We need to have an honest conversation with the public about social care

By Joanne Harding

This piece is part of a new book “Labour’s Reset: The Path Back to Power” which is being released today. The book looks at the barriers for voters in picking Labour, what the party can do in opposition to tackle these issues and the type of policy platform that would attract switchers to Labour at the election.

‘If you neglect physical infrastructure, you get roads full of potholes and buckling bridges, which prevent your economy functioning properly. The same is true if you fail to invest in social infrastructure.’ These  were the words Liz Kendall used as she addressed a conference of directors of social care back in April this year. I think we can all agree that social care has been neglected by successive governments for years. The question is what could and should Labour do to truly address what I believe to be one of the most difficult policy challenges of our times. One of the fundamental issues with social care is that people do not really understand what it is. It is incredibly difficult to define as it ranges from supporting a person to wash and eat, to administering medication, to safeguarding, protection of liberty and to end-of-life care. It is inextricably linked with health by virtue of some of the elements of personal care, yet it is so much more than health.

However, it does not have the same branding as the National Health Service (NHS) that we all recognise and hold dear to us as a beacon of all that is good. Politicians talk about health and social care, yet they continue to leave it out in the cold when it comes to policy and funding conversations. This lack of focus on social care is reflected in public attitudes – in polling conducted by Yonder for Labour Uncut, when respondents were presented with a list of 11 different policy and just 6% of voters picked social care as the highest priority.

It does not attract the same attention as a hero workforce and life-saving and ground-breaking treatments do. Nevertheless, make no mistake about it, social care encompasses every single one of these things and more.

Labour therefore has a role to play in changing the narrative among its members and the wider public. Maybe then, we can have a more honest conversation about the areas I feel we need to tackle if we are to reform and transform social care.

Funding reform

This will surely be considered the most contentious and difficult element of our policy work. If we truly want a publicly funded social care system in England, we need to establish how we are going to pay for it. Projected  growth on spending for social care is simply not in line with predicted growth pressures, which are rising at 3.7% annually in real terms. More than 1 million people aged 65 or over will require varying degrees of social care support by 2035; this is up from 783,000 individuals in 2015. As people live longer and advances in medicine and assistive technology support people to live with chronic and long-term health issues, greater strain will be put on an already creaking system.

We know we cannot simply stand still as we will have a predicted gap of £3.5 billion to fill by 2025 to maintain our existing standards of care, which are frankly failing too many people. Age UK reports that 1.5 million people living in the UK have an unmet care need and if current trends continue, this could grow to 2.1 million. Furthermore , the government have offered  short-term bungs over the years to paper over the cracks. Relying on a council tax precept and business rates cannot possibly be a sustainable funding model for an infrastructure that is so vital to a healthy society. It also creates inequity in local authorities that will be living with greater health inequalities and higher levels of poverty. Current provisions are  truly a postcode lottery.

Johnson’s statement to the House of Commons last week has done nothing to reassure those of us who live and breathe social care that reform is coming anytime soon. The  majority of the income generated by a regressive national insurance rise will not really go towards funding social care. For three years, all of the money will go towards easing the NHS backlog; in fact, only £5.4 billion of the £36 billion will head in the direction of social care. Councils may well be forced to raise council tax yet again in order to meet demand. Social care is in crisis right here, right now. The Tory Party’s talk of funding and reform are actually just warm words.

In 2010, the Dilnot Commission put forward the recommendation of a lifetime cap on care. This alone is not the solution to longer-term social care investment reform, but it does go some way to protecting families against catastrophic care costs. Consequently, this is something that I do believe Labour should push to be implemented. The original recommendations were initially accepted in 2013 but have never actually been applied. The cap on care is the right thing to do, but that will not come into place until 2023 and such a measure actually does nothing to reform the system.

Keir Starmer has put forward some potential solutions in relation to a wealth tax, which would involve taxing the income of landlords, and those who buy and sell large quantities of financial assets, stocks and shares.  Clearly , more detail is needed from Labour, but how about if Labour shifted the narrative and did not actually talk about funding? Let us instead talk about investment. Then, when we come to the point of putting forward potential solutions, we are framing the discussions as the right thing to do (of course they are, but we need to be really clear as to why), because the cost of not reforming social care funding is just as important.

When Labour talks about the home first model, which I will always champion, we need to tell the story of what this means for older and disabled people who rely on social care. We must stop framing the debate around older people having to sell their homes and instead talk about the fact that one-third of social care users are working-aged adults and how half of the budget is utilised in conjunction with their needs. The  King’s Fund explains in more detail some of the options that Labour may want to consider, but this is not an area that the party can continue to fudge; as has been said before, if not now, when?

We noted earlier that the public do not fully understand what social care is and the role of care in our society. What has become apparent to me as a councillor with portfolio responsibility is that they understand even less how care is funded and paid for. Indeed, it can come as an incredible shock to many families when they have to make decisions about a loved one going into a residential setting. The public are under the impression that care fees are picked up by the NHS or that councils pay the bill. In fact, Ipsos Mori polling from 2008 (that contributed to the green paper, ‘Shaping the Future of Care Together’) showed that many people simply cannot distinguish between the NHS and social care. If people genuinely believe this and want it to be true, it would therefore make more sense for Labour to open up discussions in our communities in these post-Covid times. We should work to ensure people really do understand how social care functions by talking about it with the same passion as we do with regard to the NHS. Labour must start to develop and promote a vision of social care in the very same way that Nye Bevan did in relation to our health service.

