in the NHS.

The Health Foundation’s masterly 2021 analysis revealed a social care funding gap of around £5bn just to restore social care provision to 2010 levels, £10bn to extend provision to all people with moderate needs, and £15bn to remove means tested co-payments for care.4

Even between the publication of Build Back Better and the white paper, the government backtracked on commitments about the assets ceiling for care payments. This will hit people with moderate assets proportionately harder than those who are wealthier, whose assets will be better protected by these “reforms”—hardly the “levelling up” the Conservative cabinet keeps claiming credit for.

The white paper says nothing of note about expanding the social care workforce or filling the vacancies, ensuring better pay (when other industries with recruitment gaps are competing for staff), or altering immigration rules. It says nothing on widening access to adult social care. And it acknowledges that the long term vision and statutory provisions of the 2014 Care Act,5 a well regarded piece of legislation, have not been implemented—leaving people, especially carers, short of the support and assessment they’re legally entitled to. The government could have done more to implement and fund the ambitions of the Care Act in full, instead of introducing more primary legislation.

There are some welcome pledges: £500m for training, qualifications, and skills in social care; £150m for technology to support care; and £300m to integrate housing into care strategies, including more use of supported living. Much smaller amounts are pledged to support carers, to repair and adapt disabled people’s homes, and to help localities implement change.

None of this comes close to “fixing” or “solving” adult social care, better integrating it with healthcare and public health, reversing years of cuts, expanding access, or solving the recruitment and retention crises that seriously threaten social care services.

The commitments in the white paper fall farcically short of the big rhetoric and “boosterism” pumped out by ministers. The most I dare hope for in this parliament is some one-off emergency cash injections and a relaxation of visa rules. Social care has certainly not been fixed.