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William Lee, Policy and Parliamentary Executive of the British Healthcare Trades Association

William Lee, Policy and Parliamentary Executive of the British Healthcare Trades Association (BHTA), provides a whistle-stop tour of the social care reform journey and explores some of the key points made in the UK Government’s recent adult social care reform whitepaper.


On 1 December 2021, the Department of Health and Social Care (DHSC) published a whitepaper, ‘People at the Heart of Care’, that sets out its 10-year vision for adult social care and provides information on proposals that will be funded by the £1.8 billion-per-year increase earmarked for social care from the government’s 1.25 percent rise in NIC levy (£5.4 billion total over three years).

BHTA has commented previously on this funding increase (announced in September 2021), and we are pleased to see the government begin to flesh out its plans for social care. It is clear, however, that this whitepaper – as described by the Secretary of State in his Executive Summary – is really only a “journey-planner” for social care reform.

The whistle-stop tour includes:

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Disabled Facilities Grants (DFGs) – More of the same, more needed

We are pleased to note plans to continue DFG funding (see Chapter 4.18) at near its current rate (£573 million/year 2021-22; £570 million/year 2022-23 & 2024-25), not least since DFGs so often fund life-enhancing adjustments supplied by BHTA members (e.g. stairlifts, wet rooms, and other home modifications).

As Care & Repair England points out, however, inflation and rising cost of materials and labour would have made a DFG funding increase more welcome, and we continue to wait for more detail on how new homes will be made more accessible, a decision that has again been delayed (see Chapter 4.24).

Digitisation and caretech innovation – The future is now?

An earmark of £50 million/year over the next three years (£150 million total) to drive digitisation across the social care sector and unlock the potential of caretech innovation that enables preventative care (e.g. measuring and monitoring devices) and independent living (e.g. tablets, e-readers) is a welcome development (see Chapter 4.28 ff).  BHTA and its members agree with analysis from the Technology-Enabled Care Services Association (TSA) that indicates “digital tools can be used more proactively across adult social care, so that people can live healthier lives for longer, in their own homes.”

We call on funders at all levels of government – NHS, DHSC, local authority, etc. – to ensure that uptake of innovative products is as streamlined as possible, with focus on 360-degree positive effects of such innovation for patients and carers alike, rather than a narrow, cost-only view.

Social care/occupational therapy workforce – Who cares for the carers?

OTs and others in the social care workforce will welcome the announcement of £500 million for a raft of planned workforce transformation measures (see Chapter 6.5 ff), including a Knowledge and Skills Framework and Continuous Professional Development, and it is gratifying to see OTs and others recognised for their outstanding work in helping people live richer, more independent lives.

Concerns remain, however, about gaps in pay and working conditions for the social care workforce (see commentary from the Royal College of Occupational Therapists). We hope future efforts are in line more with the lofty aspirations of the whitepaper and less with the government’s recent reticence to amend the Health and Care Bill 2021 to embed NHS and social care workforce planning/reporting in law.

Those living with dementia and their carers – Still waiting

The government’s forthcoming standalone strategy on those living with dementia and their carers (See Chapter 1.15) is keenly awaited – some might say overdue – and it remains to be seen whether it will redress funding and support imbalances that mean dementia sufferers have access to fewer resources than those affected by other conditions.

Integration of health and care services – Not quite yet

Perhaps the largest omission in the whitepaper is the lack of detail or colour around how health and care services will be integrated going forward, which has been relegated to another, future whitepaper (see Chapter 2, p.30).  Given the amount of integration “talk” from government, the “walk” can’t come soon enough.

We applaud the aspirations outlined in the government’s whitepaper, but much more detail is needed to understand how these aspirations – which, after all, do not address urgent social care needs right now – will translate to better social care in the future. In the words of the Association of Directors of Adult Social Services:

“There is much detail to fill in and much more funding to find . . . clearly the sums identified so far can be no more than pump-priming, [and] what we need now is a bridge to that brighter future, to address the immediate crisis and ensure that everyone gets the care and support they need.”

BHTA and its members look forward to working with DHSC and other delivery partners to ensure that the social care reform journey ends at its desired destination – where people have choice, control, independence, quality and tailored social care that is fair and accessible.

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