Last reviewed 31 March 2021
A new inquiry has been launched by the Housing Communities and Local Government Committee (HCLGC) to examine the impact of the Covid-19 pandemic on the social care sector and its long-term funding. The deadline for submissions is 15 April 2021, with information on how to give evidence here.
It reflects a new awareness that, despite a backdrop of past reviews, inquiries and reports that have not yet been implemented, the pandemic has magnified certain issues that need to be taken into consideration before a solution to the funding of social care can be reached that is fair, effective and sustainable.
This call for evidence looks to understand the additional stresses on an already challenging environment and the likely long-term consequences for adult social care at a time when the pandemic has brought increased costs such as extra PPE, cleaning and staffing costs, a year on year increase in demand on services and stretched local authority budgets.
In its inquiry, the HCLGC wants to “reconsider” how more funding can be raised to ensure the sector’s long-term stability and, given the likely long-term financial implications of the pandemic on society as a whole, how it can be raised “fairly”. It will also look at how the sector can be supported to innovate in how it provides care.
In August 2020, as if in anticipation of this call for evidence, the King’s Fund think tank said social care was emerging from the initial stages of Covid-19 with issues including a sector struggling to come to terms with thousands of deaths; services trying to get back to some semblance of normality or just stay in business; local authorities facing increased levels of demand but uncertain finances; and “a legacy of sometimes bitter disagreement about national policy and implementation”.
Although there have been ongoing reviews of social care policy, the pandemic has raised more questions about whether Prime Minister Boris Johnson’s manifesto promises to “fix the crisis in social care once and for all” will be able to take in the new evidence and lessons from the latest inquiries when his plans are “brought forward” to later this year.
A re-evaluation of problems in light of the pandemic
In 2019, the King’s Fund discussed eight key problems facing social care, here, and called for reforms to address them. After the pandemic “shone an uncompromising light on the sector, its staff and the people of all ages who use its services”, the think tank revisited its eight problems in the light of Covid-19. The article, written in August 2020, is here.
In brief, it said the focus has quickly shifted to the “huge, tragic impact Covid-19 has had on quality of care”. It said: “Keeping people safe is a primary duty of care and the responsibility of everyone working in social care” but the work and behaviour of regulators, commissioners, policy-makers and partner organisations during the pandemic has had a huge impact on what they can do, making it necessarily a “joint responsibility”.
It found that the pandemic has increased the problem of unmet need for social care, but the extent can’t yet be judged. It highlighted the inadequate workforce pay and conditions of social care staff and that there has been no improvement in these areas. It said Covid-19 may have worsened the postcode lottery of access to social care, but “there isn’t the data to know for sure”, and it has shaken the market especially for residential care and “seems certain to result in the loss of some providers”.
It also found Covid-19 brought rapid change in hospital discharge, with ongoing concern about its immediate and longer-term consequences.
The King’s Fund said Covid-19 had limited impact on the previously identified problems of means testing and catastrophic costs to the individual but they remained central to future social care reform and “neither is entirely unchanged”.
A brief history of social care reviews
Taking a few steps back in time, Andrew Dilnot’s report, The Report of the Commission on Funding of Care and Support, was published in July 2011 following a year’s work and extensive consultation. At its heart there were ten key recommendations, here.
A research briefing of September 2019, here, catalogues the many subsequent delays in publishing a Green Paper based on these recommendations for reform.
In the Budget of March 2017, the Conservative Government led by Theresa May said it would publish a Green Paper covering all adults needing social care in England, following its decision in July 2015 to defer the introduction of a cap on lifetime social care charges and more generous means-testing, proposed by the Dilnot Commission. These changes were postponed indefinitely.
In the subsequent General Election campaign of 2017, the Conservative Party made a manifesto commitment to introduce a social care Green Paper by the end of July 2018, but said it would narrow the focus to “care for older people”, with a separate “parallel programme” of work for working age adults.
The shift in rationale for a Green Paper
Since 2017 the rationale for the Green Paper has shifted. It originally aimed to look at how social care can be funded by its recipients, together with other policy ideas such as a cap on lifetime social care charges; a more generous means-test; an insurance and contribution model; a Care ISA; and tax-free withdrawals from pension pots. Other areas to be considered were integration with health and other services, carers, workforce and technological developments.
Meanwhile, in the vacuum created by announcing a Green Paper but failing to publish it, the research briefing said a number of bodies published their own ideas for social care funding and there was a “consensus growing” in the sector towards free personal care.
After the publication in June 2018 of a joint Health and Social Care Committee (HSCC) and HCLGC report, Long-term Funding of Adult Social Care, here, Health Secretary Matt Hancock told MPs that he was “attracted” to its “insurance and contribution model” for paying for social care, and added “there are many different potential details in how such a model can be delivered”.
The position of the report reverted to one Green Paper covering all adults. It highlighted models of “social insurance systems” that involved “an earmarked contribution, described as a “Social Care Premium” to which individuals and employers would contribute, either as an addition to National Insurance, or through a separate mechanism.
It included the principles of risk pooling in the system, which would help to protect people from the unpredictability of care costs; that contributions towards the cost of care should be fairly distributed between generations; and should aspire over time and move towards, “as funding permits, universal access to sustainably funded social care, free at the point of delivery”.
By July 2019 the Financial Times reported that the Green Paper had been “ditched” and instead a White Paper would be published in Autumn 2019. In August 2019, the NHS Long Term Plan, here, set off the process of increased integration by requiring all of England to be part of an integrated care system by April 2021. In September 2019 Matt Hancock said a plan for reform would be published “in due course”.
The 2020 inquiry into adult social care: funding and workforce
An HSCC inquiry, Adult Social Care: Funding and Workforce, was paused in March 2020 to enable the Committee to focus on the pandemic. When it was reopened in June 2020, here, a new question was introduced: “What further reforms are needed to the social care funding system in the long term?” The report was published on 22 October 2020, and it noted that the pandemic had brought the social care sector further into the public spotlight. The Government’s response in January 2021, here, said in planning reform it was now “mindful of the impact of both the unprecedented nature of the pandemic and the uncertainties it has created, as well as the expected demo-graphic change in the social care population”.
The Government’s response said its current priority for adult social care was for everyone who relies on care to get the care they need throughout the Covid-19 pandemic. The one-year 2020 Spending Review was being used to “stabilise the adult social care market, during and immediately after the Covid-19 pandemic.” The response concluded: “As set out in the 2020 Spending Review, the Government is committed to sustainable improvement of the adult social care system and will bring forward proposals in 2021.”
Even when a Green or White Paper is eventually published, it may only be a consultation, probably with a change in direction from previous reports, with the potential for many more months of waiting before social care providers get a clearer picture of the future funding policies that will affect them.