An estimated 3.5 million people are not receiving the care they need. While carers and staff still make incredible differences despite the system’s challenges, variabilities in cost and quality highlight the need for change.
Last month, Prime Minister Andy Burnham proposed a “National Care Service” based on NHS principles where “everyone contributes and…is covered”. So far, it covers free personal care for over-65s, similar to the Scottish system. This would be a significant step as personal care includes hygiene, mealtime support and mobility, and will cost £7.5 billion. But questions remain over further care, what does community support look like? What are accommodation costs? How will levels of need be set? How will it be funded?
Broadly-speaking, the term “national care service” could mean anything from fully taxpayer-funded, to an amended form of the current system – Burnham’s proposal seems aligned with the latter. Presently, social care is managed by local authorities, mainly funded through council tax, business rates and ad-hoc central government payouts.
Constrained budgets have struggled with increased demand, destabilising the care provider market and driving high staff turnover. Unlike the NHS, access to publicly-funded care in England is means-tested – assuming a user’s needs are assessed to be high enough, free support is restricted to those with assets less than £23,250. Most service users pay for themselves or, if they get some support, still contribute significantly. 1 in 7 over-65s face costs above £100,000.
Fairer and clearer funding is required but reforms must also address: the workforce, quality of care and the relationship with healthcare.
Low pay, inconsistent training, unstable employment, poor conditions and lack of career structure has resulted in chronic understaffing. Investing in an environment that safeguards staff wellbeing, especially given the high proportion of migrant and female workers, is vital. This requires working with care providers, to ensure they can deliver high-quality care and handle higher wages simultaneously, and balancing public sector involvement.
The blurry boundary between healthcare and social care creates chaos pitting local authorities and the NHS against each other, with service users caught in the middle. A national care service that creates a professional standard, empowers the workforce and engages with care providers while splitting the bill fairly between the state and service users could well be a solution.
One reason it is so hard to determine what this should look like is that Britain has never decided what social care means. Achieving a long-term solution without getting stuck in endless funding arguments requires remembering that we all want the same thing for us and our loved ones – the opportunity to live and age well.