…so it seems right to pull together what’s been said about social care, and comment on the various parties’ stances.
The idea that a government introduces legislation and then persistently removes the necessary funding for it from the sector stuck with the statutory duties to deliver it, could have emerged as THE political hot potato of our time.
Neither of the two parties in direct contention, however, has given any commitment to addressing the overall funding levels, despite the LGA saying authorities in England face a £6.2bn funding gap over the next two years. The LGA has also linked this year’s rise in the national living wage to £11.44 an hour to an extra 1.6bn in commissioned adult social services, during 2024-25.
The government is even appealing an order of the Information Commissioner (arising out of Access Social Care’s request for disclosure) that it shares the rationale and modelling behind the funding that it does provide, which does not bode well.
The Care Costs Cap promised for October 2025
I doubt anyone cares what the exact level of the care costs cap will be, or what it will cost government, or when exactly it will come in, right now.
What matters is that it is the right thing to do to stop unfairness of two different types.
Firstly – the unpredictability for everyone of the risk of needing to pay for care, the liability for which turns on chance, most of the time – whilst being faced with inheritance tax if one is lucky, and does not need to use the money, after all.
Secondly, the better-off who end up needing care, paying up to twice as much for the same kind and level of care as those who are state-funded.
Bringing in the cap is the only way to get rid of the private client subsidy that is extracted, not from choice or greed, most of the time, but from necessity, given council commissioners cannot spend more than they have been given, and central government has got away for far too long with using de-funding to keep the cost of care down, to the extent whereby the care home market has practically collapsed.
I do not believe that the cap cannot be afforded. Nobody could seriously believe hand-wringing of that nature, after the billions spent on furlough, for which I am sure we are all grateful and the billions wasted on Brexit and then on Covid-19 strategies and useless PPE.
I do believe it will be a bugger to ORGANISE and I do not think that ADASS, the LGA and the DHSC have enough time and acumen to do it for October 2025.
It is meaningless for working-age people and those disabled from birth to talk about a care costs cap, since one may never have had the capacity or ability to earn a living or hold money in one’s own name. One will be charged from income and the income will be derived from benefits. By the time they are 35, if they’ve paid charges from their benefits for the care in a care home or supported living for say 15 years, they will easily have reached the cap. The issue there is not catastrophic sudden liability but the standard of living that people in Britain live at if they live with a disabling condition because of the level of the charges.
What matters about the cap is that everyone understands their rights, so that they can make an informed choice, and not just believe what they’re told by career civil servants with no actual knowledge of the sector. The DHSC has no recent history in spelling out people’s legal rights in anything other than ambiguous language, and I don’t see civil servants getting any better at that, without robust engagement with the public about advice and information, and with decent lawyers.
If all a prospective Parliamentary candidate can say about it is that it means no-one would have to sell their house to fund their care, then there is going to be a steep learning curve ahead the week after winning. It is already generally true that people do not have to sell their homes in their own lifetimes, because of mandatory deferred payment arrangements operating in every council.
The Conservatives are also promising to provide greater power to individuals by enabling self-funders to request that their council arranges a care home placement.
This is a duty already owed to self-funders if they lack capacity, as it happens and even where one does not, councils can already take on the care of people whose assets are above threshold, in their discretion, as long as they do not treat them as entitled to pay less than full cost. Since it is cheaper to rely on the council’s bulk purchasing power, it still means that people CAN get the benefit of the council rate if they want. The difference would be that it would become a duty if requested by above threshold people in the future. To make that possible, one would have to give more funding to local authorities to pay for a fair cost of care to stop care homes keeling over, or leaving the market, as thinking changes and self-funders turn away from the posher end of care.
A significant proportion of ‘care’ costs did not ever even count towards the cap. Further, the tapering of contributions left those with fewer savings comparatively worse off. The next big controversial change forced through by government was to make the charges paid, rather than the cost of care, the spend that proceeded to the cap, so the already subsidised poor (subsidised through the charging system, meaning that they would not pay full cost anyway) would take MUCH longer to get to £86K.
I thought it was interesting this week to note that commentators responding to the commitments by the two main parties to introduce the cap by October next year did not think it was likely that they would be met by then.
