IN THE NEWS
The end of November and the start of December was a busy time for those in adult social care, with the Government firstly putting its amended legislation for the social care cap through the House of Commons, followed just over a week later by the unveiling of the long-awaited White Paper, People at the heart of care.
Both voting on the cap and the White Paper saw a mixed response both from inside and outside Westminster.
The Care Cap: So good that “no one will lose” or “a regressive step”?
The Government’s proposed social care cap sets a lifetime limit of the amount people have to pay for their care of £86,000. On the 23rd of November the Government introduced an amendment to their social care cap legislation whereby council contributions to care fees do not go towards the cap. Health Minister Edward Argar stated that “no one will lose from these reforms, compared to the system we have now”, but reaction from the opposition benches and more widely suggested otherwise.
Shadow Minister for Social Care Liz Kendall stated that the amendment meant the Conservatives had broken their promise that “nobody would have to sell their home to pay for care. James White, Head of Public Affairs and Campaigns at the Alzheimer’s Society, said that with costs due to hit the less well off, “progress here feels like two steps forwards, one step back”. Even Jeremy Hunt, chair of the Health Select Committee, said “I was conflicted” and he ended up “abstaining because it is a big disappointment that they changed the way the cap is calculated”.
Sir Andrew Dilnot, the economist who devised the original recommendations for a care cap back in 2011, feels that the cap in its proposed form is “not tackling catastrophic costs… for the less well-off”. Meanwhile, calculations by investment Group Quilter for The Telegraph suggest that millions of British workers will have pensions £150,000 too small to cover both care costs and the costs of a comfortable retirement.
Social Care White Paper: “Is that it?”
The Government faced further criticism when it unveiled its social care white paper at the start of December. The paper promised £5.4 billion of funding over the next three years, and £1.7 billion for major improvements across the adult social care system. Gillian Keegan, Minister for Care, wrote in The Telegraph in relation to the white paper, “We promised to tackle the challenges facing adult social care and that is precisely what we are doing.” Liz Kendall’s reaction – “Is that it?”
Much of the reaction to the white paper centred around the amount of funding promised. In her Spectator column, Isabel Hardman argued that much of the white paper relied on the assumption that Health and Social Care Levy funds would actually find their way to the sector, as opposed to being swallowed by the NHS. Hugh Alderwick of the Health Foundation feels that £1.7 billion is not enough to tackle high levels of unmet need and workforce shortages.
On top of the funding issues, many have taken aim at the fact the paper, in their view, does not deal with the problems currently affecting the sector. Sally Warren of The King’s Fund felt “the steps outlined don’t go far or fast enough”; Mike Padgham, Chair of the Independent Care Group, said the white paper was “short of support for the here and now”; and Caroline Abrahams, Charity Director of Age UK (see this month’s interview) felt that instead of “the formula one vehicle that was required, the Paper is an underpowered saloon car at best.”
INTERVIEW
For the December edition of Cura Insight, we spoke to Caroline Abrahams, Charity Director of Age UK. She argues that while there were some useful measures in the recent White Paper, how these will be funded is a different matter, especially given the issue of staff shortages to deal with as well.
What is your view on the Government's recent social care white paper which was released this month?
There are some useful measures in the White Paper, which over time should make a difference, but overall it was rather disappointing. "Is that it?" was the response many who are interested in social care made to it. The elements I like include the plan to collect more and better data about social care, and to expand the use of digital technology, e.g. broadband in all care homes, but these are quite modest. The Paper won't drive transformational change and that's what we really needed. There was only £1.7 billion behind the Paper and it shows - you can't build bricks with straw.
Many of the measures set out in the White Paper rely on the Health and Social Care Levy for funding; is this funding enough or will more be needed?
The Health and Care Select Committee has said that by 2022-2023 we need to be investing £7 billion extra a year into social care, so that local authorities can fulfil their statutory duties and we can start to make inroads into the 1.6 million people who are living with some unmet need for care. The Spending Review was the place for an announcement of this kind to be made but it was spurned by this Government. As things stand, the extra funding given to social care for the next three years will be mostly absorbed by cost pressures and the new cap, with little if anything to expand and improve services.
