Ending the crisis in social care has been a long-held ambition of those who enter Downing Street from whichever party – and was certainly one of mine as health secretary. But coronavirus has removed any possible excuse for the delay, as it has brutally exposed the fragility of the sector – alongside the bravery and service of those who work in it.
As we grasp the nettle of social care reform and prepare for a second wave, we must learn the lessons of recent months.
When the peak of the pandemic approached and NHS beds were desperately needed, vulnerable people were discharged from hospitals into care homes without proper testing. Other countries introduced restrictions on care home visitors at an early stage in the pandemic, and required people being discharged to care homes to either have a negative test result, or to be quarantined for 14 days in a separate facility. It is essential that we adopt examples of best practice.
But we also need to be honest about the underlying issues in the sector. When, as health secretary, I negotiated an extra £20bn for the NHS to go alongside a new 10-year plan, I argued strongly that the social care sector should also receive extra funding. I was told this would follow – but, two years on, we are still waiting.
It is very welcome that the prime minister has committed to finding a long-term solution. But if he is going to deliver a new deal, we should be clear about what that entails: first, a long-term solution that addresses inequity in the current system, such as Andrew Dilnot’s eminently sensible proposal for a cap on care costs, or free personal care as recommended by the Lords economic affairs committee. It is highly significant that this cross-party committee chaired by Lord Forsyth, a self-described Thatcherite, advocated an expansion of state responsibility.
But second, and equally important, is the need to increase annual funding available to local authorities. The Health Foundation estimates that demographic pressures and rises in the “national living wage” alone will add £4bn a year by the end of this parliament, and will require significantly more to address the sector’s long-term needs. An inquiry into social care by the health and social care committee, which I chair, aims to identify how much extra money the government must commit over the next five years in order to fix the gap in social care funding and reduce pressure on the NHS.
Our annual winter crisis arises because the wraparound care people need is not provided, so they end up in A&E and cannot be discharged from hospitals to social care. The head of the NHS, Simon Stevens, has acknowledged that the issue needs to be resolved within the next year. As he told our committee, not to do so would be “inconceivable”.
We have heard some harrowing evidence. Take Anna, a doctor in her 30s who is unable to practise because of a genetic condition that causes chronic severe pain. Dependent on social care, her life is structured around hourly payments for showering, dressing or preparing food. She lives in fear of a cut in her care hours.
Or Dorothy, who, in her 90s, lived in her own home before a series of emergency admissions to hospital. She wanted to return home but the care she needed was never put in place. An array of NHS and local authority officials dealt with her case – her daughter counted 101 people in total. But, as Dorothy said: “Everyone who is meant to have helped has done harm.” Because, despite all those brilliant professionals, there was never any co-ordination or teamwork. Dorothy spent seven months of her last year in hospital before her death.
Better integration of hospital and social care services could have given her those months at home. The division between the NHS and social care goes back to its founding when medical care was made “free” but social care was means-tested. Now, with more people living for longer with multiple health conditions, this distinction has become artificial and destructive.
As has another distinction, namely the stark divide between care workers and hospital staff. Social care workers describe feeling like “underdogs” and “Cinderellas”, demoralised to see shops offering generous discounts to NHS staff but not to them. One care worker described people tutting at her for wearing her uniform in the street between home visits. Social care workers need a proper career path and to be given the recognition they deserve. The introduction of care certificates marked an important start, but more needs to be done.
It is no surprise that annual staff turnover is 30% in social care, rising to more than 40% in the home care sector. When “cost per minute” is the basis for payments to home care staff, do we really expect our older people to be looked after with dignity and respect?
Britain spends a lower percentage of GDP on social care than countries such as Denmark, Norway or the Netherlands. We Conservatives always said the purpose of the painful measures taken in 2010 was short-term: to put the economy on its feet so we would be in a better position to increase funding for public services. We have delivered that for the NHS – now we must be as good as our word for social care. A once-and-for-all fix for this crisis cannot come too soon.
Jeremy Hunt MP is a former health secretary and chairs the House of Commons health and social care committee