Time to step up and invest in social care

Featured article - 16 June 2020
By Deborah Alsina MBE, Chief Executive, Independent Age

Since the beginning of the coronavirus pandemic, the Government has been clear in its resolve to ‘Protect the NHS’, ensuring it had, in the Chancellor’s words ‘whatever it needs’. This was welcome. I’m sure we can all think of times when we’ve needed to rely on the NHS, but the same can be said for social care, for either ourselves, our family or friends. Yet the support offered by the Government to protect social care has not been as forthcoming.

• 8 March. Rishi Sunak: NHS will get whatever it needs to deal with coronavirus
• SCIE: COVID-19 support for social care
• Independent Age
• Other opinion articles in this series

We’ve heard from our colleagues in the sector about the struggles care home managers have faced to get access to the basics like personal protective equipment (PPE). The Methodist Homes Association, the largest non-profit care home provider, says that it was forced to buy PPE on the open market at inflated prices because government supplies were not getting through to them.

• 9 May: "UK care homes scramble to buy their own PPE"

As we know, care can be offered in many settings and at Independent Age we hear from people receiving care within their own home who have also been left feeling exposed. Anne, who is 66 and has carers visiting daily, told us: ‘I have about ten carers a week who each see at least a dozen people in a day. When I started doing the maths, I realised that I have huge amounts of direct and indirect contact which increases the risk of coronavirus coming into my home’. In the early weeks of the pandemic, Anne says carers arrived without PPE, or were told only to use if they were treating someone diagnosed with COVID-19.

• Independent Age: Home Truths: Changes to care, part 1

Testing

Another key challenge during this pandemic has been ensuring people using social care services, and those that provide them, receive regular testing. We’ve all seen news reports of people being discharged from hospital into care homes. The lack of a systematic testing programme has undoubtedly led to many thousands of otherwise preventable early deaths. In addition, the fact that no statistics were recorded or shared for some time also highlights the lack of parity when to comes to the NHS and social care.

However, the challenges faced by social care providers, and those using their services, are now starting to be recognised more widely, with increased media coverage and growing public concern. Our recent joint poll with the thinktanks IPPR and Policy Exchange found that 61% of adults think social care spending in recent years has been below what is needed.

• Poll. Care after Coronavirus: An emerging consensus

It’s positive that we’re seeing real political and public consensus about the need for much higher investment in social care. But what concrete changes do we need to see? Sadly, there is no silver bullet, but at Independent Age we have a few ideas for reforms which could send us in the right direction.

The workforce

First off, we need to tackle long term issues with the social care workforce. Care work is highly demanding, physical, skilled work and yet it has always been poorly paid with few opportunities for progression. It is also often insecure work with a quarter of staff on zero-hour contracts. It’s no surprise then, that there are a high number of vacancies (more than 120,000) and high turnover, with nearly a third of people leaving the sector each year. In reality what this means for the people who need care in their own home, is the likelihood of a different person coming each day to help them with basic needs such as washing or getting dressed in order that they can remain as independent as possible.

• Skills for Care. The state of the adult social care sector and workforce in England

The pandemic has helped bring to life the vital role care workers play in our society. But recognising this in practice will take much more than public figures wearing a care badge. We urgently need to see pay increases to bring it into line with similar roles in the NHS. There must be better opportunities for career development, with systems for portable, accredited training. And underpinning all of this, there must be a national strategy for the social care workforce, akin to the People Plan for the NHS.

• 15 April: Care badge announced
• Interim NHS People Plan

Funding

Second, the long overdue funding reform of the sector must finally be tackled. We know from our Helpline that people in later life and their families feel the current system is unfair, opaque and incredibly stressful to deal with. Significant funding reform would take away some of these barriers, easing the burden on family carers, and supporting people to get help earlier and stay in their own homes for longer.

There is growing consensus from across the political spectrum that Government should extend the principle of care free at the point of use to those receiving social care, paid for through general taxation. Within this principle there are a number of options, including making all social care free, or making some elements free, such as personal care.

Whichever option the Government go for, it must:

• Broaden access to support, as currently too many people are excluded from receiving the care they need
• Be personalised around the individual person
• cover the essentials, which for many people in later life include access to personal care (e.g. washing, cooking, dressing, going to the toilet) to enable them dignity, choice and control over their lives).

Third, whatever level of reform the Government opts for, people need to be protected from spending vast sums – often their life savings - due to the bad luck of developing care needs. One in ten people will end up spending more than £100,000 on their care. We need to pool risk for care needs, as we do with health. In our view it is not about choosing between capping costs and providing a universal offer like free personal care – we need to see a combination of these solutions, alongside greater investment in the workforce, to really deliver an improved system for everyone.

• What’s the problem with social care, and why do we need to do better?

Of course, it’s essential to remember that people in later life are not the only users of social care. People of working age with physical and learning disabilities account for nearly half of council spending on adult social care. A one size fits all approach will not work. People with disabilities can have very different needs to older adults, so this also must be explored under any new reforms.

The lives people want to live

None of this is easy. Social care is an incredibly complex issue that throws up fundamental questions about the state and its responsibilities towards its citizens. But it is more than a political headache to solve, or a means of easing pressure on the NHS, important though that is. Social care is about how people can be supported to live the lives they want to live.

As we hopefully come out of the pandemic there’s a clear choice for Government: continue to put reform in the ‘too difficult box’ or use this moment and growing public expectations to bring in bold reform that creates a lasting legacy for people of all ages.

• Deborah tweets @DeborahAlsina