Successive governments have acknowledged the need to tackle the issue but have failed to do so because the solution is likely to require additional taxation and is not seen to be a vote winner.
The 2014 Care Act set out a bold and inclusive vision for safe, high quality, integrated and person centred social care; where councils would work jointly with NHS partners; universal preventative services would be available to support wellbeing; information and advice would be accessible to all; innovation would produce a rich variety of providers in local social care markets; care plans would be based on an individual assessment of needs; consumers would be able to choose and even commission the best services to meet their needs and informal carers would have significant rights to recognition and support.
Over the past decade, councils have worked hard to achieve this vision, with varying degrees of success. Implementation has been hampered by funding cuts, staff shortages, rising costs and most recently the challenges of Brexit and coronavirus. An increasing proportion of council budgets are being spent on the provision of social care, leaving fewer resources for all other services. As a consequence, social care departments have been under growing pressure to focus on those with the greatest need and to reduce any services that are not deemed to be ‘statutory’ in nature.
The policy of targeting those with greatest need has meant that many people with genuine social care needs are assessed as not meeting the eligibility criteria for care. This is a great concern but could be considered just about acceptable, and in line with the principles of the Care Act, if a thriving third sector is available and is providing a range of general support services.
Services provided by third sector organisations help underpin the social care model and support the majority of people with social care needs as well as informal carers. They help maintain wellbeing, provide essential social contact and support, and help people to recover and stay well, to maintain tenancies and to develop skills.
However, the third sector ‘safety net’ is not guaranteed because, when faced with impossible budget choices, councils have been under increasing pressure to make savings on these preventative services.
Funding to third sector organisations is also being squeezed through the government’s competitive grant funding model and the growing challenge of fundraising.
These services are under threat because they are universal, non-statutory, and apparently discretionary. However, without them, the social care model is severely compromised, and short-term savings are likely to result in human suffering, more pressure on carers, increased demand and greater costs in the longer term.
Post the pandemic, our NHS partners are also required to find eye-watering savings and, with both arms of the health and care partnership facing significant financial challenges, it is not surprising if previous joint arrangements are coming adrift, even when goals are aligned and relationships remain strong.
All of these factors, combined with an ageing and increasingly unhealthy population, leave councils with a dismal choice between further undermining the model set out in the Care Act or joining the list of councils that have become financially unviable as the costs of providing services increasingly outstrips the income they receive.
Only a complete revolution in social care funding can address this.
Successive governments have acknowledged the need to tackle the issue but have failed to do so because the solution is likely to require additional taxation and is not seen to be a vote winner. In this context, Liberal Democrat Leader, Sir Ed Davey MP, is right to call for cross-party talks on social care funding after the general election. However, reaching a cross-party consensus will take time and councils do not have the luxury of time.
Integrated care systems (ICSs) present an opportunity to implement a new sustainable financial model with central funding for both health and care services being channelled through ICSs to NHS bodies and councils for local provision. This could restore the integrity of the Care Act model, averting the impending crisis for those with social care needs and for councils by transferring responsibility for social care funding from local to central government.
It will ensure that the wealth of local knowledge and expertise held by councils will continue to inform commissioning decisions, so services will be designed to meet local needs, but the unrealistic and regressive financial burden will be removed, allowing councils to direct more resources to their other areas of responsibility.
The ICS model will reinvigorate innovative partnerships between the NHS and councils, improving services for residents and delivering better value and outcomes. It will also support the development of integrated career pathways for staff working across health and social care which will help to address recruitment, retention and quality issues.
This is not an easy solution; it will increase the burden on general taxation, but it will also incentivise the development of integrated provision which will be better for those who use health and care services and will deliver efficiencies. Critically, it will ensure that the responsibility for social care policy, together with the future funding model needed to support provision, sits with those who will determine its future and who have access to funds from general taxation.
This offers a sustainable funding model for social care that is fairer than the regressive council tax-based system that has developed in recent years. It will prevent further council bankruptcies caused by the current untenable funding burden. It will restore the integrity of the social care model, enabling support to be available for the many rather than the increasingly few.
