Whatever the Government’s wider legacy may turn out to be, an inevitable and unfortunate aspect will be our instinctive suspicion of numbers in Whitehall announcements. Too many headline figures have turned out to be not quite what was purported.
When, at the end of October, the Department of Health and Social Care (DHSC) announced details of a £42.6m Accelerating Reform Fund for innovative new projects in social care – and said it also ‘includes our commitment to invest up to an additional £25m to support unpaid carers’ – observers smelled a rat. They recalled that the initial announcement of the funding, in April, had been of ‘up to £35m’ for innovation alone. Had £35m plus £25m (albeit qualified in the small print as maximums) somehow become not £60m, but £42.6m?
Asked if it was short-changing innovators or carers, or both, the DHSC hastily clarified that the single pot included the full £25m for carers and that further sums for innovation would be forthcoming. We shall see.
If nothing else, the episode exposed the Government’s wholly self-inflicted wounds on social care. Such has been its 13-year record of failure in England to deliver either adequate funding or the reform that everyone accepts is woefully overdue, its capital is all used up. Even when there is some good news, its announcement or re-announcement is greeted with scepticism or, worse, is contemptuously dismissed.
A hopeful start?
This year began with hopes higher than for some time. Even the Archbishop of Canterbury, Justin Welby used his New Year message to call for a focus on social care in 2023, declaring: ‘We know our care system is broken. But it doesn’t have to be. We can rise to the challenge of fixing it.’
Welby was speaking shortly ahead of publication later in January of the findings of the Church of England’s commission on ‘reimagining’ care, the first of a fresh slew of reports urging reform, making the case for a new covenant setting out the rights and responsibilities of everyone involved in care. ‘Caring goes to the heart of what it means to be human,’ he said. ‘It’s hard. But it can also be the most beautiful life-giving thing that we ever do.’
There was what some mistook for a following wind: the previous autumn, Chancellor Jeremy Hunt had unveiled a two-year funding boost for social care that he described as ‘the biggest increase in funding under any Government of any colour in history’, amounting to (again) ‘up to’ £7.5bn. There was the familiar element of smoke and mirrors – some of the money was in fact for children’s services, much of it came from deferring again the long-awaited Dilnot reform package, probably shelving it indefinitely, and another big chunk was simply permission for local authorities to raise cash through council tax – but recognition of the sector’s plight was broadly welcomed. Appetites were whetted for a promised further announcement on reform.
That update duly arrived in April to, it’s fair to say, widespread dismay. The Next Steps to Put People at the Heart of Care document, supposedly an implementation plan for the 2021 reform white paper, amounted to little more than a holding statement. Care Minister Helen Whately made the best of it, saying that by 2025 the limited measures in the paper would have ‘shifted the dial’ and ‘achieved real change’, although the overarching vision ‘will not be achieved overnight’. But Sally Warren, Policy Director at The King’s Fund, saw instead ‘a narrow focus on just keeping the current system afloat, with little real ambition or pace for reforms that would make a difference to the hundreds of thousands of people who draw on social care to live their lives’.
And there things that have been left, give or take. July brought the now annual funding top-up ahead of winter, £600m over two years this time in the form largely of a workforce fund to boost care capacity, and there has been a series of small announcements stemming from the Next Steps document – for example, a digital skills framework for care workers and the setting up of a taskforce studying older people’s housing needs. But the clear message from Government is that reform is a 10-year project, at least, and we should not expect to hear anything more substantive this side of the forthcoming general election.
Political agendas
Social care was conspicuous by its absence from platform speeches at the Tory party conference, with any debate confined to fringe events, and the DHSC continues to rely heavily in its PR on the ‘historic’ 2022 investment commitment, which it now uprates to £8.1bn. Short of any wholly unexpected crisis of conscience on the part of Hunt, who said a lot of supportive things about social care as Chair of the Commons Health and Social Care Select Committee, before he rejoined Government, this appears to be how the Conservatives will go into the election.
That slew of new reports on the need for social care reform continued this year with, notably, two ‘roadmaps’ projecting ways forward: one, in April, for the Association of Directors of Adult Social Services (ADASS), setting out 10 key areas of change and stressing that much could be achieved at local level ‘without the need for huge amounts of money’; and the second, in June, for the Labour Party from the Fabian Society, at long last putting some flesh on the bones of the idea of a national care service, first mooted by Labour 13 years ago.
Just how keen the Labour leadership is to endorse the Fabian ideas is unclear: at the report’s launch, Shadow Health and Social Care Secretary Wes Streeting seemed as if he couldn’t get out of the room fast enough.
Just like the Tories, Labour is playing a long game (and like the Tories, it kept social care largely off the agenda at its party conference). Streeting’s deputy for social care, Andrew Gwynne, appointed in September in place of the experienced Liz Kendall, who was moved to social security, has spoken of the need to ‘take time to hear from experts, users and providers’ about how to fashion a national care service. The immediate focus of a Labour Government, he says, would be on a fair pay agreement for care workers – intended to be the first of a series of such agreements across the economy – and on measures via the Care Quality Commission to iron out variations in care standards. Don’t expect to see much else in the Labour manifesto.
The numbers don’t lie
Can the sector wait another 10 years, maybe 15, for the next Government of whatever colour to deliver reform? The latest ADASS survey of its members shows that 83% are heading for an overspend in 2023-24, while numbers of people waiting for a care assessment, provision of a care service, allocation of Direct Payment or a care review are climbing again – up 8% between March and August this year to more than 470,000.
With 152,000 job vacancies across the sector in England alone, many observers think the show is being kept on the road only thanks to the recruitment of migrant workers. According to Skills for Care, some 70,000 obtained visas in 2022-23 under the new shortage occupation dispensation introduced in February last year. Numbers have since been running even higher.
Everyone knows this is not a sustainable solution. Quite apart from anything else, it is denuding the global south of skilled labour: the leading countries supplying migrant care workers are India, Nigeria and Zimbabwe. Tales are of a legion of exploitation by unscrupulous care agencies and many migrants are simply using the system as a stepping stone to UK residency and work in other sectors.
Not for the first time, the overriding impression is of social care having been patched up with a few quid and an expedient labour force plan, in lieu of proper reform, just to buy a breathing space of another year or two.
Chamber calls for change
Who will speak for the sector? Thank goodness for the House of Lords. In October, fully 10 months since its publication, peers met to debate A Gloriously Ordinary Life, the widely praised report of the Lords Adult Social Care Committee. Freed from the shackles of party discipline, they voiced support across the chamber for the report’s recommendations, in particular much greater support for unpaid carers and the appointment of a commissioner for care and support.
Strongly endorsing the idea of a commissioner, veteran Labour peer Lord Dubs said, ‘I know the Government doesn’t like it. It may make the job of the Government minister a bit more difficult. But it would be very healthy to have somebody who could pull things together and be an advocate for people in this field, as is the children’s commissioner for children.’
Coming up short
The frustration was palpable. ‘We don’t seem to be moving the dial one iota for people,’ said Baroness Fraser, a Tory peer and Chief Executive of the charity Cerebral Palsy Scotland. ‘We won’t enable people to have choice and control unless plans are backed up by funding and action.’
Plans, funding, action. Entering its last 12 months, the present Government is coming up short for social care on all three of those fronts. The worry is that the next Government will offer little more.