Has Boris sorted social care, then?
I wrote a piece for Policy@Manchester earlier this year on the exposure that Covid has given to the long-term policy failings of social care in England. Well, it looks like Boris has read the room and is finally trying to do something to address an issue which has been bubbling for decades. So, how does his plan look?
Image by Pete Linforth from Pixabay
On September 7th, 2021, Boris announced a 1.25% National Insurance tax increase to help fund health and social care. A very un-Conservative tax rise policy, and a manifesto promise broken, shows just how seriously he has felt the pressure in the post-crisis period, and the immediacy of the need for a fix. This follows in the wake of nearly 30,000 excess care home deaths during Covid wave 1 alone (4th March 2020 to 7th August 2020), and an NHS nearly overwhelmed, exposing decades of under-investment in workforce training across the board, and, more generally, under-investment in wider societal ‘health’. For instance, over a decade of Conservative-led austerity cuts to vital public services.
What the reform does and doesn’t do
In brief:
From April 2022, the National Insurance tax, a tax paid by employees and employers to count towards various state benefits and pensions, will rise by 1.25% (plus a similar rise for tax on dividends for those who own shares in stocks).
From April 2023, the same tax will be re-branded as a ‘health and social care levy’ (i.e. shown as a separate line on the payslip so that the NHS-loving population hopefully doesn’t get too outraged at the continued taxation).
This is projected to provide an extra £12 billion a year for the next three years (so, total, £36bn).
Initially, the money will be spent trying to catch up on all the delayed care in the NHS, left with long waiting lists due to Covid itself and the policy response to this. Around 15% (£5.4bn) of this £36bn will be earmarked for social care alone.
There are currently scant details on what the social care money will actually be spent on, but £500m (around 1.4% of the £36bn) is earmarked for workforce training and recruitment, for example.
Additionally, there will be changes to who is able to individually benefit from publicly funded social care for eligible needs:
Currently, people with assets over £23,250 (including property value for residential services) are not eligible for publicly funded social care. Only those with savings below £14,250 are fully paid for, while those in-between (i.e. savings between £14,250 - £23,250) pay for a proportion with some help from the state. There is currently no maximum cap on what an individual can spend over a number of years of care (until they reach the asset limits).
From October 2023, people with assets above £100,000 will not be eligible for publicly funded social care, those with assets below £20,000 will be fully paid for, and those in-between (i.e. with savings between £20,000 - £100,000) will pay for a proportion with some help from the state. There will also be a maximum cap of £86,000 that any individual (including those with assets above £100,000...) can pay over their lifetime, equivalent to around three years of full-time care.
So, some extra cash floating around the system is always nice, and some additional coverage for the poorest (and richest! – the total cap plus increasing the amount that an individual can have in assets, rising from £23,250 to £100,000, while still receiving a state contribution). Some improvements, at least.
But, the announcements still leave a lot to be desired. There are particular issues in:
The workforce crisis: Save for some cash set aside for ‘training and recruitment’, there is no detailed plan to address social care workforce issues. For example, over a fifth of care workers are only paid the National Living Wage (currently £8.91 per hour), with a lack of training, career development and professionalisation opportunities preventing them from advancing beyond this.
The supply side: The social care sector comprises a mess of different types of providers. For example, the care home market is predominantly situated in the private sector, with a mix of services offered, various sizes of homes, and for-/not-for-profit provider status. Within that, a mix of large chains, small/medium chains, independent, charity, and NHS/local authority-run facilities, and increasingly private-equity firms sucking out profits for short-term gain. The market is also highly dynamic, with providers entering and leaving all the time, making it difficult to co-ordinate and monitor quality.
The integration agenda: The messy supply-side outlined above makes it already difficult to contract with the NHS, for (most) users who need both healthcare (e.g. medicines and surgery) and social care (e.g. help with activities of daily living, such as getting dressed and preparing meals). Additionally, it is not clear how integrated health and care can ever really be achieved with still fundamentally different funding systems - tax-funded and universal access NHS versus means-tested social care. Sure, some more people will now be moving to completely tax-funded care, but far from everyone. This means that there will most likely be different levels of integration depending on the mix of funding and providers chosen by any individual with assets over £20,000, who will be contributing to the costs.
The near-term: The can has also been kicked down the road. More money only starts to be raised for the system from April 2022, with additional coverage for individuals beginning from October 2023! It’s currently October 2021…
The funding method: This needs more space than I can give it here (see the companion piece), but suffice it to say for now, Boris has largely saved his mates from paying for this and left it to you and me…
So, has Boris sorted social care, then?
Not a chance.