Monday 25th November 2024
What's next for social care reform?
Nathan Jones from the National Care Forum considers how well the government is upholding promised reform to adult social care
Labour’s start to government has been a little bit bumpy to say the least. Many in the sector were nervous when one of their first actions was to scrap the planned cap on lifetime care costs and workforce training fund inherited from the last government: are we about to see social care kicked into the long grass or will Labour prove to be serious about its manifesto pledges to reform adult social care?
We’ve had mixed messages since the party conferences. On the one hand we’ve seen a shift in tone from the government which would suggest the government intends to take concrete action on reform, but on the other, we’ve seen the total obliviousness shown to social care providers by the Treasury following its decision to increase employer National Insurance Contributions and lower the earnings threshold at which employers start paying NIC. Below we outline the current policy landscape and direction of travel.
Manifesto pledges
Labour’s manifesto included a pledge to reform adult social care as part of its mission to ‘Build an NHS fit for the future’. To do this, they pledged two interconnected things. First, to establish a fair pay agreement for care workers, via collective bargaining between trade unions and employers to reach a set of fair pay, terms and conditions alongside training standards. Second, to create a National Care Service ‘underpinned by national standards, delivering consistency across the country. Services will be locally delivered, with a principle of “home first” that supports people to live independently for as long as possible’. We’ve seen some movement on the first but still lack fundamental details for the latter. More on this below.
A changing tone
After a period of silence on their plans, the government has begun to recommit to its manifesto pledges and talk more freely about adult social care reform, albeit minus the funding required. A shift in tone was evident at the Labour Party Conference. In several fringes and speeches, Secretary of State for Health and Social Care, Wes Streeting and Minister for Care, Stephen Kinnock talked about how important adult social care is to fixing the NHS but also as an essential service in its own right which enables people to live good lives and boost economic growth. Streeting even went out of his way to describe himself as the Secretary of State for Social Care. There also appeared to be an acknowledgment that any long-term reform must be accompanied by short-term stabilisation measures, particularly for the workforce, but there was very little detail on what that would entail.
Much of the conversation around adult social care reform was in the context of what the government has described as ‘three shifts’ in health care:
1. Shifting from hospitals to communities
2. Shifting from sickness to prevention
3. Shifting from analogue to digital
Clearly, the government’s health and social care team is viewing social care in the wider context of their 10-year health plan and the findings of Lord Darzi’s report in the NHS. The shift in tone and an apparent willingness to work with others to find a way forward is welcome, but we still need to understand the full details of what might be proposed.
"Streeting even went out of his way to describe himself as the Secretary of State for Social Care."
A fair pay agreement
In October, the government introduced its Employment Rights Bill. Alongside a series of strengthened workers’ rights, the proposed legislation creates a framework for a legally binding fair pay agreement which may be negotiated by an ‘Adult Social Care Negotiating Body’ made up of relevant employer and worker representatives. The Bill implies that this body would have a broad remit to negotiate on renumeration for social care workers as well as terms and conditions of employment and any other specified matters relating to the employment of care workers.
However, in the absence of detail, the Bill empowers to Secretary of State to lay further regulations at a later date through secondary legislation. It is likely we will see a lengthy consultation and implementation period so we’re probably a few years away from any fair pay agreement.
Any implementation of an agreement must be backed by state funding as the matter can’t simply be passed to local authorities and employers in an unfunded manner, or it will fail.
With social care providers having to find millions of pounds to fund the employer NICs requirements, it makes it much harder to see how we move to a fair pay agreement any time soon – and in fact it undermines the ability to keep paying the Real Living Wage where providers have committed to that.
National Care Service
The National Care Service remains a vague outline, and we suspect the government is still figuring out what it might do as part of their 10-year health and social care plans.
At the very least, the government’s vision of a National Care Service is not one which would see providers nationalised or forced into a top-down command and control structure, mirroring the NHS. Rather the intention seems to provide social care a ‘brand identity’ while also ensuring funding streams are rationalised and standards and quality are improved; the ambition seems to be national consistency while ensuring local control, that public money is used effectively and transparently, and more people are able to access care and support at an earlier point to promote independence.
@pilgrimsfriendsociety Empowering care for older generations! ❤️ Nathan from the @National Care Forum breaks down the key factors for improving care for older people. Let's create a future where every senior feels valued and supported. ☀️ #pilgrimsfriendsociety #empoweringcommunities #community #carematters ♬ original sound - Pilgrims' Friend Society
There are multiple reports that the government can use to inform the shape and development of a National Care Service such as, the Fabian Society’s ‘Support Guaranteed’ ADASS’s Time to Act or the Archbishops’ Commission’s ‘Care and Support Reimagined: A National Care Covenant for England’. The latter report will have resonance with readers as it seeks to inject more humanity into the social care reform debate. It uses, as its starting point, one of the most fundamental aspects of Christian theology – we are all made in God’s image and as such we all have significant dignity and worth. The report develops this theme and calls for a ‘national care covenant’ to underpin the National Care Service which sets out the role and contribution of people, communities and government and clear expectations of what support should be available. It seeks to go beyond a mere government taskforce or commission, to fully engage people across our society.
WHAT NEXT?
With services in every part of the country, it is crucial that we continuously remind the government that adult social care is a key part of our nation’s infrastructure, with the potential to unlock economic prosperity and combat socio-economic and health inequalities. The Chancellor’s decision to increase employer National Insurance on social care providers shows that there is a lot more work to do to educate the government about the vital public services we all deliver. DHSC may have got the message, but the Treasury clearly is not yet on board. Investment in social care is essential for the government to meet not only its health mission, but also its missions to kickstart economic growth, break down barriers to opportunity and move towards net-zero and environmental sustainability.
All those with a stake in care need to reach out to the many new MPs who have backgrounds in local government, as paid and unpaid carers and as people accessing care and support services. It is going to be much harder for this government to ignore adult social care reform due the numbers who have direct experience of care and we need to harness that. The Liberal Democrats in particular have made social care reform a central plank of their policy agenda. This is strengthened by the fact Layla Moran, Lib Dem MP for Oxford West and Abingdon, is the chair of the Health and Social Care Committee. It seems to us there are many routes to pushing social care reform and holding the government to account over its pledges and actions it may take which undermine those pledges.
At the National Care Forum, we’d be interested in hearing from readers about what your hopes are for social care reform from this new government. Please do send your thoughts to my colleague Victoria Garratt on victoria.garratt@nationalcareforum.org.uk
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