Will Boris turn the tide for social care investment for the "Red Wall" constituencies?

Boris Johnson’s landslide General Election win in December saw the Conservative Party capture dozens of seats in Labour’s former heartlands; its so-called ‘Red Wall’ in the North and Midlands. Post-election there has been much talk of how the Conservatives will hang on to its new supporters in these areas. Having lent the party their votes, will these constituencies stay blue in five years’ time?

While much of the focus has been on the need for investment in infrastructure away from London and the traditional Tory shires, there has been little serious discussion of another crucial issue to these voters: social care. The fact is, the disparities between these regions and other parts of the UK isn’t just about spending on roads and railways. There are also troubling signs that these less affluent areas are falling behind when it comes to social care provision. This side of our national infrastructure may not be as headline-grabbing as the kind involving hard hats and high vis jackets - but it matters to people.

 As the Daily Telegraph reported in December, more care homes closed last year than opened. That trend has continued unbroken for eight years, and last year alone saw a net loss of more than 23,000 beds. But it’s also where homes are closing which is interesting.

 Increasingly, we are seeing the closure of homes in more deprived areas where a majority of residents are funded by (lower paying) local authorities. And where homes are opening, they tend to be in more affluent areas where residents are more likely to be (higher paying) self-funders. As Caroline Abrahams of Age UK observed: “the market is voting with its feet”. A “disorderly series of local capacity crises and sudden price shocks” is predicted.

 In the government’s post-election Queen’s Speech more funding was promised for the social care system: an additional ￡1 billion a year for local councils. Consultation on raising a further ￡500 million through a council tax precept is also underway. While this funding may cover the cracks, it won’t address the long-term challenges.

 The government’s long game remains opaque. More attempts to obtain cross party consensus have been promised. But unless we are serious about breaking down the barriers between separate health and social care systems these will be a non -tarter.

 As always, the NHS remains the top of the government’s priority list. As the former health secretary Jeremy Hunt said recently in an interview with Health Service Journal “the political pressure is never as great for social care funding”. Mr Hunt revealed in the interview he had pushed for a 10-year plan for social care similar to that agreed for the NHS claiming he was blocked from doing so by the then chancellor Philip Hammond.

 However, if we continue to make social care secondary to the NHS as a priority we will do neither service any favours. Greater support for social care has the potential to alleviate pressure on the NHS, representing a win-win for both parts of the system. And as I have said before, only by properly integrating these two currently separate services can we hope to achieve that. One of the biggest questions facing the NHS is how do you stop people going into hospital. The social care sector has at least some of the answers to that critical question.

 At the moment, the two systems are operating independently and in their own silos - apart from in a few areas where health and social care integration is being trialed (Greater Manchester for example). There is a disincentive for either the health or social care sector to do the right thing. For a local authority managing a social care budget where is the incentive to fund someone’s care when it is perfectly possible to offload that cost to the NHS? Only where health and social care are working as one system can we have any possibility that the most effective and efficient approach to care will be adopted.

 Greater focus also needs to be placed on prevention; to addressing some of the social problems which are causing pressures higher up the system. Preventing people becoming ill and needing care is one side of that coin. The other side involves stopping things getting worse where people do need social care. Dementia is a good example of this. Up-front investment in tackling problems like loneliness and isolation can alleviate pressure higher up. If you can take steps to prevent someone with dementia from having a fall, for example, you will reduce their chances of ending up in hospital.

 But caring for the elderly and those with dementia is only one piece of the social care puzzle which the government must solve. Adults with physical disabilities, learning disabilities or mental health issues is the other. Again, under-funding remains a key part of the problem. Towards the end of last year a survey of directors of adult social care revealed only a small percentage were confident they had the funding needed to meet their legal obligations in this area.

 Beyond funding, we must also ensure people have access to opportunities to lead rich and fulfilling lives. In my view, not enough emphasis is placed on helping people to achieve the things they want in life. Where possible, that should mean additional help to access employment opportunities, training and education. Making sure people can enjoy fulfilling activities and leisure opportunities is also important. It was with this in mind that we recently launched the Valorum Foundation to explore ways to broaden the involvement of volunteers in this aspect of people’s care.

 Finally, let’s not forget the workforce and pay rates. Rising living wages rates are to be welcomed - but they have to be paid for somehow. I’ve yet to see a convincing answer from government as to how it plans to square this circle. What doesn’t help is the timing of announcements around living wage rates. Last year we learnt what these will be in December, yet we won’t discover what the corresponding rates of funding from local councils are until early spring. Greater clarity about what the funding gap will be is essential. Planning is enormously difficult for us as a social care business otherwise.

 Consistent rises in the living wage rate are also having some unintended consequences, not least a narrowing of the gap between the lowest paid care workers and those on higher rates of pay. This can act as a disincentive to staff to take on roles with more responsibility - or demands for higher pay. All of which adds to the challenge of keeping and retaining the people we need.

 Addressing these questions must be at the top of the in tray for the Secretary of State for Health and Social Care. Incidentally, it seems perverse that we can easily combine both health and social care in Matt Hancock’s job title - yet struggle when it comes to the systems themselves.

 Whoever finds themselves in that role in the coming years (and a predicted reshuffle could see changes at the top sooner rather than later) we must end the cycle of broken promises. Clarity on the green paper on social care would be a good start, as well as some sense that things are going to be different this time. For those who work in the social care system, or who rely on the system for care and support, sadly it is not just Boris Johnson’s electoral fortunes in the North and Midlands which are at stake.