Roll back to September 2021. The Government, then led by Boris Johnson, committed to a ‘transformation in adult social care’, promising the introduction of a cap on care costs and ‘wider support for the social care system, particularly our brilliant social care staff’. £5.4bn would be spent over three years – £3.7bn on the cap and other charging reforms and a further £1.7bn on the wider system reform. Three months later, in December 2021, it set out details of how it would spend that £1.7bn, promising pots of money that included £500m for workforce development and £300m to transform housing and support options.
While these were not all the sector had hoped for – the cap was less generous than hoped and the Government notably had no proposals for improving the pay of those ‘brilliant social care staff’, for example – they were a promising start to what would inevitably have to be a long-term process of reform.
That promise did not last long. Barely a year later, in November 2022, the Government put back introduction of the cap on care costs until October 2025. The length of this delay, with a general election having to take place before then, meant postponement might very likely mean cancellation.
It did not help that this was a case of history repeating itself: plans to introduce a similar cap on care costs had been legislated for in 2014 but postponed in 2015 and then abandoned entirely. And as in 2015, the Government justified the delay by saying it would redirect reform funding into a creaking wider social care system – this time, with up to £7.5bn over the next two years. But even here the news was not as promising as it seemed: of the £7.5bn, £1.6bn was to be shared by local authorities and the NHS, £3.15bn was to be split between adult and children’s social care and £1.7bn was dependent on local authorities raising council tax to the maximum. There was also a clear focus from the Government across all the spending on tackling hospital discharge delays.
There was, however, still that £1.7bn for wider system reform. Or was there? Details were taking an awful long time to emerge from the Department of Health and Social Care. Finally, in April this year, in its ‘next steps’ for reform, the Government published its plans to spend the £1.7bn.
Except they did not add up to £1.7bn or anything like it. The money for workforce reform had been cut from £500m to £250m and the £300m housing transformation had become a £102m fund for housing adaptations. In total, the promised funding came to £590m – roughly a third of what had originally been promised in 2021 and not even the £700m that the Government PR machine tried to proclaim on the day of the launch.
So, what of the rest of the money? Over a few days, it transpired that the gap between the £590m and the £1.7bn was made up of:
- A spending cut of £100m (part of the original £1.7bn was to be funded by savings that did not happen, so the money has been lost).
- £300m that DHSC says it has already spent, even though it has given no breakdown of where this money went.
- £710m which DHSC is saying it will spend over the next two years, although it has not yet any plans for how. The smart money is that much of it will go towards the current urgent priority, tackling delayed discharges from hospital.
This, then, is a Government retreating from bold, ambitious plans for system reform and instead moving pots of cash around until it identifies the next hole in the system that it needs to plug.
Instead of a strategic approach to reform, it is short term and short sighted. And that approach is easy to identify because it is, sadly, what social care has become used to over many years.