What next for social care?
The Covid-19 pandemic has exposed more starkly than ever before, the Cinderella status of social care. Left to languish behind calls to protect the NHS, ignored until a mounting death toll in care homes engendered a public mood to right the obvious wrongs, and increasing media pressure managed to force the Government’s hand.
The integration of health social care into the NHS has long been assumed the answer. However, this may impede the NHS from doing what it does best – delivering the best possible health modern medicine makes possible- and risk relegating social care even further into Cinderella territory.
If the wellbeing of working age and older disabled people who need care and support is to have the public esteem and political support that matches the NHS, we must look a little deeper into why that isn’t already the case.
For this, we need to understand the role played by local authorities. They have a legal responsibility to know the needs of the communities they serve and put in place sufficient services to meet those needs. The pandemic has exposed the ramshackle patchwork of impoverished care services, which fails to meet the needs of the community.
How have councils allowed such a second-rate system to continue under their watch?
The perennial beef is that they are underfunded. The Local Government Association, the body that represents them, says an up lift in the order of £7.5bn, an increase of some 50% of current spending levels, is required, even without an additional £6.4bn to make personal care free. However, throwing more money at the care sector will not 'fix' a broken system.
Local authorities have to control spending within a budget, just as the NHS has to spend within a budget. However, the problem arises because social care controls its spending through a needs test. If an individual’s need passes the test it is deemed ‘eligible,’ and it is guaranteed to be met. Councils are not allowed to fail to do so. If the need does not pass the test it will not likely be met. All councils work to the same national ‘eligibility criteria’.
However, these national eligibility criteria are nothing more than window dressing. The council still has to match the ‘eligible needs’ with their budget. This leaves them with no choice but to adjust the needs test on a highly localised basis to the budget available to them. Essentially, councils must match the scale of the required care and support in their local community to the budget that they are given, rather than the true needs of the older and disabled people.
Within broadly comparable budgets per head of population, deprived communities have some 50% more people in need of publicly funded care and support than the more affluent communities, as more people can fund their care. Councils report shows that in 2018/19, the highest-spending 10% of councils spent an average of £22.7K per person; the lowest spending councils £12.9K – a difference of more than 70%. The highest-spending councils tend to be ones that serve more affluent communities and the lowest more deprived. This evidence is not only unfair and unjust, it completely undermines the sector’s case that more funding alone is the answer.
Covid-19 has brought to the attention of the public that the social care sector - the way older and disabled people have been treated, and many of the staff - is an outrage. To have a decent social care system, we must first step back and ask what we want from our social care system. The electorate places a high value on the NHS which serves to give us the best health that medicine makes possible. Do we not also expect to access the best quality of life that good social care can make possible as we age or live with an impairment?
Of course, the answer is yes. So, we must call for the pernicious needs test to be abandoned. People, and not resources, must lead the approach of social care as we rebuild society. The needs of what each person requires to have a good, decent and independent life must first be identified. And only then, can one look to whatever budget they are provided with. Crucially, councils must be free to be honest if the resources they are given fall short and be determined to do all in their power to secure the necessary resources.
Political leaders must be willing to hear what resources are actually required and accept their responsibility to do the best they can to provide them. What self-respecting politician would say no to that?