First the funding reforms were scrapped. Then the training and development fund was scaled back. Although the Budget announced an extra £600m for social care from next year, commissioners and providers are united in questioning whether this will cover the extra costs the Chancellor has piled on to providers and councils through the National Minimum Wage and higher National Insurance costs, especially in relation to part-time workers.
The local government financial settlement expected before the end of the year will set out the important detail, such as how much of that £600m is for adult rather than children’s social care and what councils will be allowed to raise through the council tax precept. But as things stand, it seems highly likely that the impact of the Budget will be to leave adult social care in an even worse position than it was before.
The resulting prospects for people who need care and support remain grim. The CQC has highlighted the ‘precarious’ state of social care in its recent annual assessment of the state of health and care. The autumn survey of council directors of adult social care describes the system as being at ‘breaking point’ – a record 81% are over-spending their budgets and over a third are expected to make further savings despite escalating costs and needs.
A comparison with how the NHS is faring is instructive. A high-profile programme of public engagement has been established to deliver a 10-year plan for investment and reform. It got a whopping £22bn in the Budget and although in historical terms this only restores past average increases, social care’s allocation seems crumbs from the table.
So, what can be done? First, the Government has some convincing to do that social care reform is still a key priority and to correct the mismatch between words and deeds. There seems to be a vacuum at the heart of detailed policy thinking about adult social care, compared to the clear and well-articulated vision for the direction of NHS reform.
Organisations involved in social care, and the people who draw on it, remain very committed to working with the Government. Before disillusionment spreads, the Government should move quickly to bring forward work to develop a proper long-term plan. This should begin to put some flesh on the bones of what a National Care Service would mean in practice and how it would address the longstanding and well-documented challenges.
Second, everyone involved in social care, especially those campaigning and lobbying for reform, need to reflect on why it is that this Government, like most of its predecessors, always prioritises the NHS over social care? A blunt truth is that one reason they do so is because the public prioritises the NHS. Despite its current travails, it retains overwhelming public support as a universal service used by large sections of the population.
In contrast, social care is little known and poorly understood. Scattered across 153 local authorities and 19,000 independent providers, it lacks a single, strong and distinctive national brand. In poll after poll, social care barely registers as an issue of concern to the public, whereas the NHS is usually at or near the top of the list. It is hard to avoid the conclusion that campaigners need to spend more time making the case for reform in the court of public opinion and not just in the corridors of Whitehall.
For more information and commentary on the announcements and reports cited in this column, read the latest CMM News.
Richard Humphries is a Senior Policy Advisor to the Health Foundation.
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