This week, reports warned that some of the country’s largest care home providers may be at risk of financial collapse as a result of the Government’s recent increase in the minimum wage. Sadly this didn’t come as a surprise, since it’s widely known both that social care providers are chronically under-funded and carers are chronically under-paid.
But the warnings did offer a timely reminder of the larger crisis facing social care, of which staffing costs are just the tip of the iceberg.
In many ways this crisis is rooted in the artificial dividing line drawn between health care, which is financed by protected Government funding, provided universally and free at the point of use, and social care, which is provided by cash-starved local authorities and is heavily rationed and means tested.
Moreover, arbitrary distinction between health needs and social needs means that access to care in later life is all too often determined by what might crudely be described as a disease lottery.
If you fall ill with cancer, your care will be provided by the NHS free of charge. But if you suffer from dementia then responsibility will fall to the social care sector, where you’ll be expected to pay as much as you can possibly afford. This hardly seems fair in a society in which we expect – and rightly so – that care should be provided on the basis of need, not ability to pay.
But as the Government knows, local authorities’ budgets – within which social care funding is not ring-fenced – have been so severely cut back that restricting access to state-funded care has often been the only way of making ends meet. As this week’s reports confirmed, the challenge of funding adequate care for those who need it is especially acute when combined with a requirement to pay carers a decent wage.
My own local authority, Islington Council, will by next year have seen its funding cut in half since the Tories took office. To its credit the council has maintained its commitment to ensure that carers are paid the London Living Wage, but this has inevitably meant that some very difficult decisions have had to be made elsewhere.
Last year the National Audit Office reported that, in the first three years of the coalition Government, three quarters of the fall in spending on adult social care was achieved by reducing the amount of care provided. In 2005, 47% of councils provided social care only to those with needs classed as “substantial” or “critical”. The proportion today is 90%, and the number of people getting state-funded social care has fallen by around 400,000.
As Kate Barker, a renowned economist who chaired the independent Commission on the Future of Health and Social Care last year, recently said, “the fact is, the costs of caring have to be met, either publicly or privately: they cannot simply be avoided”. In other words, the obvious result of the rising demand combined with falling state funding has been a marked increase both in the number of people expected to fund their own care and the amounts they are expected to pay.
The Care Act, which was passed last year with cross-party support, sought to recognise some of the structural deficiencies in the social care system, and recognised the unacceptable burden that costs often place on elderly people and their families. The law introduced a number of new measures, including a cap of £72,000 on the amount any individual would be expected to pay for their care in the course of their lifetime.
Under the Care Act as it was passed, this was supposed to come into force in April 2016, but last month the Department of Health quietly announced that its implementation will now be delayed until 2020.
Some of the rhetoric thrown about by the Tories when the legislation was passed seemed hyperbolic at the time. Now it just seems ridiculous. Jeremy Hunt promised “the most comprehensive reform of social care legislation in more than 60 years”, in which the Tories had realised “a vision that was talked of for 13 years by the previous Government and actioned in three by this one.”
How ironic that, having then given himself two years to prepare for the introduction of his Act’s most significant reforms, Jeremy Hunt has now backed off, insisting that he needs another four.
As I’m sure everyone would agree, carers who do the difficult job of looking after the elderly and vulnerable deserve to be paid a decent wage that they can actually live on. They deserve more than just words. And the hundreds of thousands of families who struggle with the crippling burden of providing care to their loved ones deserved more than yet another broken promise.