Ridout Report: December 2019 Election Special
What do the political parties have to offer social care in the December election asks Nythan Smith.
The election is around the corner and the social care sector has been given manifesto-shaped presents in advance of the festive season. But what is contained in these presents for the sector…
Conservative manifesto on ‘Getting Brexit Done’
The Conservatives pledge to create a cross party consensus on how to solve the country’s problems relating to social care. The cross party commitment is designed to ensure that any changes that are brought in are likely to stand the test of time and are not short term solutions which last the duration of a session of a parliament session only to be overturned by successive administrations. That consensus will be underpinned by the premise that no one should have to sell their home to pay for their care. Unpaid carers are to have their entitlement to leave extended to one week. They have also confirmed their commitment to providing an additional £1 billion for each year of the new parliament. The Conservatives will also commit to finding a cure to dementia by doubling research funding in that area and speeding up trials for new treatments. There is also the commitment to £74 million to support increased capacity in community care settings for those with learning disability and autism.
If the Conservative party are successful at the forthcoming election it still doesn’t appear that much thought has been placed into addressing the challenges facing the social care sector. This manifesto effectively continues to kick the can down the road with its commitment to ensuring that it gets around the table with others in order to find a solution. It would have been helpful to have some clear options in this manifesto which addressed the issues in the social care sector in relation to how the Government is going to address the issues with the chronic underpayment for the cost of social care and how standards can be driven up within the sector.
Labour party’s manifesto of ‘Hope’
The eye catching policy for the social care sector is Labour’s proposal to establish a National Care Service. At the heart of this new service would be the introduction of free personal care to all beginning with the over 65s and extending it to all adults in due course. This proposal will be equivalent to £6 billion per year in funding from the public purse. Personal care does not include living and accommodation costs which would continue to be payable by individuals as required. Labour sees personal care as a fundamental right which should be provided for by the state through taxation of the country as a whole. This entry level intervention is designed to plug the gap between those that require personal care but cannot afford it from slipping through the gap and make the provision of personal care a right which is offered to all.
Labour intends to increase local authority capacity to deliver care to those in need with staff that are employed directly by local authorities. Local authorities, as currently modelled, simply do not have the capacity to take care requirements in house and they would need to cooperate with the independent sector in order to fulfil this enhanced responsibility. Labour have set in their crosshairs those private providers that it considers target profits rather than the quality of care and points to Southern Cross as an example of this. This does fail to acknowledge the clear fact that largely the two (profits and quality of care) are intertwined and a company which fails to provide adequate care is properly held to account by the regulator and by those that pay for the costs of their care. Labour also targets the up skilling of the social care workforce and hopes to utilise its National Education Service to provide training requirements for staff.
Labour also proposes a lifetime cap on care costs but do not state what that cap will be nor what will happen when a person has reached that lifetime cap.
Labour is committed in investing in local authorities to provide the care required for individuals rather than seeing investment go into private companies.
These proposals will be welcomed by those currently in receipt of care and those that should be in receipt of care but as an adviser exclusively of providers of care the proposals appear to have neglected the vital role that private providers play currently in the provision of care. If Labour get into power it would be remiss of them to fail to acknowledge the systems that are already in place and ensure that the current model continues to play a significant role- as it will in any future landscape. There is unlikely to be a cliff edge moment where all care is shifted to that which is in local authority hands so a partnership with private providers has to form part of the future landscape.
Liberal Democrats manifesto of ‘Stopping Brexit and Building a Brighter Future’
The headline pledge made by the Liberal democrats is an increase in income tax by a penny to pay for NHS and social care. This is expected to raise an additional £7 billion per year. It is not clear quite how these funds will be split between respective areas but there is reference to addressing the social care crisis by tackling urgent workforce shortages and investment.
