Social care reforms more dispiriting than inaction?

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.