Boris Johnson has unveiled plans for a £12 billion-a-year tax increase from April 2022 to fund social care reform in England and tackle the NHS’s COVID-induced backlog of cases.
The demand for care – from short-term needs to long-term support – is increasing and levels of unmet needs are rising. Social care requires urgent investment.
Each of the four UK countries has its own care system. In England, requests for social care have increased by 6% over the past five years, but support has declined. About 14,000 fewer people have received the help they need.
The announcement of additional funding aimed at filling that gap should be encouraging. However, the money the government is asking for is geared not only to reform the social care system but also to finance the NHS rescue scheme. Returning to pre-pandemic levels of NHS service alone is expected to cost around £17bn. Critics fear the new levy will be used up within the NHS and that there is little left to spend on improving social care. The research I’ve done on care markets and sustainable care systems highlights that these new offerings are unlikely to deliver what we urgently need.
a complex system
Social care, which provides long-term care for people with disabilities and age-related disabilities, is an extremely complex system. This includes a wide range of residential care, home care, day services and community support.
In the UK, most of these are provided by the private sector in a diverse marketplace of thousands of providers and community groups. People currently pay for their care if their wealth exceeds a certain level (£23,500 in England), otherwise care is purchased for them by their local council.
People are living longer with many conditions that require support from the care system. Although much of the conversation about care is focused on older people, half of the spending is actually on working-age people with disabilities. Families also provide a large amount of informal care and support.
Boris Johnson has been promising social care reform since he took office in 2019 and, finally, announced what that would be. The plans include a national insurance increase that the government is labeling as a health and social care levy. They also include a £86,000 limit on how much people will have to pay for care over their lifetime.
There is currently no maximum amount a person can pay for care. For some people with long-term conditions like dementia, costs run into the hundreds of thousands of pounds.
There is a real need for new money in the system. But of the £36 billion that will be raised from this levy, only £5.4 billion will go to social care, and half of that will pay for the new care cap, rather than easing any existing tensions in the system.
Proposals to impose a cap on care spending are welcome. But we already have the limits of the law. It was part of the CARE Act 2014 and was then dropped due to concerns about the feasibility of implementation.
The expense of the self-financing (a relatively invisible and difficult for the research group) would need to be monitored by local authorities to make it clear when the limit was reached. We don’t yet have systems in place to do this. The current proposals (a cap on spending with a sliding scale of contributions for those with assets of £20,000 to £100,000), appear to be even more complex than those attempted in 2014.
The new proposals also do little to address the low wages for the 1.5 million people working in the care sector. They will not improve the extent, quality or adequacy of social care, a system that many say is about meeting basic needs rather than increasing well-being or allowing people to thrive.
For those expressing a more ambitious account of what social care reform can achieve, there is little to celebrate in the new announcements.
If the proposals make it into law – and there is a long road ahead with potential hostility from all sides – they will apply to caregivers from 2023. After paying for the health and social care levy, many of these people will have high expectations of what they will get from social care. If the money goes to the NHS, putting social care in crisis, there could be political costs to Johnson beyond the current headache of a broken manifesto promise.