Dick Sorabji: Ministers must ensure that funding for social care increases at the same rate as the NHS
The government should use the Health and Care Bill to ensure that additional funds for social care reform are protected in the future, writes the acting chief executive of the London Councils.
Adult care reform is difficult not because it is complicated, but because it is so expensive. A financing reform that survived a general election could be a defining political achievement. But demographic pressure will quickly turn any one-off success into an underfunded failure. The government therefore needs an additional protection policy to protect its heritage.
Users and caregivers know what the reform entails. The freedom to trade the support between the time of getting dressed and the time of preparing a meal. Freedom from fear of contracting a disease not covered by the NHS. Easy switching between suppliers according to changing needs.
In turn, this requires reform of a care market that relies on cross-subsidization to maintain corporate solvency. Retention of staff based on the conditions enjoyed by NHS colleagues and career development paths. Greater investment in prevention ensuring that costs rise more slowly. Investment in technology transforming isolation into independent living.
Without a mechanism to protect the gains of a major reform, care will quickly become underfunded again
The biggest costs come from restoring supply to pre-austerity levels, providing free personal care, and capping payments for life. Current spending is over Â£ 23 billion. The Commons Health and Social Services Committee suggests population pressure and the national living wage already require Â£ 3.9 billion. Free personal care would cost Â£ 5 billion. A cap on care payments costs more than Â£ 3.1bn. Returning access to funded care to 2010 levels costs Â£ 8 billion. Funding providers for the actual costs of care add up to an additional Â£ 7.9 billion.
The numbers overlap, but more than Â£ 10 billion is needed. It could fund half the police force in Britain, or all the courts. It costs 2 pence on income tax. To find these sums, you have to think beyond the comfort zone of any political party. That is why success could define the reputation of government.
Using the Health and Care Bill to Protect Funding for Adult Social Care
However, any one-time solution will soon fail. The growing needs of young adults and older people require annual funding increases of 3.9%. Without a mechanism to protect the gains of a major reform, care will quickly be underfunded again. We need a way to give healthcare funding the political commitment to funding the NHS.
The Health and Care Bill currently under consideration in Parliament provides this possibility. The bill promotes equality of status and collaboration between sectors. This could include a legal requirement that regardless of the annual increase in NHS funding, the same rate of increase should be applied to adult care.
In the last year before Covid, the NHS received a 0.5% increase in adult care; adult care fell short of Â£ 114million. Small sums compared to reforming the system, yet today’s crisis is the result of this small injustice that repeats itself every year for decades.
Whatever plan the government makes, legislating to link subsidy changes in the NHS and adult care can provide long-term protection for their achievement.
Dick Sorabji, Acting Managing Director, London Councils