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Kari Gerstheimer

CEO, Access Social Care

Quotation Marks
“The Department of Health and Social Care has inadequate data to understand the scale of the problem or funding needed to fix it.”

Social care reforms more dispiriting than inaction?

Social care reforms more dispiriting than inaction?


Kari Gerstheimer evaluates if social care reform enhanced or exacerbated problems for vulnerable people accessing support

Many of us had doubts the Prime Minister would meet his promise, made on the steps of Downing Street in 2019, to “fix social care once and for all”. Some had doubts he would even try.

To his credit, he tried – and unlike his predecessors, oversaw publication of a reform package. But unfortunately, these efforts, along with announcements at the recent spending review, fall woefully short.

The funding reforms, announced in September and updated in mid-November, will, for the first time introduce a cap on lifetime care costs, limiting personal liability for care. However, at £86,000, the limit is set too high, and only personal contributions count towards it. Worse, only “eligible” needs count towards the cap, creating a perverse incentive not to invest in prevention to stop social care needs escalating.

For richer, for poorer?

The cap will benefit the rich much more than it will poorer people. To put it simply, if you have serious social care needs and assets worth £1m, the cap ensures 90 per cent of this is protected; if you have assets of £186,000, 90 per cent of your wealth is in danger. The requirement to have your needs assessed as eligible in order for payments to count towards the cap will place even greater strain on struggling local authorities, whose leaders told us recently over 400,000 people are waiting for an assessment of need.

This is a regressive policy, which we first saw on the policy agenda in 2011. Four years later, it was thrown out by the Conservative administration on grounds that it was inequitable – and this was with a significantly lower cap, which counted state contributions.

At a time when demographic changes mean the UK population’s social care needs have never been greater, the reforms largely overlook millions of people across the country who don’t get any social care at all. Years of chronic underfunding means unmet need has swollen uncontrollably. The Department of Health and Social Care has inadequate data to understand the scale of the problem or funding needed to fix it. The White Paper makes some reference to demographic pressures and the rising cost of delivering care due to rising salary costs, but implied – very worryingly – that councils should address the problem by raising council tax.

Postcode lottery

As Access Social Care research shows, the decision to shift local authority funding away from the central government grant and towards council tax was a major mistake of the austerity years. The result has been richer councils get richer and poorer councils get poorer, and this is reflected in social care provision. Social care is much more available in the richer South than in the most deprived parts of the country, like parts of Greater Manchester and Tyneside.

We hoped that we were wrong, that the September reforms would have a major second part revealed at the October spending review which would speak to the issue of social care funding. We were not. Rishi Sunak announced £4.8bn extra cash for local councils, but this will not be ringfenced for social care. It is likely a significant part of this new money will go on other services.

Anyway, even if it were ringfenced, it would not be enough. The social care sector would still only have about 60 per cent of what it needs to stabilise services, defined by the Health Foundation as being able to meet future demand created by demographic changes and being able to improve access to care. Even more would be needed for ‘recovery’, which would include increasing sector pay to put a brake on the exodus of staff leaving for better paid jobs in, for example, supermarkets.

This was the year a UK government finally implemented social care reform after 20 years of evasion.

Whatever next?

The system will function better than it did before for the fortunate. But for those already disadvantaged it will entrench inequalities – the same inequalities this government was elected to fix. We can safely predict the care gap between richer and poorer regions will widen, both in terms of both of care provision and the personal financial burden. How’s that for 'levelling up'?

This year has been in many ways more dispiriting than the previous two decades, because change is no longer imminent. The risk is, the system will now be left without further reform for the foreseeable future. Social care is complex and politically sensitive –the worry is the next government or several after may not wish to reopen this can of worms.

Kari Gerstheimer is CEO of Access Social Care, a charity providing free legal advice and information to people with social care needs: