Melanie Weatherley MBE, Co-Chair of the Care Association Alliance, explores why financial inequality in adult social care provision must be addressed.
Adult social care is an essential service designed to support individuals who are living with physical and mental challenges due to age or disability. helping them maintain a quality of life. Although social care is seen as part of the wider health and social care system, it is delivered and funded in a very different way to the NHS. Concerns have arisen about whether access to high-quality care, or even any care at all, is disproportionately dependent on personal wealth. Does our adult social care system perpetuate inequality, and if so, how can this be addressed?
The Role of Wealth in Accessing Care
In the UK, while the NHS provides healthcare free at the point of need, adult social care is means tested and commissioned locally. The commissioning has to happen within a financial envelope which varies massively across the country, but in every geography it is insufficient to meet the demands. This means that people with savings often find it easier to access care, as they only have to consider their own ability to pay and do not have to consider their needs in relation to others.
Being wealthy does not provide access to better quality care; care providers in England are regulated by CQC and work very hard to provide the best quality care within financial constraints. However, having personal wealth may buy you a better environment or lifestyle in residential services and more choice within home care.
While publicly funded home care is often very good quality, it is designed to meet needs and nothing else. Those who can afford to pay for their own care may choose a level of companionship and support which makes their lives much better, and this level of care would not necessarily be available with a local authority funded package.
This extra support often leads to better health outcomes and enables individuals to feel more productive.
In residential services, the local authority may only be able to afford a basic home, which may be very different from what the resident would really like.
How Inequality is Widened
Inequality in access to adult social care doesn’t just impact individuals; it can have broader social implications too. The divide between those who can easily access care and those who cannot contributes to wider inequality. When people with limited resources cannot access the care they need, they are more likely to experience deteriorating health, which can lead to long-term disabilities, hospital admissions, and even premature death. This compounds existing health inequalities, particularly in marginalised communities where access to both social care and healthcare is already strained.
The big issue is that there is insufficient funding for social care:
- The threshold for publicly funded support is too low, which means that most people contribute financially towards their care or pay for it in full. And if you’re paying for your own care, you can very quickly spend your life savings.
- Where individuals are totally funded by the state, the amount of funding available for each person is not enough to cover the full cost of care – as clearly demonstrated by the Fair Cost of Care exercise undertaken by the previous government. Recent changes to National Insurance Contributions make the gap between needs and costs even more difficult to manage.
- In residential care it has become the norm that self-funders subsidise the delivery of state funded care.
The Government’s Role: Challenges and Solutions
We must address our system’s reliance on personal wealth to access care in a timely way. The recent debate around adult social care reform has been a step towards recognising these issues, but the political will to radically overhaul the system remains uncertain, and the timescales are too long.
The Casey Commission will be looking at the wider question of funding, and whether the cost should be met from the state, by families or through some other mechanism; but we cannot wait for three to ten years to start to reduce inequalities.
Increasing investment in social care is vital to ensure that the system is not only accessible but also of high quality. Improved pay and training for care workers, as well as better working conditions, would help reduce turnover and improve the quality of services offered.
The government should also consider innovative solutions such as expanding the role of technology in care. Remote monitoring, AI-driven health assessments, and digital health tools can all enhance service delivery and reduce the strain on human resources, making care more accessible to a broader range of people.
To ensure a fairer and more just system, the government must focus on policies that provide equitable access to care, invest in the care workforce, and explore innovative solutions to improve service delivery. The question is not whether adult social care should be reformed but how to do so in a way that addresses these glaring inequalities and ensures that no-one is left behind
