It speaks volumes about government priorities that the Treasury briefed journalists ahead of Wednesday’s autumn statement that an extra £1.3bn would be spent on roads. Yet we have been kept in the dark over any rescue package for the tottering social care system, on which the chances of the NHS getting through the winter so critically depend.
As it happens, £1.3bn is also the price of a basic rescue for social care. It is the calculation by the Local Government Association (LGA) of the gap between what care providers in England say they need now to sustain threadbare state-funded services for older and disabled people and what councils say they can afford. To meet rising demand, inflation and the costs of the “national living wage” next year would require the same sum again.
Pretty much everyone outside the government understands the perilous position of the social care system, highlighted again this week by withdrawal from the market of another leading homecare provider, Mitie, and by a survey of councils suggesting that four in five local authorities do not have enough provision in their areas – especially for care at home, “extra care” housing with support and specialist nursing homes for dementia.
Relations between social care and the NHS have frequently been awkward and testy. Yet health leaders have been queueing up to say that if there is any spare cash going, give it to the poor folks next door (provided they spend it on keeping people away from hospitals already bursting at the seams two months before winter pressures traditionally bite). Even the health and social care regulator, the Care Quality Commission, has bravely stood up and warned of a system almost at tipping point.
Expectations are modest. While sector leaders say there must be a far bigger long-term settlement, for now they are looking realistically for renewal of the power English councils were given this year to add up to 2% to council tax bills for adult social care, ideally increasing that amount. They also want the extra funding, under the so-called Better Care Fund, already earmarked for the end of the decade brought forward to next year.
That there has been no word on this from the Treasury, even obliquely from the usual sources, is worrying. In a reply last week to Sarah Wollaston, chair of the Commons health select committee – who had warned that NHS reforms would be undeliverable without urgent action to improve social care – the chancellor, Philip Hammond, said he recognised that conditions were challenging and would “continue to closely monitor the position”.
Most observers still think he will find something for social care. But their faith in that extends little beyond rationalising that “he must, mustn’t he?”. Treasury officials are notoriously deaf to special pleading and, let us be frank, social care has done rather a lot of that over the years, not always very well.
One problem is the sector’s apparent inability to make a unified case. Even now, various figures are put on the scale of the funding gap it faces, from the LGA’s £1.3bn (or is it £2.6bn?) to £1.6bn advanced by social services directors and £1.9bn put forward by three leading health thinktanks.
While the size of a water bottle may be immaterial to a man dying of thirst, The Treasury expects precision and rigour in the cases it considers. Another problem is that the evidence of crisis isn’t entirely consistent. Even as care-home chains are privately warning ministers that up to a quarter of beds are at risk of closure, a leading property consultancy is reporting that profitability of homes is rising. Our Treasury friends will not have missed that. A key reason, paradoxically, is that closure of some homes – and overall capacity is falling – is increasing occupancy rates in the others.
But if there should be nothing for social care in Hammond’s statement, or if there is too little to make much difference, the consequences can only be bad: bad for councils, which are braced for an onslaught of legal challenges as it becomes clear that they cannot fulfil their duties under the Care Act; bad for the NHS, as hospital beds fill this winter with older people who could and should be receiving care and support at home; and, above all, bad for anyone who cannot afford to pay for their own care and support.
The distressing scenes of ill-treatment seen in BBC Panorama’s secret filming inside two Cornish care homes this week will only be repeated again and again as long as the care system remains underfunded, underskilled and undervalued by the rest of society.
Even the Care Quality Commission has stood up and bravely warned of a system almost at tipping point
The social care system needs a rescue package – to help the NHS survive
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