Mike Padgham, Chair of the Independent Care Group and contributor to the very first issue of Care Talk, looks back at the last 10 years of social care.
At its best, the last 10 years has seen improvements in care, advances in the use of technology to deliver that care and at least some greater recognition of the role the sector plays.
At its worst it has been a time of struggle and pain for care providers. Of some £8bn cut from social care budgets since 2010-11 and 1.4m going without the care they need.
It has been a decade of provider closure and staff shortages – 120,000 vacancies in the care sector on any one day.
Above all, it has been a period of big promises and even bigger disappointments.
Government after government has promised reform of the social care sector but none has delivered, all shying away from a nettle too painful to grasp. To put it in greater context, at least 17 social care funding reform white papers, green papers and official reviews have been published in the past 20 years and we have had 13 social care ministers in those 20 years too.
So, 2010 to 2020 was a decade of struggle. Demand for ever more complex care was rising sharply but with funding struggling to keep pace, that demand could never be met.
It was a miracle that the sector survived. It was only through the sheer hard work of providers, and in particular their staff, that it did. And care continued to be delivered to a very grateful, if slightly dwindling, sector of the community.
Indeed, in its State of Care report for 2019-20, the Care Quality Commission (CQC), reported that care delivered the previous year was ‘mostly of good quality’. Some 80% of adult social care services were reported as ‘Good’ by the CQC and 5% as ‘Outstanding’ as of 1 March 2020.
However, that same CQC had been warning for years about the fragility of the social care sector. And on the ground, we knew that care was on the brink, the perfect storm of rising demand and falling funding pushing more and more providers to the edge and some out of business.
To borrow boxing parlance, by 2020 social care was battered and bruised, on its knees and almost out for the count. What we didn’t need then was the potential knock-out blow of a merciless and virulent pandemic that would tear through health and social care like a whirlwind.
But that is what we have had since the start of 2020.
As Covid-19 hit at the start of the year, social care was in a vulnerable position. Under-funded, short-staffed and with morale at rock bottom.
What it needed was massive government support to cope with a pandemic that was bound to affect the vulnerable people the sector cares for most seriously.
But with the Government focussed on ensuring the NHS was properly supported and did not become overwhelmed, at a crucial moment, care settings were left behind. The Government wrongly believed that Covid-19 would not have a big impact upon care and nursing homes. So they struggled to get access to proper personal protective equipment (PPE), adequate testing and even the right, clear advice. During the panic to protect hospitals, patients were discharged into care and nursing homes without being tested, with the result that Covid-19 got into those vulnerable settings.
Improved testing, better access to PPE and finally the vaccine have had a huge impact in recent months, but the damage had already been done. More than 31,000 people died from Covid-19 in care and nursing homes. And care settings, already in crisis after a tough previous decade, have been left shell-shocked.
The impact of coronavirus is going to take a long time, and a lot of help and support, to recover from.
So what of the next 10 years?
Well, it can’t be any worse than the last 10, can it?
We have to hope that the heroics our sector has performed during Covid-19 puts the spotlight upon it and we get the long-promised reform we desperately need. It is time we put social care at the front of the queue and give the millions of frail and vulnerable people the care they need and deserve, in a civilised country.
We urgently need a root and branch overhaul of the way social care is planned and funded; NHS care and social care to be merged and managed either locally or nationally; extra funding for social care, funded by taxation or National Insurance; dementia treated like other high priority illnesses, like cancer and heart disease and a fixed percentage of GDP to be spent on social care.
One easy step which could have been taken at the Budget but wasn’t, would be for social care businesses to be zero-rated for VAT, saving providers money they could then invest.
These measures, which must come now, before the momentum is lost, would start to restore the sector, begin to rebuild it after Covid-19 and set about creating a sector that does what it is supposed to do: deliver care to older and vulnerable people at a time and place where they need it.
Social care already contributes £46.2bn to the economy and employs 1.5m. With the right support it could contribute even more. Aside from tackling the scandalous number of people who can’t get the care they need, investing in care would also make a valuable contribution to the economic recovery too.
Above all, we would see the amazing staff, who have performed miracles during the pandemic, finally getting the recognition and pay they deserve. Social care is a great profession but it remains the poor relation to NHS healthcare in the way it is regarded. Any reform of the sector must put those wonderful carers on parity with their NHS counterparts and make social care a more attractive profession to work in. It is, after all, highly skilled work and they deserve better pay.
I’ve said it before, but social care needs its Nye Bevan moment, someone to come along and finally grasp the issues and make a name for themselves as the figure who got social care done.
Social care has so much potential. But it must be unlocked. Whether anyone has the key at this moment in time will determine whether social care is set for a fantastic next 10 years or a decade of more of the same.