Social care has hardly been out of the news these past few months as the cumulative effect of chronic underfunding finally cut through to the public and the media. The council tax precept and £2bn over three years for social care announced in Philip Hammond’s budget should offer some relief and help stabilise the sector.
But both the prime minister and the chancellor have acknowledged the need for a long-term solution to the social care crisis. The demographics are clear: we are living longer and while many of us will maintain our independence well into later life, if over-85s remain the fastest growing section of the population then the number of people needing 24/7 care will continue to increase.
So what should the green paper promised by Theresa May to address these issues cover?
Of course it needs to address funding, namely the question of how to raise the extra money required to meet those demographic pressures and tackle the rise of multimorbidity. The green paper must spell out the choices and balance to be struck between our collective and personal responsibilities to meet the costs of care. This is not necessarily about reviving Dilnot’s care cap – although there is a case for that – but about thinking through what combination of taxation, personal resources and financial products is required to raise the extra money the sector needs.
New money is just the start. We also need to tackle unfair local variations in care provision and make the best possible use of the £14bn or so spent annually on social care. The local government productivity programme I funded as a minister unearthed many opportunities here. These lessons need to be learned so we can implement a better, fairer, nationally mandated and locally delivered programme.
The green paper must signal a transformation in care. Social care, and the NHS for that matter, needs to be more data driven. Only by taking a population health approach and making better use of technology can we begin to move towards more predictive, anticipatory care models that reduce the demand for costly crisis care.
The green paper should therefore also signal a technology-enabled care revolution. Rather than seeing this as a bolt-on to existing care processes, it should instead be part of a complete redesign of services and of the training and professional development of staff. This is not about selling particular bits of kit but about looking for ways to promote personalised, technology-enabled living. If advances in technology can be properly linked up with other areas of social care, it can deliver better outcomes and savings.
Social care needs to be more skilled at equipping and helping families to tap into their own support networks and be more self-reliant and resilient. That means recognising the incredible work of informal carers and investing in support for them. Great care is seldom just something done to you; it is the result of collaboration and training. The green paper must map out the evidence and actions needed to promote this.
One particular area ripe for action is housing. The market for later life housing has huge potential. Over-65s today have assets worth more than £850bn. The green paper needs to stimulate the private sector to increase the supply of later life housing. While new supply is essential it will not be sufficient on its own. Investing in and incentivising adaptations to existing homes to make them fit for later life must be on the agenda too.
Finally, there is the social care workforce. According to a study by Independent Age, published before the EU referendum, the care sector will face a workforce shortage of around 200,000 by 2020. The green paper must set out measures to tackle this, by promoting care work as a career, but also by suggesting ways to make better and more coordinated use of the whole healthcare workforce, across both social care and the NHS.
May has said she recognises the need for a long-term solution to care. The power of that statement should not be underestimated, but in a government unable to think about anything other than Brexit, she needs to make it a reality.
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