Families and loved ones saw for themselves the way care homes (not just for older people but also for those adults living with a learning disability) were impacted during the COVID-19 crisis. It was an underfunded and undervalued sector that was ill-equipped to cope with a global pandemic. Labour must now set out its stall with a ten-year plan that outlines our need to invest in the development of a social care system that is sustainably well-funded, well-staffed and fit for the future.

Healthy communities

‘Don’t we all want to live in the place we call home, with the people and things that we love, in communities where we look out for one another, doing the things that matter to us?’ This is an excellent quote from Social Care Future who I have had the great pleasure of being connected with over the past few years. They are a growing movement of people who know what they need to live healthy and fulfilling lives, and they are among the people that Labour must start listening to and involving as we develop our vision for social care provisions that are fit for purpose in the future.

When we are fit and well, we take for granted that we will live in our own home, surrounded by the people and things we love. Social  care must always be about allowing people to make their own choices and empowering them to live independent lives. The vision we set for the future cannot be developed by politicians and policy wonks alone. Only this week I have been made aware of policy discussions and panel sessions taking place at a national level that have not involved people who are directly impacted by decisions on social care. Social Care Future have led the calls that say enough is enough with regard to the tokenism in this area. Labour can lead the charge and ensure that our National Policy Forum sessions are not just about members sitting in a room, talking about privatisation in the NHS.

Social care is a force for good; it empowers, enables and supports people to live independent lives. We must talk about social care in the same way we do about the NHS; it is as vital to our daily lives as health services are and not just something that is tagged on at the end when people start to struggle. Keeping communities healthy and well is a must if we wish to avert a continued crisis across social care. Flicking the switch towards well-being and prevention of ill health must be a central tenet of the Labour Party’s health policy. The public health grant in 2020/2021 was 22% lower in real terms compared to 2015/2016, and this was with a recent uplift.

Social care as a portfolio not only covers older people’s care but also substance misuse, mental health and learning disabilities. Labour must commit to reinvesting in public health and ensuring prevention is a prioritised policy area. When invested in properly, sexual health, smoking cessation, healthy weight and drug and alcohol services are able to provide those early interventions that keep our communities well.

As we reset and rebuild from Covid, we must not lose sight of the creativity that has flourished at a community level. Many community-based and voluntary groups have come together to start to develop their own solutions that enable people to live independent, rich and fulfilling lives. Alongside public health and prevention work, Labour must make an absolute commitment to integrating housing into our health and social care vision. The time has come where we must stop merely mentioning health inequalities.  We will commit as part of party policy to implement the recommendations of the Marmot Review. Only with a true collaboration of public, private and voluntary sectors can we ever hope to achieve a generational shift in health inequalities.

All this being said, the government has made the decision to dismantle Public Health England and look into establishing a new National Institute for Health and Protection. Alongside a complete restructuring of the Health and Social Care Act, these changes present us with risks and are causing unrest and uncertainty in an already exhausted system. There is disruption ahead, and it is up to Labour to really hold the Conservatives’ feet to the fire, while not getting caught up in old arguments about US care systems coming for the NHS.

I will finish where I started: social care has had one too many potholes and buckling bridges. As we start to set out our policy vision, Labour has an opportunity to truly build our social care bridges back better.

Joanne Harding is Executive Member for Adult Social Care in Trafford and carries out consultancy and leadership training for local government


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2 Responses to “We need to have an honest conversation with the public about social care”

  1. Tafia says:

    Stephen Kinnock giving a very good, honest and realistic interview on GB News (and I don’t even like the bloke LOL, although his dad is a mate of my mother’s from here union convenor days for the old NALGO). Unequivicably and categorically rules out Labour rejoining the EU or the Single Market/Customs Union.

    Says we have become over-reliant on cheaper imported workers which inevitably leads to lower wages and conditions. Minimum wage levels must be raised as that will raise all wages, but only at a pace that business can afford and people will have to accept it will fuel inflation. More must be manufactured in UK, by UK workers and we must change and learn to be less reliant on imported labour and cheap imported manufactured goods.

  2. Anne says:

    Really good article Joanne – demonstrates an understanding of the complexities facing health and social called care. This problem has really been with us since in inception of the NHS. It has grown in intensity because people are living longer and better treatments, especially in chronic illness management. This problem has been recognised within the professions themselves with schemes developed within the communities for people to remain within their own homes for longer. This has been achieved by services working in partnership – community nurses usually providing health care and local authorities providing social care. There are different training and qualifications required and different professions and different funding. Charities also have an input in this partnership working – Age Concern do a fantastic job. Some hospices also only received limited funding from government and depend on charity funding. Although end of life care is usually provided by the NHS. When individuals can no longer manage at home then comes the minefield of residential care. These again are funded in different ways, and provide different levels of care. Some are managed by local authorities, some private, and some by charities such as ‘Abbeyfield’ The type and standard of care offered has been under the microscope for a number of years – hence the inception of ‘the quality commission.’ Each care provider is inspected and reports compiled. What the pandemic has highlighted is the problems identified within the care sector – such as training, and funding. Quite right Joanne in that most people don’t really understand the funding aspect until perhaps they have a relative requiring care. Usually social workers are involved with sorting out funding. There are no easy solutions to the funding. If social care is to be placed on the same footing as the NHS then this is going to be costly.

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