OPINION: Health and care organisations say social care funding reforms do not go far enough
Following the Department of Health and Social Care’s (DHSC) recent announcement about reforming the NHS and social care in an effort to tackle COVID-19 backlogs and cut waiting times, national organisations have weighed in.
The UK Government revealed a record £36 billion investment to tackle pandemic backlogs, reform adult social care, and bring the health and social care system closer together on a long-term, sustainable footing.
Perhaps the most significant part of the announcement was the revelation of social care funding reforms. From April 2022, DHSC said a new Health and Social Care Levy will be introduced and ringfenced for health and social care. It will be based on National Insurance contributions (NICs) and from 2023 will be legislatively separate.
All working adults, including those over the state pension age, will pay the levy and the rates of dividend tax will also increase by 1.25 percent to help fund this package.
This will raise around £12 billion in extra funding per year, which will be invested in frontline health and social care across the UK over the next three years.
Now, influential organisations, such as the Royal College of Occupational Therapists (RCOT), Chartered Society of Physiotherapy (CSP), Age UK, and Association of Directors of Adult Social Services (ADASS), have weighed in on this significant reform.
RCOT’s chief executive said that the levy will provide relief for some people, but the lack of guarantee of sustainable long-term funding beyond this is a “big concern”.
Commenting on the announcement, RCOT Chief Executive Steve Ford said: “Social care should be provided to all who need it and free at the point of use, to help address the inequalities COVID-19 has shone a light on the sector. Whilst today’s announcement will provide relief to some, the announcement of £5.4bn over three years with no guarantees of sustainable funding beyond this is a big concern for the long-term future of care.
“Nor does it say the government will address the real issues in the social care workforce which are leading to chronic shortages all over the country. Occupational therapists as well as other allied health professions will have listened in vain to hear about how the government intends to tackle the issues they face on a daily basis.”
Steve also said that the £500 million investment into developing the social care workforce is not enough.
“For social care staff it is offset by the extra levy that they and their employers will pay, which will take more resources out of the system,” he continued.
“It is now the time to improve access, quality, and levels of social care and rehabilitation support, so that those who need it receive the care they need, when they need it. Those working in social care must have parity of esteem with the NHS workforce and be given proper development opportunities. We cannot wait until 2023 to start tackling these issues, we need to start now.”
Similarly, the Health Foundation says that the new social care cap is a positive and bold step forward, but that the funding won’t ‘fix’ social care or tackle hospital backlogs.
Anita Charlesworth, Health Foundation Director of Research and the REAL Centre, commented: “The introduction of a cap on social care costs is, at long last, a positive and bold step forward. It will provide people with greater certainty about the future costs they need to plan for and help reduce the care cost lottery.
“But the funding announced today falls well short of what is needed to stabilise the current system and deliver the comprehensive reform that is so desperately needed. The proposals are less generous than those legislated for in the 2014 Care Act.
“With the cap set at £86k, most people will be protected from catastrophic care costs, but those with modest assets and high care needs will still risk losing a high proportion of their wealth in future. For example, an individual whose house is valued at £125k still risks losing almost half of their housing wealth whereas a cap set at £50k would have enabled them to retain two thirds. By comparison, a person with a house valued at £500k risks losing less than a fifth of their housing wealth.”
Echoing both the Health Foundation’s and RCOT’s thoughts, the NHS Confederation also highlighted that while DHSC’s social care reform announcement reinforces the vital work that local authorities do, it is concerned the funding levels do not go far enough.
Danny Mortimer, Deputy Chief Executive of the NHS Confederation and Chair of the Health for Care coalition, remarked: “We are concerned that the funding levels do not go far enough and will fail to deliver the sustainable social care system we all want to see. More will be needed to ensure that the support and certainty that social care and the communities and families they serve have needed for so long is delivered.”
Stephen Chandler, ADASS President, also weighed in on the government’s social care reforms: “This welcome announcement feels like a significant step forward and we hope that this will be the start of a new chapter for those of us with care and support needs, or who care for family members who do.”
In contrast to ADASS, the Chartered Society of Physiotherapy (CSP) has criticised the government’s announcement for adult social care reform, saying that the National Insurance hike will not do enough to address the “spiralling care backlogs”. The organisation also believes that the National Insurance increase is not a fair way to reform funding.
Rob Yeldham, Policy Director at the CSP, responded: “While we support more funding for health, rehab and social care it isn’t clear that the amounts being discussed will address the spiralling care backlogs and enable much needed improvements.
“Focusing only on funding misses a vital opportunity to improve access, quality and levels of rehab and social care. We are disappointed the government is not addressing the need for better care.
“Social care should be provided on the basis of need, be free at the point of use and funded on a fair basis like the NHS.
“Hiking up national insurance is not a fair way to reform funding and widens inequity. National insurance only applies to the self-employed and employees and is capped for higher earners.”
Additionally, Age UK says that while it is concerned about the funding mentioned in the government’s announcement, the prime minister deserves credit for finally trying to fix the social care system and has praised the cap providing “much-needed” clarity.
Caroline Abrahams, Co-Chair of the Care and Support Alliance and Charity Director of Age UK, commented: “If the Prime Minister’s proposals are put into action he will deserve real credit for breaking a log jam that has held back social care reform for far too long. The intense debate about how to pay for it must not obscure the paramount importance of action being taken now to stabilise and rebuild care, especially after its terrible mauling by COVID-19.
“At £86,000 the cap provides some much needed certainty and removes the fear of care bills spiralling to infinity, though at that level it will help fewer people than many had hoped. A more generous means test is arguably the more significant announcement for most and will result in greater numbers receiving at least some financial help.”
The County Councils Network (CCN) has noted that the social care funding reforms to make paying for care fairer will have “enormous implications” for councils and providers. It said that a cap on care and extended means-test will not address the issue of local authorities having to turn down council-arranged care requests due to insufficient funds.
Cllr Martin Tett, Adult Social Care Spokesperson for CCN, explained: “Last year, some 58% of all requests from people for social care services in county areas were not eligible for council-arranged care, due to insufficient funding for councils leading to a very high eligibility bar for individuals to access services.
“A cap on care and extended means-test will not address this – and unless further funding is announced in the Spending Review, councils will not have the means to increase the level and quality of services provided for care users already within the system and those who needs are currently going unmet, including working-age adults.
“CCN recognises the need to address the unfairness in the fee levels paid for care by self-funders compared to local authority clients, but today’s commitment to make them fairer will have enormous implications for councils and providers.
“At present, private fee payers in effect prop up local care markets by paying significantly more than local authorities, who have not been in a position to raise fees owing to financial pressures. This has led to a care market fee gap of £670m in England’s counties alone, and in order to make private and council fees fairer, significant investment will be needed – possibly more than currently committed.
“Councils want to work with government to understand the implications on this commitment and ensure that it does not further destabilise local care markets.”