Around 2BC (that is, two years before COVID-19), The King’s Fund published some analysis of the state of social care under the relatively provocative title ‘What’s your problem, social care?’. It concluded that there were eight fundamental problems: a restrictive means test; catastrophic costs (people selling their homes to pay for care); unmet need for care; uneven quality of care; the workforce (poor pay and high vacancies); provider market fragility; lack of integration with health and other partners; and variation in local authority provision (the ‘postcode lottery’).
When COVID-19 struck, we updated the analysis to consider the impact of the pandemic on those problems. In most cases, we argued, the pandemic had made things worse. The two main exceptions were the means test and catastrophic costs: though these remained problems, COVID-19 had made little difference to them.
Scroll forward to September and the Government outlined its proposals for reform of adult social care. With a roll of drums, the reforms were revealed to focus on … the means test and catastrophic costs. It was almost as if COVID-19 hadn’t happened.
‘Almost.’ To be fair to the Government, there were nods to other issues in the reforms. The biggest of these was around workforce, where £500m was pledged over three years for wellbeing support and training. Yet there was nothing about workforce pay and, indeed, the immediate impact of the new health and care National Insurance levy will make many care workers worse off, not better.
You could also, at a push, argue that, in making the means test more generous, the Government was tackling unmet need. Yet the promise that 75,000 might benefit from this measure – when estimates of unmet need for older people alone stand at 1.6 million – suggests that its impact will be modest.
The Government might also point to the money it has channelled to social care providers through the Infection Control Fund as evidence of its intent to improve provider fragility. Yet, while this has worked in the short term, the longer-term reform proposals announced in September actually run the risk of destablising the market even further. That’s because a mooted ‘fair price of care’ reform would reduce or eliminate the self-funder subsidy that many care home providers rely on to survive.
It is true that the Government has begun to address two of the other problems on our initial list – variation in local authority provision and lack of integration – through the health and care bill currently working its way through parliament. This will give the CQC oversight of local authority social care commissioning and, through the formalisation of integrated care systems, aims to join up health and care provision more effectively.
Still, when you consider the overall balance sheet, it’s clear that the reforms are rooted in the urge to deliver on the promise of the 2019 manifesto – that no one needing care has to sell their home to pay for it – rather than the realities of social care in the wake of the pandemic. That’s a gaping omission that will need tackling in the promised social care white paper by the end of this year and in the long-term financial settlement for local Government.