The Conservative manifesto has offered no new money for care reforms, but said that at the next spending review, a multi-year funding settlement would enable councils to “take forward the reforms in our ‘People at the Heart of Care’ white paper”. That was where the cap on care costs was laid out in some detail, last time round.
The Shadow health and care secretary Wes Streeting followed suit, regarding the concept and the timing, despite it not being mentioned in the Labour manifesto and said: “That’s the plan, as things stand.”
The original estimations by the government were made years ago before the economic and financial shocks of the past 7 years; the consultants paid to pore over the impact assessments even in 2022 were sure that the money being offered even then was not enough.
The money for the preparation phase has been used, at least, on shoring up the system before the tipping point was reached.
Labour does not think that tackling catastrophic cost exposure for the few, is the right place to start, if they are victorious. We would have to agree, when the absolute basics of funding the Care Act would be a more obvious and sane commencement point.
While the cap has been explained as a way to “protect people’s inheritances”, Sir Andrew Dilnot has been quoted as believing that this cap would do “precisely the reverse”. His logic is that he “wants to see more people spend their money before they die, not hoarding it in case they need social care” – presumably because that would signify a flood of people’s money INTO the economy, and spending it in the way that they think is best for themselves and their families.
He may be thinking that reassurance will lead to relaxation about the level of funding needed, but that’s probably the case only if £86000 can be put aside in an interest bearing account, or bought through a new kind of financial service sector instrument or bond of some sort.
For that to happen, it’s got to make fiscal sense to the investor and commercial sense to the financial services industry as a form of insurance. That’s why good old social workers’ eligibility decisions will be seen as the convenient loch-gate for the protection of the financial services sector’s profit margins.
A National Care Service?
The Labour manifesto stated: “The sector needs deep reform: there are inconsistent standards, chronic staff shortages, and people are not always treated with the care, dignity and respect they deserve.”
That is the understatement of the campaign, to my mind.
There is abject meltdown in the rule of law, in fact, and an apparent pact of silence about what to do about it.
Labour want to trial ‘neighbourhood health centres’, bringing together existing community services such as family doctors, district nurses, care workers, physiotherapists, palliative care specialists and mental health specialists under one roof. This is a similar idea to Buurtzorg Nederland, I think.
But what does moving to a ‘neighbourhood health service’ with more care delivered in local communities, shifting resources to primary care and community services over time, mean?
Move the resources from where? This is just more place based planning, is it not?
At the same time, the Labour manifesto discusses establishing a national care service, similar to the NHS to improve funding and oversight.
These reforms include a pledge to “undertake a programme of reform to create a National Care Service” that Labour says would “underpin national standards” that “ensure providers behave responsibly”.
Providers are already regulated by CQC, and subject to the Ombudsman’s remit already.
In what way can Starmer be envisaging that they need more regulation? Could it be with regard to how much profit they can feasibly make, even though it’s not their statutory duty to meet needs?
That not insignificant feature – the return on investment into one’s business – will already be under government control, if the Care Costs Cap comes in, because councils will then be very much the major purchaser, and not merely a 50% purchaser alongside private self-funders!
I don’t know if this is Marxist or the complete opposite -ie to leave the property in the hands of the private owner, and boast about low taxation in general, whilst ‘fixing’ the market so that the owner cannot decide how much to charge for the company’s services but must just take what s/he is given by central or local government.
One cannot tell what a national care service would even involve, structurally.
At one extreme, it could mean withdrawing it from local authorities’ functions altogether, thereby leaving the NHS in charge of social care.
That would be the cessation of ASC as we know it and one of the obvious outcomes behind the 2022 Health and Care Act integration agenda.
The public law duty under NHS law is not owed to individuals; it’s not mandatory or enforceable.
The duties under the Care Act ARE all those things, in law – hence 25 years of effort on my part to be shouting that from the rooftops!
Integration – in the form of Discharge to Assess Guidance, has already meant 100 different ways of being discharged from hospital, in the name of place-based strategies making the most sense.
The Care Act applies nationwide in England, already; the Care and Support Guidance is applicable nationwide. There is one ombudsman for English social services complaint investigation. There is one set of complaints regulations. The case law applies nationally. Arrrrrgh!
The idea, apparently, behind a national care service is to ensure that people will receive better care and support to live at home for longer. They also aim to provide “consistency of care across the country”.
