Our last remaining local services are at risk. Social care reform could save them

By addressing unmet needs, current users of social care, and their families, will live more dignified and fulfilling lives

Care workers

Tim Littlewood is a member of the Fabian Society Local Government and Housing Member Policy Group

The cost of social care in England is increasing. This month’s King’s Fund Social Care 360 report confirmed that adult social care spending in England increased in 2021/22 by 3.8% in real terms, to £26.9 billion — an overall rise of £2.6bn since 2011/12. Local councils’ spending on adult social care reflects this trend, increasing by 12% in real terms since 2015-16, following a decline after 2010. We should handle these statistics on overall spend carefully, particularly as spending increased during the coronavirus pandemic. However, the figures continue a long-running trend of increased spending on care over time. The factors driving this increase will probably continue driving up costs.

While inflation is predicted to fall to 4% by the end of the year, demand for social care is increasing as our population ages, and long-term health needs increase. Increased demand on local authorities for adult social care has been driven in large part by increased requests for short-term support.

Who, then, funds this additional demand for social care? Often no money changes hands, and care work is done by unpaid carers — friends or loved ones whose work during the pandemic was valued at £530 million a day. Where care is funded, commentator Richard Humphries observes that responsibility for long-term care has been moving from the NHS, which is free at the point of use, to the social care system. This system imposes a complex system of mechanisms and public bodies — often resulting from piecemeal changes to the system. Costs are covered by Local Authorities, the NHS, private individuals and charities, based on bureaucratic means-testing criteria.

As the cost of care increases, so does the proportion of local councils’ budgets that is spent on care. This is because — unlike some services — most local authorities must provide social care by law. The Local Government Association (LGA) claims that these councils now allocate nearly two-thirds of their total spending to social care. The National Audit Office similarly points to an increase in councils’ spend on social care as a share of service spend: from 59% in 2010/11 to 69% in 2019/20. Over the last decade, councils have already diverted £2 billion from other services to fill the widening gap in adult social care. Additional demand for care, then, is effectively channelling money into the English social care system that was previously spent on other local services.

As demand for social care increases, and the government reduces funding to councils, the weakness in England’s social care system becomes apparent. Its funding model now puts at risk the quality, accessibility, and in some cases continued provision, of many public services that people use weekly or daily. This includes waste collection, street cleaning, parks, culture, events, libraries and family services. Since 2010, reduced grants to local authorities from central government have already forced local authorities to make significant service cuts.If things continue as they are, local authorities will need to make further service cuts in order to continue looking after people. Central government may shirk responsibility for these cuts, since they fall within local authorities’ legal duty to set a balanced budget. However, maintaining a social care funding system that is outdated and destabilising is a political choice that we should challenge.

All political parties recognise that England’s care system needs reform. Richard Humphries counts “at least 14 government White Papers, Green Papers and consultations of one type or another” since 1997. Yet, little substantive progress has been made. The government’s 2021 White Paper People at the Heart of Care notes that many people who are entitled to social care do not receive it. The paper commits to improving data-gathering to understand the scale and nature of this unmet need. Yet, as the LGA point out, the additional funding outlined in the paper would be insufficient to actually meet these needs once identified (an annual cost they estimate at £9bn by 2024/25 if care workers and providers are paid fairly). If every person who should be getting local authority care were identified, what could councils do? Within the system we have, they are left in the bizarre position where supporting residents (as they must do by law) necessarily means making painful and controversial service cuts elsewhere, which may themselves increase demand for social care in the longer-term.  

Any reform to the Social Care system should recognise the perverse incentive this choice creates, and seek to move past it. Nobody would accept their local library being closed because of an increase in the number of heart transplants taking place. Social care should be no different. Keir Starmer’s Labour Party is currently predicted to win a 318-seat majority. A victory anywhere near that would give Labour a once-in-a-lifetime opportunity to fulfil the promise of 1945 by establishing a popular, comprehensive and sustainable social care system. For a starting principle that is both fair and popular, Labour need look no further than that of a National Care Service outlined in its 2010, 2017 and 2019 manifestos.

I am encouraged that Labour have asked the Fabian Society to help develop a roadmap to a National Care Service. However, I would urge Labour not shrink in the face of opposition from the right-wing media, making the same recycled argument that the sixth-largest economy can afford billions in defence waste but not to care for its own population. Twenty-five years of tinkering shows that making progress on this issue means making big commitments and sticking to them. If we fail, whatever is left of vital local services will remain at risk, and social care will remain bureaucratic, wasteful and inaccessible. If we succeed where previous governments have failed, everyone will benefit. By addressing unmet needs, current users of social care, and their families, will live more dignified and fulfilling lives. By reforming funding, local councils will be given a chance to rebuild the services we all use.

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