There are some useful measures in the White Paper, which over time should make a difference, but overall it was rather disappointing
One area of care that seemed to receive less attention in the White Paper's announcement was the issue of unpaid carers. Does the White Paper do enough to provide support in this area?
There wasn't much in the White Paper to give hope to unpaid carers, though it was good to see some funding allocated for more day care and respite provision. However, it won't stretch very far and we know many unpaid carers are very tired after approaching two years of this pandemic. Possibly the best current news for unpaid carers is the greater acceptability of flexible working and moves from the Government to make it available from day one in a job - not in this White Paper at all but in a separate consultation from the Business department.
Do you agree with Edward Argar MP, Minister of State for Health, that "no one will lose" from the social care cap reforms, and that "the overwhelming majority will win"?
Not entirely! It's true that even in its diminished form, the Government's cap on catastrophic care costs and the means-test changes that have been announced do not make the system any meaner than it is now - but given the Prime Minister made a public promise to "fix social care, once and for all" you can see that this reform package falls awfully short. It isn't so clear that the "overwhelming majority will win" either: the large numbers of people with only modest wealth won't gain from the cap if the Government's amendment to the Care Act is passed, but some could get a small amount of support from the means-test. I don't think that really counts as 'winning'.
Looking ahead to 2022, what are the immediate priorities the Government needs to tackle in the social care sector to, as the Rt Hon Jeremy Hunt MP put it, pull the sector “back from the brink”?
The two biggest problems social care faces at the moment are not enough funding and insufficient numbers of staff. There have been chronic staff shortages for years, but the pandemic has made them worse and now care workers are being lured away by higher wages and better terms and conditions in the NHS, retail and hospitality. Care just can't compete, largely because there isn't enough money in the system to pay them a fair rate for the important and responsible work they do. The White Paper commits to putting some proper workforce structure in place, such as better training and proper career pathways, but it was silent on the topic of pay. However, getting more money into care workers' pockets is what's most important now.
opinion
December’s edition of Cura Insight features opinion from Damian Green MP, Conservative MP for Ashford, Chair of the All-Party Parliamentary Group (APPG) for Adult Social Care, and author of a 2019 Centre for Policy Studies report on ‘Fixing the Care Crisis’. He argues that while a cap is a reassuring step, concerns remains over the potential geographical inequalities that may arise.
The Government’s policy to “fix” social care is coming out in a very odd way, with the tax rises to pay for it and therefore the way people will be protected from having potentially to sell their homes announced at a different time from new policies about actually providing the care.
The latter were outlined in a White Paper which it would be polite to call high-level, in the Whitehall jargon, as there are many details still to come. The former has more detail attached so it can be analysed. The first thing to say is that the proposed £86K cap on care costs is not quite as was presented in many places, as it does not cover the hotel costs of a residential care place.
Nevertheless, it does provide a degree of reassurance that at least the care costs will be capped. Another level of assurance is provided by the protection of overall assets once they have been reduced to £100k. This is considerably more generous than the previous figure contemplated by the Coalition Government, when they passed the 2014 Care Act which was based on the Dilnot proposals for a cap.
We are moving forward with care policy, and the Government should be congratulated for grasping this long-lasting nettle
However there are still problems with a flat cap across the country, whether 86 thousand or any other figure. For the vast majority of people their wealth is overwhelmingly the value of their home, and this differs so markedly in different parts of the country that a single figure for the cap creates unfairness.
In my Ashford constituency the average house price is £380,000. I have Conservative colleagues where the average house price is half that. So telling someone that they (or often their children who will inherit) could lose 86 thousand of that figure is a much bigger blow in some parts of the country than others. In a paper for the research institute Public Policy Projects I have argued that instead we should go for a fixed percentage of assets which people can be guaranteed to keep. That would eliminate the geographical lottery that otherwise arises.
My other main concern is whether an insurance market will develop to allow people to buy policies to give them peace of mind. The Government assumes that it will, but the insurance industry is not yet convinced.
We are moving forward with care policy, and the Government should be congratulated for grasping this long-lasting nettle. But many important details are not settled yet. Social care is some way from being “fixed”.