At the beginning of April, the government published its ‘next steps’ paper on social care reform – the implementation plan for its 2021 White Paper. The plan was met with universal dismay from the sector, with the Association of Directors of Adult Social Services (ADASS) saying the vision for reform is ‘in tatters’.
Here I attempt to briefly set out the big picture implications of the plan and what it means for the government’s ambitions and promises on social care.
When people ask me what is needed to ‘fix’ social care, I usually say three things:
fund the current system to meet demographic need and cost pressures – in effect, keep the current system going
reform the system to improve quality and outcomes – make the system better
clarify who, the individual or the state, pays for what – make the system fairer.
In 2021, the government set out plans across all three areas of action, with a commitment to a new extended means test and a cap on care costs, and a new White Paper detailing the first steps on a 10- year reform journey. But in the past six months, we have seen attention narrowly focus to just keeping the existing system going. Let’s take look at those three areas of action.
Fund the current system
In the Autumn Statement, the government announced £7.5 billion of funding for the social care sector for 2023/24 and 2024/25. Coming from a complicated mix of pots of new money, recycled money from delays to other reforms, and assumptions about large Council Tax increases, this funding was intended to help meet inflationary cost pressures and demand. This scale of funding to help meet costs and demand was welcomed given the scale of financial pressure the sector faces, although some of it coming from Council Tax and from delayed reform was a disappointment.
Reform the system
In December 2021, the government originally announced £1.7 billion of funding to support wider reform, with the 2021 White Paper initially committing £1.1 billion of those funds. This covered issues such as workforce training, innovation in housing, digitisation, unpaid carers. In early April, in the ‘next steps’ for the White Paper set out investment of £615 million (the Department of Health and Social Care says that £700 million is committed but this is not in the public documents), with £600 million still remaining unallocated. So the investment that was first set out in detail has been scaled back and much of its purpose shifted towards meeting current cost pressures. The Department says no funds have been cut, but the numbers committed are clearly lower. Only when you look at the detail do you spot several things:
£100 million has indeed gone (due to complicated interactions with the Department for Work and Pensions’ Attendance Allowance budget),
£300 million has already been spent. However, aside from a small amount spent on digitisation, no one knew at the time it was being spent on reform, so we can safely assume that most of this was spent on delayed discharges in 2022/23, not on improvement and reform
£100 million of what was meant to be a £300 million investment to spark innovation in housing is now paying for home adaptations (meeting the current cost of the system) and the balance of £200m is now lost. This means of the committed £615 million, not all of it is being spent on reform, it’s really just £515 million.
Overall then, of an initial £1.7 billion for reform and improvements, the commitments now read just £515 million for reform, £100 million is lost, £300 million already spent to fund existing pressures through delayed discharges and £100 million to be spent on housing adaptations. £600 million is yet to be allocated – and is clearly at risk of going in the same direction and being spent to keep the current system going, not on improving it. A big reduction to pace and ambition for reform here as the government shifts money to keeping the current system going.
Clarify who pays for what
The government had committed £3.6 billion to extend the means test and introduce a new cap on care costs. Both of which we warmly welcomed. These measures were originally to start in October 2023, but in November 2022, the government announced a two-year delay, pushing implementation till after the election. The £3.6 billion originally intended for this new funding deal was ‘recycled’ and given back to the sector as part of the £7.5 billion allocated in the Autumn Statement to meet the demand and cost pressures in the current system.
So where are we now? From a hopeful position just 16 months ago, when there were reform and investment commitments across all three areas, we now have a government with a narrow focus on just keeping the current system afloat, with little real ambition or pace for reforms that would make a difference to the hundreds of thousands of people who draw on social care to live their lives, by transforming the system. The current actions planned from the government barely make a mark on tackling the myriad of systemic problems in social care.