Action on social care – but how fair will it be?

Much remains unclear about the future of social care now that a government has finally had the courage to come clean about the financial implications of sorting it out. Governments have talked about it for well over 20 years, but action has never followed. Now there is action.

One day, taxes had to rise, even if the 1.25% hike to National Insurance isn’t the tax increase many would have chosen given the disproportionate impact on younger workers. The additional £1.8 billiion earmarked annually for social care in England over the next three years – and the cap of £86,000 on each person’s lifetime social care costs – will help to stabilise a system that was lurching from crisis to crisis.

But, if social care is to be truly equitable, it is not the whole answer. Alzheimer’s Society said the cap would need to be considerably lower than £86,000 if it was to make a difference to more than a handful of people with dementia. The government says it wants to make the overall system fairer by ensuring those who fund their own care do not pay more than state-funded individuals, but closing the gap will itself be hugely expensive as self-funders pay up to twice as much as their publicly funded counterparts.

According to the Institute for Fiscal Studies (IFS), the additional money amounts to a 9% increase in local authority adult social care budgets which barely makes up for the 7.5% cut to those budgets resulting from government austerity measures post-2010. Among the government’s other expectations of the new funding are better training and support for the social care workforce and improved services and signposting for care recipients and informal carers. All praiseworthy, but how much of it will be affordable?

The real elephant in the room is the sheer number of people who have been squeezed out of local authority-funded services over the past decade or more. Age UK estimates that 1.4 million older people are struggling without the help they need to carry out basic activities of daily living – eating, dressing, bathing, and so on. Attending to these basic needs while also ushering in a new era of fairness and better rewarded and trained staff is likely to cost considerably more than £1.8 billion, especially when you consider that there are well over 100,000 social care vacancies to be filled.

A white paper on integration of the NHS and social care is promised later this year which will presumably give more details on how it will all work. An extra £21.7 billion has been allocated to the NHS up to 2025 to clear the huge waiting list resulting from the covid pandemic that showed social care’s shortcomings in such a lurid light. If the white paper signals a relationship between the NHS and social care in which these mistakes cannot be repeated, so much the better. But whether it will also be fair to everyone with dementia is another matter entirely.