In this blog, Ros Altmann reacts to the Government’s statement on care funding in the Queen’s Speech. It was originally published on Ros’ blog and is republished with her permission
- If not now, when? Queen’s Speech missed another chance for social care reform.
- The pandemic has highlighted so many failures in our social care system, leaving elderly people without the care and support they require.
- 25,000 people relying on social care at home died, with excess deaths in some areas doubling or trebling as Covid-19 interrupted care services.
- Thousands more care home residents died last year as care homes were relegated to second class provision.
- Legislation is urgently needed for systemic overhaul of the structure and funding of care and NHS.
Sad to see yet another missed opportunity to properly address social care: After the ravages of Covid-19 has shone such a vivid spotlight on the failings of the UK social care system, it is disappointing that there are no concrete plans for the urgently needed radical overhaul of social care funding and delivery. The care system has been neglected for far too long and remains the poor relation in our national health system.
NHS was prioritised over care homes and home care services, putting frail lives at risk: The current artificial separation between NHS and social care meant care homes and home care services did not receive adequate supplies of PPE, as the NHS was prioritised. Social care was relegated and neglected, with care homes or homecare being used as hospital overflow services, when so many Covid patients were prematurely discharged from hospitals, putting lives at risk. Social care must properly integrated and funded, with parity of esteem alongside the NHS, to treat those with care needs with the dignity they deserve.
28,000 people relying on social care at home died last year in England and Scotland, with some areas reporting a doubling or trebling of numbers of deaths: Overall numbers of deaths for those receiving home care in England increased by 50% in the year to March 2021 over the prior year and the numbers in Scotland increased by 70%. This was not related just to Covid, with the majority of excess deaths being from non-Covid causes. The stark figures suggest a failure of social care services through the pandemic, with fragmented domiciliary care provided by private sector, councils, charities and NHS trusts, but no joined up oversight. CQC figures show that deaths at home in 38 English councils doubled last year and in ten areas the number of people dying tripled.
Tens of thousands of excess care home deaths last year: The enforced early discharge of elderly patients, regardless of Covid infection, endangered the lives of care home residents and their dedicated staff. Care homes reported tens of thousands of excess deaths last year.
This is about both funding and organisation – a radical overhaul of both is essential: The pandemic has highlighted the neglect of social care services relative to our NHS, which points to the need for proper integration between all parts of the system. But there are also failings in funding as well. Social care is funded on a short-term basis and councils are given money which is not ring-fenced for care. The most draconian of means tests governs whether councils will pay or whether these vulnerable people must pick up the huge bill for their care. Taxpayers cover all the costs for millionaires with cancer who are treated on the NHS, but widows with dementia lose their life savings to pay for their care. Some of those who died, were ejected from hospitals and then forced to pay thousands of pounds for the last few weeks of their lives in care homes which could not cope with the Covid overflow.
There is an urgent need to fix the broken care system: We are still waiting for the promised proposals and legislation to reform both funding and delivery of social care, and to ensure it is fair to those who are unable to live independently, whether in their own home or in a residential setting.
What can be done?: There is no silver bullet here, the decisions will all be difficult, but if we count ourselves as a decent country, we must look after the most vulnerable. There are several vital elements to social care reform, which the Government must grasp. It has a huge majority, there is cross-party agreement that a solution is urgent and we have just seen the failings cost thousands of lives. This must never happen again. If not now, when?
National system of basic social care paid for by all – similar to principles of pensions: Everyone should pay something whether or not they need care – with a national system of contributions towards care costs, along the lines of our pension system. If Beveridge was designing our National Insurance system today, he would undoubtedly have included provision for care of elderly people within the pension. It is time to bring the welfare state up to date. This could require a 1% levy on everyone’s income, including older people, but the money will have to be found.
Also need Incentives for private provision on top of State basic care – Care ISA, Care Pension, National Equity Release scheme: The State can provide a basic care service, but everyone could then be incentivised to provide more money for themselves if they prefer to have more choice and control on the types of care home or home care they receive.
This would include savings incentives to help people build up money for care, just as we have done with pensions and perhaps even included in auto-enrolment. For those no longer working, a social care levy may be needed, to ensure all will pay something, but there is also the potential of encouraging those already in their later years to allocate some of their ISAs as a Care ISA fund.
Others could be offered the chance of tax-free pension withdrawals to pay for care earlier or of a different standard than national basic services. And a nation-wide equity release system that enables people to use the value of their home up to a certain maximum limit.