The government’s white paper setting out its plans to reform adult social care in England contains some eye-catching pledges, but what impact will it have?
In December 2021, the Department of Health and Social Care published a white paper setting out its ten-year vision for how adult social care will be reformed across England. Its three key objectives are: supporting people to have “choice, control and independence”, providing “outstanding quality of care”, and ensuring that care is provided “in a way that is fair and accessible to everyone who needs it”.
The paper proposes some eye-catching changes, including the pledge that no one will face unlimited or unpredictable costs. It sets out funding for a range of areas over the next three years that, at first glance, seems ambitious.
But, as with any proposal for social care, the question is whether these changes will have a real positive impact on the lives of those receiving care, as well as those working in the industry.
The government’s Health and Social Care Levy will help to pay for the changes. While £5.4 billion is being set aside for the next three years, this is only about 18% of the £30.3 billion total forecast to be raised by the Levy, most of which will go to the NHS.
The King’s Fund notes that the actual budget increase for care in the spending review will rise by just 1.8%. Given the UK’s ageing population – with 19% of people aged over 65, rising to 24% by 2043 – this is unlikely to be enough to achieve the government’s ambitions.
Workforce and recruitment
It’s no secret that the sector is facing a recruitment crisis. Late last year, Third Sector reported that there were more than 110,000 vacancies, while 74% of providers in an NCF survey reported an increase in staff exits.
The white paper acknowledges that recruitment is an issue, setting aside £500 million to support the workforce through things like training. That’s not enough, according to Karolina Gerlich, CEO of the Care Workers Charity, as workers are still paid too little.
In the face of a cost of living crisis, with rocketing energy bills on the horizon and inflation at 7%, the 6.6% increase to the National Living Wage this year will barely make a difference. As Gerlich puts it, “very little is attractive enough about social care work… for somebody leaving school”.
The white paper also pledges to support carers’ mental health. But providing adequate pay in the first place would be a better way to achieve this, as well as helping carers to do their job better, says Gerlich. “If somebody is worrying about food, worrying about bills, worrying about their children having the right clothes, how are they supposed to be in the right frame of mind to deliver outstanding care?”.
For Gerlich, one of the main areas this white paper is missing is accreditation: “They know they're skilled, they know they're professionals, but nobody else seems to acknowledge that.” Not only do care workers feel like they don’t belong, but they don’t have a professional body to turn to in cases of mistreatment or other emergencies.”
The white paper allocates £300 million to “integrate housing into local health and care strategies”, with a focus on increasing the range of new supported housing options available. This includes a new support service for minor repairs, along with an increase to the Disabilities Facilities Grant, which provides support for adaptions such as wet rooms and ramps – although how much that will be increased by remains unclear.
Another big focus area in the white paper is technology. A minimum of £150 million will go towards facilitating digitisation and a greater uptake of technology. It notes that 1.7 million people already use assistive technologies such as personal alarm systems and smart devices to support their care. They also use them to fight loneliness. Technologies like e-rostering systems and digital social care records can also improve efficiency, it says.
According to the The Local Government Association, however, these proposals do not go far enough. Although it welcomes the fact that funding is earmarked, in a statement on its website the organisation says that “this funding will not in itself be able to resolve the under-investment in digital technology within adult social care over the last decade”.
In the face of an ageing population, pandemic recovery, and an ongoing recruitment crisis, it’s a common sentiment that the government’s proposals do not go far enough. There are positives to be found in some areas, like housing and technology, but for Gerlich, the government “needs to be brave and bold, and it really needs to focus on the workforce.”
Providing a better quality of care all boils down to how you treat the people behind caring, she says. “The workforce is as important as the people who draw on social care. One cannot exist without the other, and both sides need to be looked after much better than they are.”