On taking office, Boris Johnson pledged to fix social care ‘once and for all’. In his departure speech, he declared that he had, indeed, delivered on manifesto commitments to do just that. However, despite these bold claims, Liz Truss has inherited a system that’s far from fixed and is actually edging closer to breaking point. Secretary of State for Health and Social Care, Thérèse Coffey, appeared to quickly grasp that all is not well in social care – in her second day in the job, reports were circulating of plans to divert NHS money to pay for care home beds.
Johnson’s administration did set in train some reforms which are being implemented. Under these changes, more individuals should receive public funding for care through a more generous means test, a lifetime cap on costs and by enabling people who pay for their own care to favourable rates. These reforms are set to take effect from October 2023 but there is already concern that the financial envelope is insufficient. While welcome, these proposals focus on just one of the problems plaguing the system – people facing catastrophic costs for care. However, in recent years that issue has arguably been eclipsed by a more fundamental problem – people struggling to access care at all.
A decade of austerity and a failure to implement any reforms over two decades has left social care in a fragile state at a time when need for care has risen. Reliance on sporadic short-term injections of money instead of a sustained and certain source of funding, has rendered providers of care and councils unable to effectively plan or invest in services over the long term. Failure to address deep-seated workforce issues has resulted in a serious shortage of staff, leaving provider organisations unable to recruit and retain workers. Covid burnout and competition from other sectors have added to the issues of low pay and poor conditions and seen staff leaving the sector in large numbers. Vacancies hovering around 165,000 at last count mean that providers are not only unable to expand to meet growing need but also to fill existing posts. Long waits for care assessment and packages mean that councils are struggling to meet immediate needs, let alone facilitate development of new innovative models of care to suit growing demand and changing preferences.
One of the more visible manifestations of this crisis is the number of delayed discharges from hospital but much of it is playing out behind closed doors in people’s homes as they struggle to do everyday tasks and increasingly rely on friends and family for support. Whoever is carrying the keys to 10 Downing Street, top of their urgent to do list should be to retain and expand the beleaguered workforce and shore up fragile providers ahead of winter. But she also cannot afford to neglect the long-term. A true fix for this broken system requires a strategic long-term plan that addresses the underlying fault lines, not just short-term sticking plasters that simply delay collapse.