The Liberal Democrats are the only one of the three parties in England and Wales who propose a tax to address long term funding issues in both sectors. The intention is to also make other tax reductions but to clearly show employees on their payslips what proportion of their pay is being spent on health and social care. A cross party convention on health and social care will be established which will involve wide engagement across patient groups, the public and devolved governments in order to reach a consensus on how to sustainably fund health and social care in the long term. An independent body will be set up which will report on how much money the system needs in order to be sustainable every 3 years taking into account projected increases in costs for the system.
The Lib Dem manifesto for social care is one which sees social care as part of the wider system of health and social care and as such requires solutions which see the system in the round as opposed to in isolation. The critique on this position is that there has been an increased political will to integrate sectors of health and social care but for all of their shared experiences the issues facing each are distinct and unique. The flaw in this line of thinking is that the NHS behemoth is one which would attract the lions’ share of investment at the detriment of social care.
Social care in isolation?
I have particularly avoided the parties’ pledges on commitments to the NHS itself as the conflation of the NHS and social care has proven to be something of a gift and a curse for the social care sector. Lip service appears to be paid to social care by lumping it in with NHS proper in discussions about how to reform the social care sector. Social care needs to be looked at in isolation and not as a rider to discussions about the NHS. There is no doubt that there is a close symbiotic relationship between the healthcare and social care sectors but both need looking at separately.
The drive to forming a cross-party consensus on how to address the issues with social care is an important step but one which should have been taken quite some time ago. The green paper on adult social care was announced in March 2017 to form an agreed way forward but has been held up by differences of opinion on that course and of course by Brexit, which continues to cast its quite considerable shadow across Government business. The manifestos do show that each of the big three political parties in England have given some thought to how the crises facing adult social care should be addressed.
What’s in it for social care?
None of the political parties’ manifestos appear to be radical enough to step out and suggest a wholesale reform in the manner in which social care is to be provided and funded in both the short and longer term. Perhaps it does not offer itself as an area upon which voters are likely to hang their hats en masse in this highly unusual election but social care remains an area ripe for reform.
There remains the persistent underpayment by local authorities to pay the properly considered cost of care which properly takes into account the individual costs of employing those carers that care for the individual and the cost of running the care service. At present the cost of care paid by local authorities is determined by commissioners who are local authority employees and are constrained by their local authority budgets and take into account the condition of the overall market when setting fee levels. The lack of independence of commissioners with regard to the fee they pay for care is part of the problem. An independent arms-length organisation should be created to determine the cost of care in true partnership with the private provider and the cared for person to address this imbalance.
There is also the issue of the underpayment of the social care workforce which is a follow on from the inability of the local authority payer to meet the cost of employing those working in the sector. This includes the operational costs of a provider of care. The social care workforce is increasingly paid towards the minimum level possible owing to the inability of providers to recover the cost of care from often their largest payer- the Local Authority. This means that staff retention is low which in turn impacts on the quality and continuity of care offered to those that are cared for. Rates paid need to increase sector-wide to allow providers to increase the amount that is paid onto employees and offer those providers the incentive to reinvest and ensure that services remain at the highest level they can be. Social care workers’ wages need to be increased in order to attract the best individuals to the sector. It shouldn’t be the case that those tasked with arguably the most important paid role in our society are paid the least. They should be rewarded financially and in kind. Funding must be increased in the sector which is imbalanced at present heavily in favour of the local authority weighted against private providers’ which necessarily pass those underpayments onto those that privately fund their social care requirements. It should not be the case that the cost of care is determined as according to how it is assessed by local authorities. Providers of social care need a stronger voice individually in their relationship with local authorities which takes into account the specific costs faced by providers to those in their care.
The wider debate on precisely how the social care system is to be funded is one which isn’t addressed in any of the manifestos in any great detail. Commentators in the sector have pontificated for the introduction of a tax which affects all individuals and provides for care in old age much like competing systems that are in place in other countries such as Japan and Germany. There exists no consensus despite the almost unanimous opinion that social care is in crisis currently and the crisis is projected to get worse in the years to come.
The sector can only wish that whomever is elected to form the Government on 12 December 2019 builds on those promises in each respective manifesto to prioritise the reforms required to impact positive change in the social care sector.