Another winter, another set of broken records for the NHS. A&E waiting times for December hit their worst level on record, with 2,000 patients waiting 12 hours for a bed. Experts cite the struggle to find social care support as one of the key causes of increased pressure. 

Demand for social care is rising, but cuts in services mean that less people receive care. Tens of thousands of older and disabled people are being denied basic support such as help with washing and dressing and overall Age UK estimates suggest there are 1.4 million elderly people not receiving the care they need.  

The impact is familiar, neglected health conditions worsen, piling on the pressure to A&E and an inpatient hospital beds. The lack of social care packages also means many patients are stuck in hospital waiting for a social care packages. 

Providers and Royal Colleges speak out as NHS performance falls to its worst ever level

After a period of funding cuts, the government is putting more money into social care, but like the health service, social care is also facing a workforce crisis. Staffing shortages in the social care sector stand at 122,000. To meet the needs of the ageing population, there is a projected need of 580,000 additional social care workers by 2035. 

Boris Johnson pledged to fix the social care crisis in his first speech as Prime Minister. The Conservative manifesto said it would put £5billion towards social care over the next five years – but so far no plan has emerged. 

How is social care funded currently?  

The funding of social care is complex and confusing, with many people unaware of the potential costs involved until they reach a point of needing the services, but in reality it rarely ends up being free. 

Even if you have care needs resulting from healthcare conditions like dementia or Parkinsons disease, you will only receive NHS funding for significant and ongoing problems. 

People with dementia typically spend £100,000 on the care they need, according to the Alzheimers Society. 

Otherwise you will be directed towards your local council who are responsible for organising social care services. People with assets over £23,350 must pay for their own social care.  

Even for those who get help, cuts to council funding – 5% in real terms since 2010/11, have meant that less care is available and despite recent funding increases, spending is still around £1 billion less than it was at the start of the decade.  

As a result, the number of elderly people receiving publicly funded care between 2009 and 2016 fell by 400,000. 

What has been suggested to solve the social care crisis? 

Various commissions and reports have been dedicated to solving the deep-rooted issues in social care over the last 20 years. Governments of all colours have kicked the issue into the long grass, fearful of confronting voters with extra taxes or insurance payments. 

The Royal Commission on Long-Term Care in 1999 called for care costs to be split between living costs, housing costs and personal care. They suggested that personal care – help with washing, feeding and medication be free at the point of use. This was rejected by the then Labour government, but was adopted in Scotland. 

The Dilnot Commission in 2011 set out plans to protect people from extreme care costs, which the King’s Fund described as a ‘costed and credible’ way forward. It recommended a cap on care costs after which the state would pick up the bill. 

The Barker Commission in 2014 went further by calling to establish more equitable support by removing the barrier between health and social care, introducing a single ring-fenced budget and raising the amount of free social care. 

Election debate 

In the midst of many promises at the latest election, the Labour Party proposed plans for a ‘national care service’ with free personal care for over-65s.  

However, the pledge had little detail to it and the £11.1 billion funding pledge still falls short. In fact, a Health Foundation analysis found that none of the main party’s election promises pledged enough to meet growing demands. It estimates that an additional £12.8 billion of funding would be needed to bring back social care to the access levels of 2010/11. 

Election rhetoric didn’t address the true challenges for the NHS

Amongst the plans from charities and campaigners is a report by The National Pensioner’s Convention – Sustainable Funding for Social Care, which describes in more detail how a National Care Service might work.  

Their plan is costed at £12 billion and would provide free domiciliary and residential care to service users who are currently self-funding. It would also expand to cover: 

  • 1.2 million older people whose needs are currently excluded from the system, 
  • modernisation of residential homes,  
  • improved terms and conditions for care staff,  
  • and improved monitoring and regulation.  

There are various options available for funding this cost outlined in the report. Including:- 

  • restricting pension tax relief to 20% for all earners, raising an annual £12 billion 
  • reversing previously proposed corporation tax cuts from 20% to 17% could save £7.5 billion. 

What is the Government doing now? 

In November 2019, PM Boris Johnson announced to business leaders that he would be shelving the planned reduction of corporation tax. Instead he pledged to spend the savings on public services.  

However, the Tory election manifesto failed to outline any solid plans on social care. It pledged a vague plan to “build a cross-party consensus on long-term social care funding” and only an additional £1.1 billion in funding, well short of the £12.8 billion figure outlined by the Health Foundation. 

Calls for a cross-party consensus which have not been unachievable in the past seem less necessary for a Government that has a big enough Parliamentary majority to push through its own agenda. So where is the big idea and what principles will govern their approach?  

The last detailed Tory policy pledge on social care was announced by Theresa May during the 2017 election, The idea was that people would pay for care until their assets had fallen to value of a £100,000 – including their house, but payments after death could eat into any inheritance. It was dubbed a ‘dementia tax’ in the press and subsequently dropped.  

Ever since there has been a palpable reluctance by government to move forward on the issue. Publication of Green Paper on Social Care was repeatedly postponed and is now three years overdue, originally planned for the summer of 2017, but delayed by an election, Brexit negotiations and more elections.  

Despite the delays, social care still sits at the top of the PMs in-tray and his own stated priority list and so surely it can’t be avoided, or can it? 





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MA Poverty and Development Graduate - Institute of Development Studies.

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