What is The Social Care Crisis all about?

As we approach the general election, those of us with an interest in social care (and perhaps some degree of masochistic tendency) have dived into the main manifestos to see what is being said. The short answer is, as anticipated, ‘not much.’ A more reflective answer is that there are considerable similarities across the main manifestos, with references to the “crisis” in social care as well as little substance in respect of future funding, but the ways forward are significantly different. While the Liberal Democrats and the Green Party are both committing to “free personal care,” the Conservative and Labour Party plans are largely a reissue of previous policies. You almost have to admire the Conservatives for their fortitude in sticking to the capped cost model which they have failed to introduce for the past 10 years, and Labour is once again proposing a model of a National Care Service although what that actually means and when it might see the light of day are I suggest open to a large amount of speculation.

So, indulge me – let us take a look at what this crisis exactly is, where does it stem from and what should or could be done about it.

What Crisis?

Well that largely depends on who you are talking too. But I suggest most people when referencing the Social Care Crisis have in mind one of more of the following:

1. A lack of sufficient care services, care homes and care workers to meet increasing demand

2. A lack of a robust local government funding (amount and mechanism)

3. A lack of support in terms of training, status, and salary for care workers

4. The ongoing existence of catastrophic social care fee costs incurred by some, sometimes involving the sale of the family home

5. A key contributor to the NHS crisis (again defined in any number of ways)

6. A lack of an overall strategic plan

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How have we got to this point?

In whatever way you choose to define the Social Care Crisis, how have we got to the point where the word ‘crisis’ is ubiquitous? I think there are at least eight reasons (probably more) that include:

1.????? All governments going back thirty plus years or so seemingly taking little necessary action in terms of two looming issues:

·?????? the UK’s ageing population, and linked to this;

·?????? the shrinking personal tax base and its implications for government spending

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Throughout this time little has been done to counter the fantasy that we can have both Scandinavian public and welfare services and a US/ Western European levels of taxation (unless of course you tax more or borrow even bigger and more often, none of which are politically attractive).

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2.????? The fragmented combination of public and private care that has hugely complicated matters when it comes to clarity and delivery. Some may not remember the 1990 NHS and Community Care Act that required local authorities to commission services rather than provide them directly. So, by 2010, almost all previously local authority-run services including care and nursing homes were privatised, turning care into a profit generating activity, a commodity to be bought and sold.

3.????? A over reliance upon unpaid carers, the army of “invisible” (largely female) carers working – unpaid – to support family members and friends at home, without acknowledgement or support.

4.????? A lack of a proper social care workforce plan. It is now getting to the point where a lack of staff has resulted in providers having to withdraw their services and the care regulator expressing concern over the safety of services?due to persistent understaffing .

5.????? The way care is viewed. Linked to 3 and 4 above, the skills and expertise needed to care appear not to be valued within our society. In contrast, acute medical care requires expertise that takes many years to acquire and is part of a high-status medical profession.

6.????? Politicisation - Social Care continues to be used as a political football alongside the NHS, although too often played out on separate pitches. Let’s be blunt - the NHS cannot be fixed unless the care system is transformed – it is that simple. For the care system to be transformed, it needs political consensus, or failing that, the solution taken out of the political arena altogether.

7.????? A lack of open and honest dialogue with the electorate. For example, Boris Johnsons promise and subsequent plan to ' fix social care' in England only addressed one aspect of the problem, namely the catastrophic costs some incur. But even then, the talk around what the ￡86000 care cap actually meant and how it was to work was grossly oversimplified (seemingly a classic case of not letting effective communication get in the way of a good headline) and I would go as far as to say deliberately misleading. Most self-funders will have to pay in excess of ￡200,000 for residential care before they get anywhere near the ￡86000 cap, given what is and is not allocated to the cap, should it be eventually introduced in October 2025. They will also have to pay significant open ended ongoing fees in respect of accommodation costs and costs in excess of what their local government would pay to meet eligible needs.

8.????? Short- term financial sticking plasters - sporadic, large sounding lumps of money being thrown at the problem by government, without any robust, long- term plan that reflects both current supply issues and long-term demand. This includes a realistic, flexible, and long- term funding mechanism if social care is to remain the responsibility of local authorities.

Of course, the resulting fragility of the social care system was utterly exposed by COVID.

The decision to discharge elderly people into care homes in the early days of the pandemic is seen by many as one of its biggest scandals. More than 40,000 people are thought to have died in care homes in England and Wales due to COVID, with many harrowing accounts of residents being “locked away” or dying alone with families forced to stand outside.

A staffing crisis, leaving the sector short of over 165,000 carers, led to some homes being declared closed to new admissions – the knock-on effect of which has been hospital bed blockages and people going without the care they need.

Despite one government after the other promising to get a grip of Britain’s care service, some argue the system is now in a worse state than ever.

So, what is the solution?

Some have argued that the crisis is of such magnitude that social care needs to be removed from the political arena altogether, perhaps one of a number of issues to which the label ‘urgent national crises’ can apply (for example tackling climate change, securing future energy needs etc) to be dealt with via a UK people’s assembly or some such non-political mechanism.

Others have suggested the best option to tackle the crisis would be a cross-party parliamentary commission of MPs and peers, led by a select committee chair, who would then champion its recommendations beyond the life of the next parliament if required.

Others have taken a counter view that the time for more discussion is over, and that governments of the day simply needs to get on with delivering their plans, whatever they are, presumably on the basis that any progressive change is better than nothing.

Assuming it remains within the political arena, ultimately of course, it comes down to choices. For far too long, past governments have tended to place care in the ‘too difficult box,’ talk reform and then deliver very little. Even where they have attempted to act, the language used has been at best misleading.

I believe the provision of care for an ageing population is one of the biggest issues facing society today. The pandemic has raised public awareness of the need to strengthen and modernise the care systems across the UK as well as in many other countries. Some countries appear to have been better able to translate this public awareness into political will. But the UK appears to be trapped in a vicious cycle of low expectations about the social care system. The result is a lack of political will to engage with the more fundamental reforms that are needed.

If the Social Care Crisis is not to become a visible UK wide national shame, it seems to me that the first step must be not only to increase public awareness around the nature and extent of the crisis, its causes and the options open to us all, but to make it more personally relevant. Most of us will need some form of social care at some point in our lives. Its only when this and the fact that unlike health care it’s not free is more widely understood, will it politically move from the ‘too difficult to tackle’ box to the ‘too important to ignore’ box, something that can no longer be kicked back into the long grass or met with piecemeal solutions.