Adult social care: prospects for reform?

Natasha Curry, Deputy Director of Policy, Nuffield Trust

If you’ve been following the announcements of the long-promised reform of social care over the last couple of years, you’d be forgiven for thinking you were on a rollercoaster. Promises of change followed by months of inaction, then another promise and repeat. Earlier this summer, it seemed Number 10 was on the brink of finally agreeing a funding solution with the Treasury only for it to be announced mere hours later that reform would be delayed until the Autumn.

But in all the flurry of debate about funding, are we missing the point? The people drawing on social care to live their lives and the carers (both paid and unpaid) working tirelessly to deliver it seem to get lost in the talk of caps and funding.

The Covid period has been profoundly difficult for the care sector. Over 42,000 deaths in care homes have been attributed to Covid-19 and an estimated 900 care staff have succumbed to the virus – these are just some of the measurable impacts. Unpaid carers have been left with little or no support; there have been reports of care packages being reduced with fears of more to come; and an estimated 75,000 people are now waiting for a care assessment or services. If the Covid-19 pandemic has shown us anything, it’s that social care is a vital system but one that has been sorely neglected for many years.

Learning lessons from Covid-19

The Covid-19 period has highlighted just how resilient and innovative social care can be. Amid all the trauma and difficulty, the sector kept on going, delivering essential support to the 1.1 million people who draw on it. Unlike some other services, social care didn’t have the option to go online  or to instruct its staff to work from home. We saw instances of care staff moving in to care homes to protect residents. Care staff, people who draw on social care support and their families demonstrated incredible  tenacity throughout.

But Covid-19 has also laid bare the deepest problems that plagued the sector  long before the first infection. Even before the pandemic, modest estimates suggest there were over 150,000 people over 65 struggling with basic activities of life (washing, dressing, eating etc) receiving no help whatsoever. And there are estimates of many more of all ages getting by with some, but not enough, care or support.

Years of underfunding meant many organisations which provide care were already in financial difficulty at the start of Covid-19 and they struggled to meet the rising costs of PPE and staff sickness. Emergency government support (e.g. free PPE) has helped these providers keep going but there is concern that we will witness widespread closures once this support comes to an end. This would spell huge disruption for people who draw on care services.

At the start of the pandemic, there were over 110,000 job vacancies in social care and around a quarter of staff were on zero hours contracts. Guidance during the first wave of infections expected  care workers  to self-isolate if exposed to infection – for many care workers and their employers, this was unrealistic and impractical. The government’s infection control fund has helped in the short-term but it is clear that a long-term workforce strategy that ensures staff are valued and developed is badly needed.

Prospects for reform

Barely a day goes by when social care doesn’t appear in a newspaper headline. There is now an opportunity to build on this enhanced public awareness and to construct something positive from the devastation of the last 18 months. There is an urgent need to stop the rollercoaster approach to social care policy and instead lay the solid foundations of a sustainable and resilient system fit for the 21st Century. And in all the talk of reform, the goal must always be delivering an effective social care system  which provides the care and support people need to live fulfilling lives with the dignity and respect they deserve.



Edel Harris





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