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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.