The statistics are tough, but they’re important to comprehend: over 1.4 million people in England are being denied the care they need, due to a combination of cuts in the care sector, means testing and rationing.
For many others, they receive only basic levels of care, leaving then unable to carry out simple, everyday tasks such as having a wash, or going to the toilet.
Over the last 20 years, 17 green papers, white papers and official reviews of funding for social care have been published, yet none of them have led to any meaningful reform.
The government’s much-anticipated adult social care green paper presented a real hope for reform when it was first announced in March 2017; yet having been delayed more than six times, it’s becoming increasingly hard to remain optimistic.
2.5 years on since the green paper was first mentioned, we’ve taken a look at the topics the paper will cover, the status of the delays, and what we as a sector can do to ease the current issues we face, while waiting for the green paper to be published.
Initially announced in March 2017, once published, the green paper will outline how social care for England’s ageing population will be provided.
The reasoning behind this was so the government could understand the key issues relating to how social care is funded by recipients; and to look at potentially introducing new policies including more generous means-testing, a cap on charges for social care, a Care ISA, tax-free withdrawals from pension pots, and an insurance and contribution model.
Theresa May also stated at the time the green paper was announced, that they would see how social care would integrate with England’s overall health service, workforce, carers, and future technological developments.
Frustratingly, since March 2017, the green paper has been delayed at least six times, which - according to Matt Hancock, the secretary of state for health and social care - is due to “narrow partisan politics”.
Image source: Institute for Government
With the green paper being delayed once again, in September 2019, the government said that it will instead be published in “due course”.
In July 2019, peers from former Labour and Conservative chancellors requested an immediate investment of £8billion, to tackle the issues this delay has brought about.
They outlined that this £8billion investment would relieve unpaid family carers from the pressures they currently face, by providing older people with access to good quality social care services.
They have also requested that £7billion should be invested every single year, to extend an NHS-style free personal care to everyone who needs it.
Lord Forsyth, chair of the cross-party government stated that the government should stop “faffing around”, as “social care should be a public spending priority”.
There was talk from the Financial Times that the government had decided to “ditch” the green paper, and would publish a white paper in autumn 2019 instead, but this has yet to happen.
In September 2019, Labour announced that if they were to be elected, they would introduce free personal care for older people.
However, it’s hard to be optimistic about the social care green paper being released anytime soon, considering how many times it’s been delayed - and the ominous “due course” of its publication.
While we continue to wait for the release of the green paper, we can take a look at the potential initiatives the government could introduce to ease the financial pressures on recipients, and see what we can do as a sector in the meantime, to ease the issues we currently face.
Since the announcement of the green paper in March 2017, the government has released emergency funding totalling £1.04billion. Whilst this has eased some immediate pressures, it won’t fix the long-term underlying issues, specifically:
Recruitment and retention problems
The growing perceptions of an unfair route to being eligible for public-funded social care
From research conducted, we’ve identified three key initiatives that the government could consider introducing, to make access to public-funded social care fairer.
Currently, anyone who has over £23,250 worth of capital (which, for people who own their own homes, will more than likely be the case), has to pay all of their care fees.
To qualify for fully funded care costs, the recipient must have less than £14,250 of capital. But, this isn’t an effective way of seeing who can “afford” care, because this capital will likely come from accommodation - assets that people often leave for loved ones.
By introducing a cap, this would effectively limit the amount that any individual has to pay for care, before they become eligible for public funding.
We know that one of the main flaws in the current policy is that individuals who own their own homes have to use it to pay for their care - meaning all the savings they’ve worked so hard for soon disappear. In fact, that’s one of the reasons why retirement villages are so attractive, due to their investment opportunities.
To combat this, the government could look to increase the amount of money that individuals are allowed to keep, before paying for the care themselves; effectively enabling them to qualify for more public funding.
Japan’s compulsory insurance scheme - LTCI - was implemented in 2000, driven by similar issues that we currently face. The government could consider modelling a system on this, to shift care responsibilities from individuals and families, to society.
The LTCI scheme provides universal care for Japanese residents over the age of 65, and for those with a disability, from the age of 40. Designed to be affordable and sustainable, Japan’s needs-based system provides care for everyone, regardless of income, and covers three main areas:
Care in a user’s home: Including bathing, rehabilitation, and general home visits
Day care: Including a day care service for dementia, and a combination of day care and home help
Care in a facility: Including nursing homes for dependent elderly, homes for residents living with dementia, and other living facilities
The funding is administered at municipality level, through a combination of social insurance contributions, user contributions, and tax payments.
Every single member of the population must pay into the system when they reach the age of 40, with payments equating to approximately 1.5% of an individual’s monthly income. In return, everyone receives the same level of care when they need it - and is perhaps something the government should consider introducing in England, through the adult social care green paper.
Alternatively, the government could look at the system Scotland introduced in 2002, which enables everyone over the age of 65 to have access to free personal care when needed. This means that basic tasks in the home can be carried out, such as preparing meals, dressing and bathing.
This system has already shown successes - despite the double in numbers of people receiving care, taxpayers’ money has been saved, due to a reduction in hospital admissions. Fewer people are also entering care homes, as they are able to live independently for longer in their own homes.
The continuous delays of the green paper on social care funding is frustrating, but it’s important that we don’t get down about it.
As a sector, we can start tackling the issues we currently face, and look forward to the future and the exciting breakthroughs that await us.
Statistics from Skills for Care showed that as a sector, we currently need an additional 130,000 workers every year - and this figure is set to rise to 650,000 by 2035. Brexit is exacerbating his issue, with 104,000 of the 1.47 million people working in adult social care EU nationals.
We’ve uncovered the initiatives we can start actioning to resolve the recruitment and retention crisis here, which you can read in more detail. However, as an overview, these include promoting a career in the care sector to students, highlighting career development opportunities internally, and speaking with staff to identify other underlying opportunities that can be solved.
850,000 people are currently living with dementia in the UK, but by 2051, this figure will rise to more than two million.
Rather than waiting around for the government’s green paper on social care to be released, we must instead focus our efforts on ensuring our care homes provide a safe haven for dementia residents, where they feel comfortable, while living as independently as possible.
From investing in memory aids and provisions, to changing the way employees communicate, there are lots of things we can do to help improve wellbeing in dementia residents. For more inspiration, take a look at De Hogeweyk, a model of the ideal dementia village.
Research has shown us the opportunities that technology can bring to the care sector. Some care homes have already implemented current technology, such as patient monitoring equipment and smart home devices.
However, to reap the full benefits, we need to get past the fears and stigma attached to future technology - specifically robots. For example, rather than “replacing” staff, robots can relieve employees of administrative tasks, to enable them to provide more compassionate care.
The benefits are clear, but none of us will feel the effects until we stop being scared of technology.
Until the social care green paper is passed, it's recipients of long-term care who have to pay the costs themselves that will bear the burden.
However, we mustn’t pin all of our hopes on this green paper, because once released, it will merely set out options for reform, without actually implementing anything.
What we need to consider as a sector, is what we can do in the meantime to help resolve the issues we currently face, to ensure recipients are receiving excellent quality care, and employees enjoy working in the sector.