Written evidence submitted by Health for Care [ASC 036]

Health for Care is a coalition of national health organisations – led by the NHS Confederation – which campaigns for the establishment of a more sustainable adult social care system in England.

In light of the Housing, Communities and Local Government Committee’s call for evidence into the long-term funding of adult social care, we write to you with a response on behalf of the Health for Care coalition and those our organisations’ represent across the NHS and the wider health sector.

While both the health and social care sectors have been severely impacted by the COVID-19 pandemic and have had to cope with unprecedented challenges, the experiences of those relying on and working in the care sector – in both care homes and in the community – have shone a light on an under-funded, under-staffed, and under-supported care system in desperate need of overdue decisions on funding being made. This is not to detract from the ingenuity, compassion, courage and commitment of those working in social care and those strengthening relationships across local government, communities, and the NHS in order to improve care services for older and disabled adults.

Even before COVID-19 exposed these problems, the social care sector did not have the capacity to meet the needs of those in need of care, their families, and carers. The Health for Care coalition is united in the belief that the only way that social care can be improved for everyone, is if the Government makes urgent progress towards delivering a long-term funding settlement to stabilise the current market, satisfactorily reward and compensate care sector workers, rebuild and extend provision, and improve integration between social care and the NHS. We believe that increased funding would provide the care sector with sufficient capacity to widely implement new, excellent models of care.

Making such progress will require the Government making significant decisions on public funding.

The House of Commons Health and Social Care Committee[i] concluded last October that the “starting point” for an increase in adult social care funding must be an additional £7 billion per year by 2023/24 to cover demographic changes, uplift staff pay in line with the National Minimum Wage and to protect people from catastrophic care costs. The Health and Social Care Committee acknowledges, however, that even this amount of additional funding would “not provide any improvement in access to care”, and the full cost of adequately funding social care is therefore likely to be substantially higher, “potentially running into the tens of billions of pounds”.

Further reports also confirm the need for considerable increases in long-term public spending on social care. In February, the Health Foundation[ii] estimated that under current funding projections, an additional £14.4 billion per year by 2030/31 would be the cost of meeting demand, improving access to care, and allowing local authorities to pay care providers more to improve the quality of care services.

Despite these large sums and the urgent need for increased funding and reform, we believe that the Government should acknowledge and act on the reality that a vital consensus view is emerging among decisionmakers across political parties, and across both national and local government.

Between November and December last year, our coalition commissioned YouGov to conduct a poll of representative samples of 96 MPs in the House of Commons and 520 councillors serving in English local authorities. The poll[iii] found that 90 per cent of MPs and 92 per cent of councillors agree that local government does not have enough resources to meet growing demand for care services from those eligible for state-funded or subsidised care. Additionally, the poll also found that, across both the Conservative Party and the Labour Party, more MPs agree than disagree with the proposal for social care services to be paid for by a new collective funding mechanism across the population.

To guide the Government’s and parliamentarians’ formulation of a new vision for the adult social care system, the Health for Care coalition has developed seven key principles which we believe should underpin a new system for the funding and provision of adult social care. These are:

1. Sharing costs: A system providing the care people need should be funded by the introduction of a new financial contribution drawn from across the population. This may require differences in when, how, and how much people pay towards the care system.

2. Fair eligibility: Eligibility should be based on need and must be widened to ensure that those of any age with unmet or under-met need have access to appropriate support. Eligibility must also guarantee parity of esteem across physical, mental and cognitive health.

3. Improving integration: Social care services should work more effectively with other sectors, including with the NHS and the housing sector. Personalisation should be at the heart of greater integration, so that care recipients hold maximum possible control over the support they receive, enabling them to live healthy, independent and meaningful lives.

4. Sustainability: Establishing a sustainable social care system will require closing the existing funding gap in the short-term, as well as establishing a permanent funding settlement that would enable both members of the public and care providers to plan for their long-term future. Levels of funding should also sustain a diverse and stable market of providers.

5. Valuing the workforce: More workers should be recruited to, and retained within, the care sector. Furthermore, those who work within the care sector should be offered sufficient pay, higher quality training (along with the protected time away from work to undertake training), opportunities for career progression, and new career paths.

6. Supporting carers: Unpaid carers should be eligible for increased support from the state. Additionally, offers of care should not be reduced on the basis that someone may be a recipient or possible recipient of informal care.

7. Accessibility: The criteria and assessment process for receiving state-funded care should be simple enough for everyone to understand, with guidance on offers of care to be made widely available. In addition, assessments of individuals’ care needs should be conducted by appropriately-trained assessors.

Fundamental social care reform is long-overdue, yet – as demonstrated by the poll of MPs and councillors mentioned above – it is the tragedies of the COVID-19 pandemic which have brought forward the conditions in which real change has become politically achievable. Crucially, the pandemic has also impacted most on people needing care and support, highlighted inequalities and exacerbated difficulties on the frontline of social care services, making the need for reform ever more pressing. It has also, however, highlighted the value of social care, support, and safeguards, and enabled more personalised responses to individuals (for example, more support has been provided at care users’ homes, rather than within institutions).

With the Government having committed to finally publishing proposals on social care reform later in the year, the Housing, Communities and Local Government Committee has an important role to play in holding the Government to account in this area, and in ensuring that they produce proposals that comprehensively address the challenges facing the care sector.

Through its inquiry on social care, your Committee has the potential to play a decisive role in effecting the delivery of bold and essential reforms. The Health for Care coalition welcomes your Committee’s inquiry and we look forward to reading the inquiry’s resultant conclusions and recommendations.

Yours sincerely,