Social care: a year in, what prospects for reform?
About 2 mins
The season of mists and party conferences offers a timely opportunity to look back at the government’s record on social care after over a year in power and forward to assess the prospects of reform.
Labour was elected on a manifesto with a headline pledge to implement England’s first Fair Pay Agreement (FPA), establish a ‘National Care Service’ and a pledge by health secretary Wes Streeting to implement a cap on social care costs and more generous means testing. More encouragement came from the Prime Minister just weeks after the election, noting the ‘vital, life-affirming work’ of his sister, a care worker. Wouldn’t it be great, Starmer asked, if ‘…she could walk into any room and instantly command the same respect as the Prime Minister?’
But by this time the signals were already turning to amber. The planned funding reforms had been abandoned on the grounds they were unfunded. Months later, the job of working out what to do instead – and how to implement a National Care Service – was given to a new independent commission headed by Louise Casey.
It is not surprising that the Health Foundation’s recent assessment of Labour’s first year paints a mixed picture, in which social care ‘remains a Cinderella service’ compared with the immediate attention and priority given to the NHS.
Policy developments and concerns
For the foreseeable future, the two big areas of policy development to watch in social care will be the Casey Commission and the FPA. Behind these headlines are other relatively unsung but important workstreams in areas such as digital technology and data use, prevention and early intervention and continuing the development of a care workforce pathway. It is not as though nothing is happening, but there are some big concerns.
First is the pace of change – the timeline of policy work so far might be better described as glacial rather than transformational. It took 6 months to announce the Casey Commission. 9 months on, its modus operandi and programme remain unclear – and it will not issue its final report until 2028. What a National Care Service means in practice therefore is likely to remain hazy. Consultation on the FPA has begun but this enormous set of changes to policy, legislation and practice is unlikely to be applied to workers’ contracts before 2028. Together these timelines feel too distant for a system under acute, sustained and growing pressure. The government’s approach has an Augustinian feel – it does want to reform social care … but not yet.
Then there is the money. The £4bn extra a year in 2028/29 already announced for social care in the Spending Review was better than expected given the grim fiscal context. But much of it will come out from local council taxpayers rather than Treasury coffers. Faced with deepening funding pressures, few expect salvation to come from the forthcoming Budget, given the horrendous choices about tax and spending facing the Chancellor. The £500m promised to implement the FPA, included in the £4bn, roughly amounts to an extra 20p per hour per worker, if shared across the 1.5 million workforce. There is a real risk that a laudable, necessary and well-intentioned policy will fail under the weight of great expectations and insufficient funding.
Is reform on the horizon?
Risks will also arise from wider developments that will shape the future prospects for social care reform. These include the reorganisation of local government and reform of its funding – crucial to the future sustainability of social care – and the reduction in the number of integrated care boards and their running costs. Then there is implementation of the 10-Year Health Plan, where the proposed shift towards neighbourhood care will surely be impossible without adequately resourced social care.
Together these multiple changes will generate fresh questions about how social care and the NHS can work together and inflame the financial pinch points around hospital discharge and continuing health care. Changes in senior leadership because of structural changes could disturb the chemistry of strong collaborative relationships, on which effective joint working depends.
In 1940s Germany, the theologian Dietrich Bonhoeffer wrote from his prison cell, ‘The dismal autumn days have begun and one has to try to get light from within.’ Although the immediate horizon for social care seems gloomy, confidence in the government’s ability to deliver its promises could be bolstered by creating a more unified and compelling narrative. One that draws together the otherwise disparate threads of separate policy workstreams and that does justice to the government’s ambitions and activity. The Casey Commission’s early work could play a pivotal role in this, as well as creating momentum in building public and political support for change. And speeding up the pace and the timing of reforms would at least inspire hope that real change is possible.
Richard Humphries (@RichardnotatKF) is a Senior Policy Advisor at the Health Foundation.