Another aspect of the ‘plan’ is new national standards for adult social care to ensure consistency of care across England, with a principle of ‘home first’.
We already have those standards – they are based on human rights and public law principles underpinning all policy development and all approaches to care planning.
Such a shame if the public officers in the service just don’t happen to know about them!
If we were to get a whole new raft of Care Act standards, including a ‘home first’ one, there’d be another mini-reporting industry needed, and it would involve central government TELLING councils to ignore the cost of the care as a lawfully relevant consideration, with regard to the care plan.
I would bet my reputation on that not ever becoming government policy – whoever wins on 4 July.
Commenting on the Labour manifesto, the IFS was also critical of the lack of detail on its plan for a national care service.
“With no specific funding set aside for these changes, paying for them would mean less for other services, unless taxes or borrowing were increased.”
Turning to the Liberal Democrats – much as I’ve warmed to Ed Davey for actually including social care in his party’s manifesto, and for committing to spending an extra £3.7 billion a year on social care, I do not think that there is a thought-through plan for providing free personal care.
That is because the party’s other offer is to establish a cross-party commission to forge a long-term agreement on sustainable funding for social care – which is inconsistent with there being no charges, if the cost cap is to be the way forwards.
I can’t believe the Lib Dems would throw ALL of that thinking out and start again. I look forward to Sir Andrew Dilnot taking up a heckling role.
It is particularly bizarre that parties are calling for a national public debate about this topic, when we’ve just had an election campaign in which it has hardly been mentioned.
In Scotland, the Community Care and Health (Scotland) Act 2002 states that one’s local authority cannot charge for the following care –
- Personal hygiene tasks – such as washing, toileting and continence management, haircare, and oral hygiene.
- Support at mealtimes – such as preparing nutritious meals and supporting hydration
- Prompting and administering certain medications
- Help with immobility problems
And that is that. The personal care allowance does not cover –
- Housework and laundry
- shopping and running errands
- Support outside the home, such as attending social events or day centres.
We will just have to await with interest any developments in this regard, through whatever pressure the Lib Dems bring to bear on the successful party in coming months.
Workforce planning and care career pathways
Any party’s commitment to boosting care workers’ pay will stop people from leaving the sector because the disadvantages no longer outweigh the much vaunted upsides to working in care – and this ought to stabilise people’s care packages and the direct payment market.
Labour said this:
“We will enhance partnership working across employers, workers, trade unions and government and establish a fair pay agreement in adult social care. This sector collective agreement will set fair pay, terms and conditions, along with training standards. Labour will consult widely on the design of this agreement, before beginning the process and learn from countries where they operate successfully.
To achieve this, Labour outlines the need to “end the workforce crisis across both health and social care”. They plan to do this through the publication of “regular, independent workforce planning” and “enhance partnership working across employers, workers, trade unions and government to establish a fair pay agreement in adult social care”.
This “collective agreement” would set fair pay, terms and conditions and training standards, Labour says.
Alongside these plans there is no explicit funding allocation outlined in the manifesto. £745m is mentioned for “prioritising frontline public service delivery and public sector capability” but with no ring-fencing for adult social care.
Labour says it would
- Recruit 8,500 new staff for mental health services.
- Deliver the NHS Long Term Workforce Plan.
- Ensure the publication of regular, independent workforce planning across health and social care.
- Establish a ‘fair pay agreement’ in social care – a collective agreement with the sector to set fair pay, terms and conditions. It is councils that employ social workers and buy services, and providers who pay staff, so how is a collective agreement going to be developed?
There is one now; it’s the minimum wage plus the uplift that scarcity and dependency in any market will give you!
How one even introduces a collective agreement into a mixed market is literally beyond me.
The Conservatives promise to
- Recruit more NHS staff, projecting 92,000 more nurses and 28,000 more doctors in the NHS (compared to 2023 numbers), by end of the next Parliament, in line with the existing NHS Long Term Workforce Plan. [This is effectively a volte face with regard to shrinking their numbers over the last few years.]
- Reduce the number of managers in the NHS by 5,500, which Conservatives estimate will release £550 million for frontline services.
The Liberal Democrats would
- Increase the number of full-time equivalent GPs by 8,000, half by boosting recruitment and half from retaining more experienced GPs.
