Some recent statistics, being studiously ignored by MPs, Ministers, journalists and news broadcasters, as far as we can tell:
- Satisfaction with the NHS is at the lowest level recorded since BSA began in 1983 across every service and within all demographics and socio-economic groups.
- In 2023, fewer than 1 in 4 (24% of people) were satisfied with the NHS, a drop of 29 percentage points since 2020 which represents an unprecedented drop in public satisfaction with the NHS.
- The main reasons for dissatisfaction were waiting times for GP and hospital appointments (71%), staff shortages (54%), and insufficient government spending (47%).
- 84% of respondents believed that the NHS has a major or severe funding problem.
- When asked about government choices on tax and NHS spending, most respondents chose to increase taxes and spend more on the NHS (48%).
- Satisfaction with social care, meanwhile, sits at 13%.
- Social care services currently look after 400,000 people in care and nursing homes – that is three times the number in NHS hospital beds. Social care services look after a further 640,000 people in their own homes.
- Dissatisfaction with social care is greater than that with the NHS overall or with any of the individual NHS services in question.
- This dissatisfaction was primarily attributed to inadequate pay, working conditions and training for workers (57%), closely followed by people not receiving all the social care they need (56%) and insufficient support for unpaid carers (49%).
As of Spring 2024, the three main political parties had avoided making any firm commitments regarding social services, the legal framework, the care costs cap or the position that most Adults’ Services Directors now lack confidence in being able to meet their statutory duties. Labour has plans for a ‘national care service’ in the next ten years (assuming two terms in power) but without discussing it in detail. It is focusing on fair pay agreements for staff working in adult social care, as opposed to social work, to boost recruitment and retention. The Lib Dems launched their conference with a £5bn-a-year free social care plan [and have since promised free personal care, a new minimum wage for care workers, a Royal College of Care Workers and an overhaul of the Carers’ Allowance to support unpaid carers in its manifesto]. The Conservatives have deferred Mental Health Act reform and the Liberty Protection Safeguards as well as the Care Costs Cap (three times, now). Labour has said it is committed to the charging reforms, but has not set out it will pay for them.
Back in 2023, the King’s Fund was saying that it was interesting to note what wasn’t said at the party conferences:
“Neither Labour or Conservatives had much to say about the desperately needed and long overdue reform of adult social care. Labour, like the Liberal Democrats, committed to increasing the pay of care workers, but neither Labour nor the Conservatives set out any detail on wider reform of social care.”
(Andrew McCracken, King’s Fund, 18 October 2023).
When the election was called for 4 July, Sunak referenced NHS investment, welfare reform, and immigration levels, but not social services. The Independent Care Group, working on behalf of care providers, said this:
“It is time for the Conservatives to break their silence on what they propose for social care and for the other parties to expand on what they have said so far. Labour has so far promised better pay for the workforce while the Liberal Democrats promise free personal care for some, a Carer’s Minimum Wage and greater support for unpaid carers…. We want to see the manifestos and hear what they intend for social care. And we must grasp this rare opportunity to get the country a cradle to the grave service it deserves. When the candidates come to our doorsteps, we must ask them what they intend for social care and not let them off with weasel words or vague promises.”
A new report by the national social care charity Community Integrated Care – ‘Who Cares Wins: Unfair To Care 2024’ has revealed the size of the social care pay gap, its personal, social and societal impacts, and the true feelings of MPs and the public in exclusive polling of adults in England and a representative sample of parliamentarians.
This has been featured on the National Care Forum‘s website and repays reading: https://www.nationalcareforum.org.uk/care-sector-news/social-care-set-to-influence-election-year-community-integrated-care-launch-who-cares-wins-unfair-to-care-2024/
Unfair To Care uses exclusive measurement by Korn Ferry – international leaders in job evaluation – to reveal that the average social care worker would take home £7,617 more per year if they delivered a role with comparable responsibilities in the NHS. With the present rate of pay estimated at just £10.93 for a position that has been found to be highly skilled and accountable, social care careers are significantly uncompetitive compared to those in its partner sector, the NHS, and in easier commercial roles. With the social care sector unable to address these issues due to long-standing funding pressures, it creates an inevitable workforce crisis that permeates society.
Unfair To Care 2024 finds that there is a 2.6 million strong ‘social care vote’ of people who work in and draw on social care in England – an average of 5,000 people per constituency – that can have a defining impact on almost 100 marginal constituencies.
Interest from a different sphere comes from the Financial Services industry, on whose support the resurrection of the Care Costs Cap depends. A movement has started, looking forward to resurrection of the care costs cap. An example can be seen here: https://www.ftadviser.com/pensions/2024/05/22/still-no-end-in-sight-for-social-care-crisis/ with representatives from Royal London, saying:
“We have been calling on all political parties to be really clear in their manifestos about what they would do with social care. People deserve to know.”
The piece notes that the absence of a cap limits propositions which financial service providers can come up with (because of the ratio of profit to exposure, presumably?).
Jamie Jenkins, Director of Policy at Royal London says: “In the absence of a cap, insurance products would likely remain prohibitively expensive unless they were taken out at an early age.
“Insurance could certainly play a role in funding care if a cap is introduced as it limits the liability for the insurer, making it more affordable for the consumer.”
Natasha Curry, deputy director of policy at health think tank Nuffield Trust, says: “Private insurance is not an option. It is not a viable market for insurers and, even with a cap, insurance companies have indicated it is not viable.”
Insurance arrangements that are put in place before the point of need are limited to some whole-of-life assurance plans that pay out a small percentage of the overall sum assured in the event of, for example, dementia.
Mel Kenny, from Radcliffe and Newlands, says that while these help, they are not designed to meet the full need of paying for care.
He adds: “Solutions to meet the full cost of care shortfall and reduce the risk of an estate from being majorly impact by the cost of care, or worse still, running out of money, are met with an immediate needs annuity or deferred annuity.
“There are various ways the different insurers would deal with a cap coming in during the lifespan of current plans, with tailored new propositions ready to go if the cap does eventually come in.”
CASCAIDr CIC’s view
We think that the essence of the economics behind the cap depends on insurers being able to avoid disputes by making payment out an obligation only on an assessment of need from a social services practitioner and the costing of a care plan according to local authority commissioner’s budgets.
But whilst THAT cadre of professionals
a) wouldn’t even realise that they’ll be being used to save insurers, money – and
b) are fast losing their legal literacy skills,
c) and neither they nor the financial services sector would understand that councils’ findings are subject to judicial review,
d) and that there are immutable public law principles of sufficiency that depend on underlying market forces and not just the minimum wage, or the financial settlement from the DLUHC or the Treasury –
e) and given that half the country is using ‘streamlined’ processes, rather than the Care Act and the case law, to try to get rid of the assessment back log,
the end to dissent about eligibility, adequacy, appropriateness and sufficiency of plans and notional budgets, is not nigh.
Whether systemic de-funding, or underfunding of social care is a planned strategy for parties’ approaches to the problem, so that insurers come back to the fold, and get stuck into the middle England market, would seem to be something that journalists should indeed be probing, now that the election date has been announced.