Taking National Care Local: An Interview with The Health Foundation on the Government’s New Budget

What is the Health Foundation’s position on social care funding at present?

Since 2010/11 there’s been a big reduction in local authority budgets – after taking into account that the population is ageing, this has reduced by about 12 percent per head. That means that lots of people with care needs aren’t getting local authority care anymore, putting a burden on family and friends, and often they have to find money out of their own pockets to pay for care.

Basically, these reductions are increasing the unmet need in the population. Compared to the NHS, where funding has been relatively protected, social care has been the poor relation and we are advocating greater spending in this area.

Social care and the NHS can’t be thought of in isolation any more – when you look at some of the problems in hospitals with A&E waiting times, you might think that isn’t connected to social care – but a lot of that is about people having to stay in hospital unnecessarily because the social care support packages aren’t in place to allow them to return home.

Where should social care funding come from?

The Government can obviously raise money in different ways; general taxation, redirecting spend, taxing wealth or even having a hypothecated, or dedicated, tax like National Insurance – and I do think it does need to come from one of those routes.

It is always difficult though for governments to raise money through increasing taxes – and clearly, there needs to be leadership. I don’t think it’s impossible by any means though to fund the care system properly. Other countries manage it, although I don’t think you can just lift and shift one country’s models and copy them as there are a lot of differences.

Germany, for example, funds social care through social insurance whereby people pay through their working life, similar to our national insurance. That would be a difficult model for us because even if we set up a social insurance fund it would be many years before we’d built up sufficient funds to pay for the current generation of older people.

I don’t think private insurance is a feasible solution in this area at all. It hasn’t worked in any country, including the US, and no country relies on it other than at the margins.

What do you hope to see in the upcoming budget for social care – and what are you expecting?

I think the greatest opportunity in the budget is around signalling longer-term solutions, particularly financing in the spending review, because the gaps are so big. That cannot be fixed in one budget – even if you threw billions of pounds at local authorities, they wouldn’t suddenly be able to recruit all the staff needed. However, it would be wonderful if the Government signals something around funding reform progress – and providing more funds for local authorities to be able to shore up the current system would also be welcome.

How would you describe Boris Johnson’s Government approach to social care and have recent political events that have helped or hindered your work?

We were encouraged that the Government highlighted social care as one of its top priorities. Fixing social care and sorting out the way in which it is funded was one of the first things this Government talked about, and it shows a willingness to want to deal with this. With a large majority, the Government isn’t hindered by things that one with a smaller majority might be, so, I’m quietly optimistic. I think there’s a real opportunity here, and any government that does sort this out and creates a fairer system will get credit.

How will Brexit impact the care workforce in the short- and long-term?

The social care sector relies to a large extent on people from outside the UK – around eight percent of the workforce was from the EU, and 10 percent is from other countries, and those figures are higher in London. If you restrict immigration that’s going to create real difficulties, compounding the fact that vacancies (in England) are already in the region of 122,000 and turnover rates in the sector are also high.

The salary threshold of the recently announced immigration policy is a major issue – 30 percent of people employed in social care are paid at the national living wage and there are few people in this area earning more than that. This creates problems around providing social care – and for older people themselves, as it may mean that they can’t get the care that they need as there just aren’t the workers there. The care sector workforce in general is extremely poorly paid and not one that seems very valued. This leads to big problems with recruitment and retention of staff.