- Encourage the use of flexible staff banks to reduce spending on agency workers. They would have to be employed by someone or use NHS pool that already exists
- Bring forward a social care workforce plan, with a focus on recruiting more staff to the sector.
- Create a new carer’s minimum wage, boosting the minimum wage for care workers by £2 an hour, as a starting point for improved pay across the sector.
That is what is needed, but it must be paid for by the Treasury, via DLUHC grants.
Mental Health Act reform
Labour and Conservatives are also committed to introducing mental health provisions, with the introduction of mental health professionals and teams in all schools and colleges; modernising the Mental Health Act 1983 (MHA) legislation.
Neither party has mentioned resurrecting the Liberty Protection Safeguards, which were due to be implemented to replace the current Deprivation of Liberty Safeguards.
What can one make of all this nothingness?
In his usual trenchant style, Dr David Oliver pointed out a worrying feature that doesn’t really fit with the devolution and levelling up agenda.
“Reading the main party manifestos – and that of Reform today – one would be amazed to consider that local government exists, let alone provides the bedrock that connects and protects communities and local economies.
To an uninformed observer, you would never be able to guess … that local councils of all political hues are facing systemic financial failure.
The image heavy Labour manifesto, whose many photos of Sir Keir Starmer constantly exhort the reader to ‘turn the page’, does more naturally reflect the fact that ‘local government is facing acute financial challenges’.
It promises to offer a measure of financial stability through multi-year funding settlements and an end to competitive bid funding. These would prove crucial for effective planning and could well engender sustainable revenue streams to support the more assured delivery of statutory and non-statutory services and with that a more flexible local response.
However, the issue of local government capacity for either the shoring up neighbourhood services or public realm provision and maintenance, which the voting public care deeply about and expect action on, is not addressed.
Instead, there is total silence from both parties on the need for a local authority cash injection. All part and parcel of the fantasy fiction public finances which is our current lot this side of the next spending review.”
Chief Executive of the King’s Fund, Sarah Woolnough said Labour’s “promises on social care reform could best be described as a plan to come up with a plan”.
She added: “The current social care system in England is not fit for purpose and many people’s needs go unmet, yet it is one of the most over-looked and ignored policy challenges in recent decades.”
She also warned that a Labour government may “repeat history” as their policy aims, such as a focus on primary and community care, have been the aim of successive governments over several decades that “has not been realised because ministers have not put their money where their mouth is”.
She added: “If Labour really want to come good on this promise and avoid repeating history, it must be more than warm words; they will need to take some tough decisions on where funding, staff and political energy are directed.”
The director of the Institute of Fiscal Studies, Paul Johnson, said: “This is a manifesto that promises a dizzying number of reviews and strategies to tackle some of the challenges facing the country. That is better than a shopping list of half-baked policy announcements…but delivering genuine change will almost certainly also require putting actual resources on the table. And Labour’s manifesto offers no indication that there is a plan for where the money would come from to finance this.”
A spokesperson for the Association of Directors of Adult Social Services said it is “good” to see a pledge for a national care service and “emphasis on care at home” but added “care workers will want firmer plans on pay improvements and we’d like more info on support for unpaid carers.”
“Simply knowing how much money you will have for three years is not very helpful if it is not enough to cover basic statutory services.”
Never a truer sentiment was expressed – courtesy of Kirsty Weakley, Local Government Chronicle’s Head of Content, 2 days before the election!
So that’s what should have been taken up and pressed on MPs and ministers, by journalists, to my mind, and it is a mystery why it was not possible to get any responsible reputable journalist to take up that challenge. I can tell you I tried, believe me!
For ADASS, director of policy and analysis Michael Chard said that since neither Labour or the Conservatives have told us how they plan to stabilise and support adult social care currently or committed any new funding to it, or offered up plans for meeting immediate pressures, “these future ambitions will worry those working and using services in adult social care today.”
Vic Rayner, Chief Executive of the social care membership organisation National Care Forum, said that Labour “should be under no illusion that this is an agenda for the here and now, not for a future parliament”.
“If Labour really wants change, we need urgent action to create not just a national care service, but in reality, a national core service.
We call on Labour to think social care first, because great social care enables people to live the lives that they wish and must be at the heart of any government, focused on growth and prosperity for all.”
With all that in mind, I’m crossing my fingers for a huge turn-out, later this week, but I think the social services safety net is fatally holed.