Reforming social care is about more than funding

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Jeremy Hunt’s recent speech setting out his principles for social care reform was welcome, not least because it dashed fears that the upcoming Green Paper might focus purely on funding and ignore other systemic problems in social care. Of course there is need for more money – and this need is urgent –­ but for long-term policy there are seven other key areas that need to be tackled alongside funding reform. Jeremy Hunt touched on several, but not all, of these in his speech and the challenge for the Green Paper is now to combine them in a coherent, comprehensive plan. A tough ask but one that’s far from impossible.

Let’s take a look at those areas.

Demand management, although not mentioned by the Secretary of State, is critical. The Green Paper should recognise that while need for social care is growing, there is an opportunity to influence the size of that need and the extent to which it leads to demand for formal social care services. There are at least two critical questions the Green Paper needs to answer:

  • How we do best assess and minimise future need/demand for services?
  • How do we incentivise investment in activities that minimise future need/demand but may incur immediate cost?

Market sustainability relates to whether the current, market-based, system can meet future demand. In a sector where provision has moved overwhelmingly to independent (not-for-profit and private sector) providers, we need to understand the following:

  • Is this marketplace of independent sector organisations able to supply all current and future demands for care services?
  • And can it do that in way which is fair and affordable to purchasers, whether state bodies like councils and the NHS or private payers?
  • If the answer to either of these questions is `no’, what can be done to help the system work better?

Workforce raises a linked and equally fundamental issue, vividly illustrated by the high turnover and vacancy rate in the adult social care workforce. With up to 700,000 additional social care workers needed by 2030, the Green Paper needs to provide an answer to the question: how can we attract and retain the number and quality of people required to staff our future care services?

With up to 700,000 additional social care workers needed by 2030, the Green Paper needs to provide an answer to the question: how can we attract and retain the number and quality of people required to staff our future care services?

A fourth key area is quality. The Green Paper should seek to address this from the perspective of the service user and answer the question: which care models deliver the outcomes that service users most prize? There also need to be answers about the level of care quality the state will supply and, with many older people at risk of neglect or even abuse, how best to safeguard service users from harm.

Quality links closely to efficiency where the key question is: which models of care provide the best outcomes for the investment made? Identifying these and then spreading their use should be another key objective for the Green Paper. It should also consider the most effective arrangements for commissioning care services and how best to harness the potential of technology.

The Green Paper can’t (and surely won’t) ignore integration: how can social care services join up effectively with other services such as health, housing and – unmentioned in the speech – the benefits system. A key issue here is Attendance Allowance, the disability benefit claimed by more than 1.4 million older people and costing more than £5.5 billion but which is run totally separate to council-funded social care.

The Green Paper also needs to set out the most effective ways of delivering public funds to social care, for example, through combining health and care budgets, locally and/or nationally. And it needs to consider how people can be supported to find the right balance between informal and formal care, and how society, including businesses, can best support them in that.

It needs to consider how people can be supported to find the right balance between informal and formal care, and how society, including businesses, can best support them in that.

The seventh key area is the one that will probably generate the headlines when the Green Paper is published – the public offer and, in particular, the Green Paper’s suggestions about the level of need and/or assets that will entitle people to state funding for their social care. A critical corollary will be, if some people have to pay for some or all their care, will there be any cap on those care costs? A related question, given that so much of the current heat surrounding social care comes from people discovering that social care is not provided free of charge, is how can public awareness be increased?

And finally, back to funding. As well as the fundamental question of how to raise the extra funding required (an admittedly huge issue), there are further questions about where that money comes from and who spends it. They include:

  • Are there advantages to raising taxes purely for social care (hypothecation)?
  • If people need to pay for some of their care themselves, does the government need to require (or perhaps ‘nudge’) them to prepare for that?

Finally, a note of realism: serious reform that addresses all these issues is likely to take longer than a single parliament and requires a staged approach that operates to clearly established short, medium and long-term milestones. The Green Paper needs to be the start of that process and not just another of the policy dead ends for which social care is sadly notorious.


