Years of significant underfunding, coupled with rising demand and costs for care and support, have combined to push adult social care services to breaking point. This has been exacerbated by the COVID-19 pandemic.
Funding needs to reflect the rapidly increasing number of people with dementia. There are currently around 850,000 people with dementia in the UK, according to Alzheimer’s Society. The number of people with dementia in the UK is forecast to increase to over 1 million by 2021 and over 2 million by 2051.
Our analysis before the 2020 Spending Review showed that adult social care faced a funding gap of £2.2 billion in 2021/22, rising to £2.7 billion in 2023/24. This is just for ‘core pressures’ (demography, inflation and National Living Wage increases) and the provider market gap (the difference between what providers say is the cost of delivering care and what councils pay). This does not take into account the cost of tackling many of the challenges facing social care, such as unmet and under-met need; a lack of funding for prevention; an over-stretched and undervalued workforce; and growing strain on unpaid carers.
The 2020 ADASS Budget Survey shows that the onset of the pandemic, and the additional financial and demand pressures faced by local authorities as a consequence, has led to a significant change in the Directors’ confidence in meeting their statutory duties relating to adult social care. For the current financial year (2020/21) only 4 per cent of Directors are fully confident that their budget will be sufficient to meet their statutory duties; this compares to 35 per cent in 2019/20.
One of the few positives to come out of COVID-19 is that it has put adult social care firmly in the public, political and media spotlight. It has also shone an important light on the tireless work of our invaluable social care workforce who are providing care and support to all who need it in the most challenging of circumstances. This emergency has begun to highlight the essential value of social care in its own right to the wider public and this debate needs to be harnessed as we think about the future of care and support.
The legacy of COVID-19 for social care – and most importantly the people who use social care services – must be a reset, not simply a restart. We need a ‘1948 moment’ for social care; a moment where we collectively aspire to something bigger and better for social care, because we aspire to something bigger and better for us all.
The LGA has published seven principles for reform of adult social care, which charts a way forward for ensuring the very best local care and support in the future, so that people can live their very best life. More than thirty prominent national organisations have signed up to these principles.
The Government should make the case for increases in national taxation and/or a social care premium with different options for paying in, such as weekly/monthly, on retirement, deferred and paid from a person’s estate.
One of the (many) key issues in taking such a significant step is the framing of the proposal. Too often we hear of the ‘burden of ageing’ or ‘tsunami of support for older people’. This starts from an inherently negative position. If we can portray investment in social care as an investment in us all – as part of our national infrastructure – we stand a better chance of winning public support. What is happening in America under President Biden is interesting to observe.
Risk pooling is particularly important. One of the most fundamental problems of the current funding model for social care, is that the risk of needing care and support – and therefore its cost – is not pooled. Instead, risk and cost fall solely on people with care needs. Some people within this group, such as those living with dementia, may be required to contribute to the cost of their care in line with the financial means test, which can mean they end up having to pay significant amounts.
Social care needs an equivalent risk pooling mechanism as the NHS’; a sharing of the risk and cost of meeting care needs amongst the whole population (on a means-tested basis for a degree of progressivity) to ensure nobody faces catastrophic costs.