Someone once said that disappointment is the gap between expectation and reality. And, certainly, if you approached the government’s social care White Paper with high expectations, you would be opening yourself up to serious disappointment. It’s not that the White Paper takes us in the wrong direction, just that it doesn’t move us very far forward in the right one. And, as often, lack of money lies at the heart of the problem.
The White Paper is, to remind ourselves, the latest of four documents that together were intended to deliver the Prime Minister’s promise of ‘fixing’ adult social care. We had already had the Health and Care Bill, the Build Back Better policy document and the autumn Spending Review.
The first introduced measures to give the Care Quality Commission oversight of local authority social care activities, with the possibility of intervention by the Secretary of State if necessary, as well as moves to greatly improve data collection within (and therefore insight into) the sector. The second, funded by a slice of the Health and Care Levy, introduced the headline reforms: introduction of a cap on lifetime care costs and a loosening of the means test, along with promises of ‘fair price for care’ for self-funders and £500 million to support the workforce. The third set local government funding for the next three years.
Social care is getting just a small slice (£5.4 billion over three years) of the £30.3bn raised by the Health and Social Care Levy, with the majority of the money going to the NHS.
Yet the detail – and the money available – has proved disheartening. Social care is getting just a small slice (£5.4 billion over three years) of the £30.3bn raised by the Health and Social Care Levy, with the majority of the money going to the NHS. The cap has been reconfigured to be less generous to people with low and moderate assets. Once you have taken off the extra costs that the policy document creates for local authorities, the spending power increase in the Spending Review is only 1.8 per cent at a time when social care costs – especially around workforce – and demand for services are surging. Only this week, directors of adult social services warned of a ‘rapidly deteriorating’ picture for social care. Reform has felt like it is faltering.
So the White Paper was an opportunity for the government to regain the initiative, by offering a clear vision for the sector and a series of measures to begin realising it. The vision – of choice, control, quality, fairness and accessibility – is not at all bad. It may not break much new ground but it efficiently articulates the objectives that many seek for social care and offers the sector something to work towards.
The real problem lies in the measures to bring about that vision. There are plenty of them but they add up to something well short of a full picnic. There is a welcome focus on housing, with £300 million to help develop new supported housing options, a new ‘handyperson’ service (though no details) and more money for Disabled Facilities Grants, which provide larger adaptations like wet rooms for people who need them. There’s also £150 million to drive greater adoption of technology and small pots of money to improve services for carers (£25 million), improve local innovation (£30 million), and improve planning (£70 million).
'...the idea that the White Paper will make any real difference to the recruitment crisis in the sector is fanciful.'
On workforce, there is more detail of how the £500 million will be spent and it is all decent stuff: better training, mental health support, continuing professional development (CPD) for nurses, a digital hub for support and advice. But there is no plan for securing the staff needed and nothing to say about pay and without this detail the idea that the White Paper will make any real difference to the recruitment crisis in the sector is fanciful.
As well as workforce, there are other large gaps in the White Paper. Though the vision includes a major focus on personalisation – choice and control – there are no measures to do that, despite an acknowledgement that current approaches are faltering. And details of the ‘fair price for care – what it is and how it will work – are absent.
The big problem here is money. Of the £5.4 billion for social care from the Health and Care Levy, most has gone on the headline reforms, leaving little for the White Paper. Even a quick tot-up shows that the measures announced in it add up to barely £1 billion over three years, which must often be split across 150 different local authorities. That was never going to be enough to make any major difference to a sector offering public support to around one million people a year, delivered by 1.6 million staff and provided by 17,700 separate organisations.
Before the White Paper was published, The King’s Fund published four tests for it, based on our own vision for adult social care.
Do the reforms ensure that people can get the services they need where they want them?
Do they ensure that people have control over the services they are using?
Do they ensure higher-quality services?
Do they give more people access to state-funded support?
The White Paper only really helps with one of them: the housing measures should help some people get the services they need. But the reforms do nothing practical to give people more control over the services they use and there is little in them – particularly given the lack of action on workforce – to improve quality. And though the earlier reforms in Build Back Better will certainly improve access to care, there is nothing in the White Paper that builds on this.
Overall, then, the government has missed an opportunity to revive the faltering reform process. Far from living up to the Prime Minister’s promise to ‘fix’ social care, the foundations for reform have still not been put firmly in place.