Marion Raynor

Health and Social Care Student BSc/Worker,
New Bucks Univeristy
Comment date
05 January 2019

I have found your comments on the governments green paper extremely useful, I have used your argument in my current assignment covering the problems of health care workers working in the care sector and aging well through the lifespan. I work as a health care worker in a private nursing home before I worked in a private nursing home I worked as a domiciliary carer and an agency carer and throughout the care sector carers do feel neglected and undervalued, the feeling that we get is that the service providers do not care about carers and how exhausted they are and their mental health they are just concerned with getting the job or shift covered, for very little money.
Service providers do not encourage health care workers to progress, offering very little encouragement or recognition for NVQ qualifications or any other. I am currently studying for my BSc in Health and Social Care Science so that I can go on to teach up and coming care assistants and pass on my experience as a care worker to them (over 14yrs of both NHS and Private Sector Care). this is funded by Student Finance which I have to pay back once I have completed my studies, I asked my employer if they would fund further training past NVQ three the answer was no as they did not require any more carers at NVQ four level and there was no government funding for it.

Now my higher education and studies are beginning to pay off in certain aspects, my manager has seen a vast improvement on how elderly people with dementia are being cared for through my team leadership style. Training and staff development is important.

M Smith

Supported Living Manager various locations,
Prefer not to advertise
Comment date
11 September 2018

I would just like to comment how well your statement came across. Working for a large organisation I find that far too many hours are lost in meetings and planning for changes/(improvements) and too little hours are spent actually making a difference. More money is not going to solve the inadequacies of large organisations, decision makers being disconnected from frontline services, and 'supporting functions' that contribute little, if at all to the end result of quality care and support. My thoughts on this Green Paper are similar to those of a large organisation.... lots of time and effort into a piece of writing with likely little or ineffective follow through.

Your comments about speaking with the person being supported said more to me than the rest.. I believe if more of this happened across the board then improvements would naturally follow - person centred support and outcomes would follow, actual meaningful work for all employees!!

Anyway, I will climb down from my soapbox and continue to advocate as best as one person can for what is right, what is fair, what is needed.

George Coxon

Various inc Care Home owner,
Comment date
05 April 2018

A really useful piece Simon. More valuable response & additional narrative to the 7 priorities from Jeremy Hunt I’ll take this to our Devon Care Kite Mark steering group on Monday to encourage more reaction from such as us - hands on care providers- eager to not just survive in testing challenging times but succeed and address all of the points you make in an upbeat progressive way.
I respond to many consultations repeating similar points about INTEGRATION, LEADERSHIP, CREATIVE, CREDIBLE, CONSTRUCTIVE, CULTURE, ENTHUSIASM, KINDNESS, PRIDE and other words that are central to how we provide care and support now and in the future But words are easy The issue that must be the core driver is THE CONVERSION RATE As an ex senior NHS commissioner it was previously ‘referral to treatment’ or ‘intervention to cure’ now for me it’s ‘good idea or plan to action’ or ‘attending a meeting or participating in a strategy group or such like and it’s direct impact of those needing care & support’. Sadly I have little faith in how much impact the copious effort and time taken in working up the Green Paper will have. Sadly too many people involved are paid very decent salaries regardless of how much improved outcome is achieved. Most if not all have never been in a care home, never chatted with a person living with advanced dementia, polished their shoes with them, laughed kindly & sensitively with them, or taken time to learn about the fullness of their lives.
My enthusiasm to influence both my 2 small homely care homes (both currently boasting Outstanding ratings after recent CQC inspections) will not be diminished by the high level procrastinations or the collective societal denial & naevity in not recognising the huge need for choice of great 24/7 care for our older people ‘when the time is right’ - my focus is predominantly the over 85 yr old age group. Many of not most are in serious need of proper anticipatory care at the very least.

If I were to rate in order your headings I’d certainly see all as worthy priorities possibly with integration top of the list with mkt sustainability, workforce & efficiency next To omit quality is hard to argue for of course but I genuinely will always resist shouting about funding being the most critical priority
I dearly hope those actively involved in construction work on the Green Paper can offer a ‘can do’ approach with plenty of pragmatic direct ‘real time’ experience without this we might as well not waste time on producing yet another great tome to gather dust on shelves

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