The future of social care remains precarious

This article was first published in The MJ

Around the world our National Health Service is seen as an exemplar of how society can invest in the health of its citizens and is something that we all feel belongs to us. The same cannot be said for social care. This is not to detract from the many wonderful people who do an amazing job in the care sector. But, whilst individual interactions are often highly valued, this experience is not consistent. The fragmented nature of care makes it difficult to provide a high-quality experience across the sector, but this is what is urgently needed.

There are key points in history where events have collided to create a tipping point where real and lasting change can be realised. The pandemic has given us that possibility in social care and now is the time to be bold. Sadly, whilst the long awaited Adult Social Care Reform White Paper has some good proposals in it, it is not bold.

The strongest parts of the White Paper include the recognition of housing as an important factor in helping people maintain their independence. Equally, the focus on the enabling potential of technology and the widespread digitisation across social care is welcome. The £500m earmarked for supporting the care workforce and giving them proper skills training and routes to career progression is another positive step.

Elsewhere, the aspirations have a bit of a familiar feel to them. Previous White Papers have also talked about being person centred and the need to promote independence. There has long been an ambition to move away from residential care and focus more on early intervention and prevention. Much of what is proposed has its underpinnings in the Care Act 2014. The problem, as the White Paper recognised, is that 'the full spirit of the Care Act has not always been realised'.

If we are to drive true reform, we need to fully understand why we have this implementation gap and work out how to deal with this. For example, whilst developing better commissioning and market making skills will no doubt be welcomed, most local authorities would point to the yawning funding gap as the key reason they do not pay more to care providers. Similarly, care sector employers will no doubt celebrate the investment in the workforce but will note that the biggest challenge in recruitment and retention is pay. This is completely ignored by the white paper and means that the aspiration for social care to have parity with the NHS rings distinctly hollow.

Elsewhere throughout the paper, there are announcements of a whole range of different pots of money. There is £30m for innovation, £25m to informal carers and £5m to test new ways of providing information, but this is not a particularly effective way of funding large scale reform. Across 150 local authorities this is not going to go far. Even the £500m allocated to the workforce only amounts to just over £100 per head, per year, when you do the maths.

Another concern is the hint of a move towards compliance rather than collaboration in elements of the white paper. This can be seen in the introduction of a duty for CQC to independently review and assess local authorities' performance and the new legal powers being given to the Secretary of State for Health and Social Care to intervene where there are significant failings by local authorities to discharge their duties.

We can only wait and see if the CQC is able to align its inspection process with the vision outlined in the White Paper. If the purpose of public services is to support communities to achieve their potential then it makes sense that the inspection and regulation bodies are also aligned with this purpose, adapting their ways of working to ensure this is being achieved. Inevitably as the way we capture information on performance changes and the way we measure impact evolves, the inspection process will need to change accordingly. Assessing performance on an outdated model of care will not deliver the improvements required. We will simply know whether a failing system is failing well.

It would also be disingenuous to highlight shortcomings in local authorities' ability to enact the Care Act whilst failing to address the immense chasm between demand and funding, particularly given the latter has reduced by 55% since 2010/11.

Overall, there are some good, but not radical, points in this White Paper. The main challenge though is that there are some pressing issues that are severely destabilising the sector right now, namely the funding gap to meet current demand for services and the pay issue across the sector. The White Paper misses the opportunity to resolve these and means, despite some good intentions, the future of social care remains in a precarious state.