Yesterday's announcements of the plan to implement a cap on care costs and introduce a health and social care levy are a welcome small start towards social care reform. We all have to accept the need to contribute to providing high-quality social care for those that need it. However, behind the headlines, there is still no clear longer-term plan on the biggest challenges. The plan published yesterday "Build Back Better - Our plan for Health and Social Care" promises a white paper for reforming adult social care "later this year". The sector has had that promise broken many times before. There are some positive messages in "Build Back Better" but two critical interconnected areas I consider the Government has not committed to dealing with are workforce costs and sustainable rates for state-funded support. The white paper must be more specific about how these will be addressed.
Build Back Better states that "a qualified and skilled workforce that is rewarded and feels valued is essential for high-quality care". This is absolutely right but the plan doesn't go onto make any reference to care worker pay. It states: "offering a career where people can develop new skills and take on new challenges as they become more experienced. This will include developing a plan to support professional development and the long-term wellbeing of the workforce". These are positive words and professional recognition for the social care workforce is long overdue. However, the lack of any reference to care worker pay is very concerning. Getting realistic pay rates to reflect the skills and experience of the social care workforce is critical to making working in social care a "rewarding vocation". In the NHS, there is a clear pay structure which gives NHS staff much more favourable terms and conditions to their counterparts working in social care.
This disparity isn't because of allegedly greedy care providers underpaying staff and creaming off profits, it is because state-funded care does not meet providers actual costs of providing care even where staff are paid at or close to the national minimum wage rates. What the sector needs is a clear pay structure with minimum rates for specific roles and funding which supports that. With the number of vacancies in the sector rising rapidly, the need to address this quickly is critical.
Sustainable rates for state-funded support
A new sustainable pay structure for social care staff can only be delivered by the sector if state-funded support is commissioned on the basis that those staffing costs will be met. Behind the headline of the new Health and Social Care levy, it is apparent that less than 10% is new money for social care over the next three years. This won't change the current position of social care being second class to the NHS. The cost of delivering sustainable social care needs to be calculated and the levy should then be split out so there is transparency about what is actually going into social care.
The white paper must introduce a minimum rate that must be paid by local authorities for different types of care and support that factor in delivering a new sustainable pay structure for the social care workforce. The duties on creating a sustainable market in the Care Act are largely ignored by local authorities by necessity and have been proved to be too "light touch" to deliver what is needed. The current workforce crisis makes that clear.
If the White Paper is prepared to tackle these two issues the desire to "Build Back Better" may be realised.
The newly announced financial plans keep social care firmly in the shadows. Of the £36bn raised, only £5.4bn is for social care. Of that £5.4bn, £2.5bn funds the new £86,000 lifetime cap on individuals’ contributions to their care costs, leaving just £2.9bn over three years for reform.