Time for honesty if Boris Johnson really wants to fix social care

Has Boris Johnson delivered his 2019 promise to “fix the crisis in social care once and for all” with Wednesday’s white paper?

The PM had already capped care costs at £86,000, ending most of the “catastrophic” impact on inheritances – albeit still leaving the poorest families vulnerable. He announced a new tax to raise £5.4bn for social care over the next three years. And now the government has sketched out a 10-year vision of more independent, flexible care with a new generation of “extra care” housing schemes and improved technology to help people stay at home. Jotted on a spin doctor’s notepad, that might seem enough to declare victory.

But the frontline looks very different. Alice Ushamba, who runs a home care agency in Portsmouth, this week described how she has only three home-carers on her books when she would normally have 20. An attempt to fly in reinforcements from Zimbabwe has been scotched by Omicron. Councils reckon 1.5m hours of commissioned care couldn’t be delivered between August and October owing to staff shortages.

In North Yorkshire, Mike Padgham, who runs the St Cecilia’s care home in Scarborough, has 20 vacancies and is “giving the statutory minimum [of care] when you want to be giving in excess of that”. Sixteen per cent of social care settings in England are ranked as needing improvement or inadequate by regulators.

The flashing red lights don’t end there: 400,000 people are waiting for care assessments or services and some relatives still face the anguish of being locked out of seeing loved ones in their care homes. If things are tough now, wait for 2040, when there are forecast to be a million more people aged over 85 than in 2018.

Crossing the gulf between the government’s version of a successful policy and the one demanded by the reality above may boil down to one question: does society believe that providing the best care when our loved ones are at their most vulnerable is a priority?

When it comes to medical care in the NHS, the answer has long been yes. Cross the border to social care and the answer, when it comes to funding, has repeatedly been no. This may seem strange given 10 million adults in England are involved in social care as recipients or paid and unpaid carers. Yet of the £12.4bn the new health and social care tax will raise annually, only £1.8bn will go to social care, and most of that to capping costs to protect the value of estates. It is widely estimated that somewhere between £7bn and £10bn a year extra is needed just to maintain current standards of care, which are far from world-beating.

The most urgent need is carer pay, which averages £9.01 an hour and unless addressed will have “a ripple effect across the wider health and care system that risks becoming a tsunami of unmet need”, the Care Quality Commission regulator has warned.

But does the public have the stomach to pay more for staff and better care centres that deliver the independent lives people want?

By focusing on capping care costs, governments have repeatedly framed the social care problem as a matter of personal finances. They may have judged voters correctly. People approve more of the new tax when it is described as helping pass on an inheritance than when it is cast as guaranteeing new money for the NHS and social care, according to research by Engage Britain. Maintaining wealth is understandably more appealing than contemplating the hard reality of a parent’s end of life care needs.

But when people receiving care are suffering as a result of the current crisis, increased resources may be considered non-negotiable. It may be that the only way a government can create the political room to deliver them is to be honest and admit to the public how bad things have got.