It’s sad to see yet another missed opportunity to properly address social care. After the ravages of Covid-19 have shone such a vivid spotlight on the failings of the UK social care system, it is disappointing that there are no concrete plans for the urgently needed radical overhaul of social care funding and delivery. The care system has been neglected for far too long and remains the poor relation in our National Health System.
The current artificial separation between NHS and social care meant care homes and home care services did not receive adequate supplies of PPE, as the NHS was prioritised. Social care was relegated and neglected, with care homes or homecare being used as hospital overflow services, when so many Covid patients were prematurely discharged from hospitals, putting lives at risk. Social care must be properly integrated and funded, with parity of esteem alongside the NHS, to treat those with care needs with the dignity they deserve.
With 28,000 people relying on social care at home died last year in England and Scotland, some areas reported a doubling or trebling of numbers of deaths. Overall numbers of deaths for those receiving home care in England increased by 50 per cent in the year to March 2021 over the prior year and the numbers in Scotland increased by 70 per cent. This was not related just to Covid, with the majority of excess deaths being from non-Covid causes. The stark figures suggest a failure of social care services through the pandemic, with fragmented domiciliary care provided by private sector, councils, charities and NHS trusts, but no joined up oversight. CQC figures show that deaths at home in 38 English councils doubled last year and in 10 areas the number of people dying tripled.
Meanwhile, the enforced early discharge of elderly patients, regardless of Covid infection, endangered the lives of care home residents and their dedicated staff. Care homes reported tens of thousands of excess deaths last year.
There is an urgent need to fix the broken care system. We are still waiting for the promised proposals and legislation to reform both funding and delivery of social care, and to ensure it is fair to those who are unable to live independently, whether in their own home or in a residential setting.
Social care is funded on a short-term basis and councils are given money which is not ring- fenced for care. The most draconian of means tests governs whether councils will pay or whether these vulnerable people must pick up the huge bill for their care. Taxpayers cover all the costs for millionaires with cancer who are treated on the NHS, but widows with dementia lose their life savings to pay for their care.
So what can be done? There is no silver bullet here. There are several vital elements to social care reform, which the Government must grasp.
Everyone should pay something whether or not they need care – with a national system of contribution towards care costs, along the lines of our pension system. If Beveridge was designing our National Insurance system today, he would undoubtedly have included provision for care of elderly people within the pension. It is time to bring the welfare state up to date. This could require a 1 per cent levy on everyone’s income, including older people, but the money will have to be found.
But we also need incentives for private provision on top of State basic care. The State can provide a basic care service, but everyone could then be incentivised to provide more money for themselves if they prefer to have more choice and control on the types of care home or home care they receive. This would include savings incentives to help people build up money for care, just as we have done with pensions and perhaps even included in auto-enrolment. For those no longer working, a social care levy may be needed, to ensure all will pay something, but there is also the potential of encouraging those already in their later years to allocate some of their Isas as a Care Isa fund. Others could be offered the chance of tax-free pension withdrawals to pay for care earlier or of a different standard than national basic services. And we also need a nation-wide equity release system that enables people to use the value of their home up to a certain maximum limit.