Social care: the unanswered questions

How the government's proposals will be implemented and funded remains unclear

Boris Johnson
(Image credit: Paul Edwards / WPA Pool / Getty Images)

Boris Johnson is promising to reform adult social care in England with funding from a newly announced National Insurance hike.

The manifesto-breaking 1.25% tax increase will kick in from next April, before being rebadged as a health and social care levy from 2023. The government yesterday published a “Build Back Better” plan explaining how the money raised will be used to both improve social care and tackle the Covid-related backlog of NHS patients.

But while critics have long been calling for reform, key questions remain unanswered.

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When will the cash flow be diverted from the NHS to social care?

Most of the money raised by the tax increase will go to the NHS rather than social care for first the three years of the new funding system.

Downing Street estimates that the new tax will raise an additional £12bn a year. Of the total £36bn gained over the next three years, £5.4bn is earmarked for adult social care in England.

As The Guardian noted, that equates to “less than one in every six pounds” of the extra money. And what proportion will be allocated to social care after the intial phase of the plan remains unclear.

Health Secretary Sajid Javid admitted during a press conference yesterday that he was unable to say “how much money social care will actually get and when, because it all depends on how NHS gets on with clearing the backlog”, tweeted Sky News’ Kate McCann.

She added: “NHS bosses say it could take ten years...”

What happens to people who need care before the reforms kick in?

As part of the new social care plans, the government will introduce an £86,000 cap on how much individuals must pay towards the cost of their care.

“However, the fine print of the rushed-out plans revealed that the cap, to be implemented in October 2023, applies only to ‘personal care’, the physical acts of caring that are regulated by the Care Quality Commission,” reported The Telegraph. So the “very expensive” costs of accommodation, cleaning and food will not be included.

In a further blow, thousands of adults entering the adult care system before the new social care funding plans kick will not be protected by the cap, which is “not retrospective”, said The Mirror.

Around 250,000 people are currently in residential or nursing care in England.

Will the new money reverse the effects of previous spending cuts?

Councils fear that the money raised by the new tax hike will be “swallowed up” by covering the cost of the cap and funding the NHS, reported the BBC’s health correspondent Nick Triggle.“If these fears are realised, it would mean the system remains on its knees with insufficient staff to provide the care people need.”

The Institute of Fiscal Studies has warned that additional funding for social care over the next three years will not be enough to reverse cuts made in the mid 2010s. “Thus, while more people will become entitled to financial support as a result of the reforms planned, many people with care needs not considered severe enough will continue to miss out,” said the think tank.

According to an IFS analysis of government figures, at an average of £1.8bn per year, the social care funding boost is equivalent to around 9% of what councils spent on adult social care services in 2019-20.

“However, the early-to-mid 2010s saw big cuts in spending, despite an ageing population and rising numbers of people with learning disabilities,” said the economic research institute. “And as a result, adult social care spending per person was 7.5% lower in real terms in 2019-20, the latest year for which we have data, than in 2009-10.”

The IFS concluded that “while the precise path for spending - and hence for the availability and quality of care - is unclear, it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s”.

What about staff shortages?

The government says that under the new plan, £500m will be invested in providing “support in professionalising and developing the workforce”, including funding hundreds of thousands of training places and development opportunities.

But care companies say the plans only contain vague commitments about staff retention and training”, and should be “accompanied by clearer targets for improving pay and progression”, said the i news site.

More than 430,000 people left jobs in adult social care in 2019-20, with many citing low pay, burnout, and poorer working benefits, according to a recent report from MPs on the Health and Social Care Committee.

“While £500m investment over three years in training and improving well-being is welcome, the benefits will not be felt until next year and until there is parallel action on pay and career progression,” Nina Hemmings of The Care Worker’s Charity told the i site.

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