Reactions across care industry to Boris Johnson’s proposed tax hikes to fund social care

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Boris Johnson earlier today at Excelcare's Westport Care Home

Mark Adams, CEO of Community Integrated Care, one of the UK’s biggest and most successful social care charities, comments on the Government’s social care proposals:

“Despite the rhetoric, we are no closer to fixing the generational crisis that is engulfing social care.

Whilst reducing the cost of care for older people is vital, they represent only part of the community that social care serves. The government has focussed on the recognisable, understood and politically positive aspects of the social care crisis, and failed to recognise the millions of family carers, disabled people and social care workers who have been left behind. This solution doesn’t ‘fix social care’ but instead tidies the tip of the iceberg.

Every citizen has a stake in supporting a thriving and sustainable social care sector, but through choosing National Insurance as the method to raise investment, the debate around social care funding has become divisive and misunderstood.  Ironically, the focus on NI will likely compound the problems faced by both social care providers and their colleagues, who desperately deserve fairer pay, as we both now face increased National Insurance costs.

We are facing a systemic crisis. The sector loses 34% of its workforce every year. Frontline care workers are frequently paid £7000 less than their counterparts in other public funded sectors. Half a million people have left employment in the past two years to become family carers. Hundreds of thousands of people miss out on vital support every year. Put simply, social care sector needs bold leadership and vision from government and we implore the Prime Minister to deliver further progressive reform.

The government cannot represent to the public that this presents a fix. It needs to urgently work with the sector and people who access social care to truly build back better. This means fair pay, fair access, fair funding, and a genuine focus on driving innovation and quality, to ensure that every person can lead a good life.”

Tim Cooper, Chief Executive of disability charity United Response, said:

“Government has today (7 September) taken a positive first step towards social care reform. Whilst long overdue, this is a welcome commitment to tackling a broken, overworked and underpaid sector – on which the lives of millions depend.

“Increasing taxes to invest in the NHS and social care is a courageous step which will provide vital funds to sustain and boost the core health and care services for the nation.

“But raising National Insurance is neither a logical nor fair means of taxation for social care. It puts the burden on low-paid workers and on employers, reducing the take-home pay of already underpaid social care staff and increasing the costs for employers.

“A fairer and more effective funding solution would be to raise income tax instead, ensuring that contributions are relative to earnings. The social care sector itself is home to a high proportion of low-paid staff – hardworking heroes who we rely on to maintain a broken system. This group should not be asked to fund these long-overdue changes.

“We eagerly await the outcome of the Commons vote on these proposals and look forward to specific detail of how this plan will positively transform a beleaguered sector.

“In particular, Government must urgently address raising the status and pay of social care staff. It must also commit to funding to ensure that frontline social care workers are properly paid for the job that they do.

“Rather than reduce their take home pay by raising National Insurance, Government should legislate to ensure that social care workers receive at least the Real Living Wage.”

Anne-Marie Perry, Founder of CareMatch, commented on the proposed social care tax:

“In care, the biggest issue is morale, not money. The government recognises that the UK care sector isn’t working as well as it should be. Although extra funding is welcome this alone will not address the most important issues the industry faces. Money can’t fix the chronic shortage of carers or the low morale of a workforce in the frontline of the pandemic.

“To tackle the lack of carers and put the care sector on a sustainable footing, we need to reshape the industry to make it an attractive career. In light of the UK’s ageing demographics, its vital that we invest now in more tools, resources and systems to do this and to support carers and those they care for. We need solutions that provide more flexibility and prioritise the welfare of everyone in the industry.

“We also need to take a more collaborative and integrated approach to care – which includes government, local government, the NHS, providers and carers – if we are to make any real changes. The pandemic has reminded us of the power of community and any long-term solution to the UK’s care crisis must harness this power. To revitalise the care sector will require a more ambitious move towards a more community-focused model, rather than a modest increase in funding.”

Helen Walker, Chief Executive of Carers UK, said:

“After so many years of delay and successive governments stepping round the issue we are pleased the Prime Minister has set out his proposals for funding social care today.

On the funding proposals

“Elements of the Government’s plans will, in the longer run, help put some of our crumbling system on a more stable footing. The £86,000 cap on care costs – while far too high for many families – will take the sting out for some older and disabled people with particularly high care costs. Raising the lower capital limit to £20,000 will mean many harder-pressed families do not have to shoulder the cost of care, but they will not benefit from this until 2023. Raising the £23,500 capital threshold to £100,000 will ensure many more families get some help towards the cost of care.

Short term funding injection for social care needed now

“We understand the NHS needs money to tackle waiting lists and this will help family members looking after relatives with worsening health conditions. However, we are deeply concerned about how social care is going to be funded right now in 2021. We desperately need to see funding go to services for families who are struggling to cope so they can get the support they need over the next two years – especially unpaid carers, who are being pushed beyond the brink.

Unpaid carers must be at the heart of reform

“For years carers have been propping up a chronically underfunded care system at a huge cost to their own personal health, finances and ability to stay in work. Throughout the pandemic they carried a huge load, with 81% taking on more care for relatives and 72% unable to take any breaks whatsoever from their caring role. They desperately need support to regain quality of life and enable them to continue caring. The Government must recognise the toll being placed on unpaid carers and deliver an immediate injection of funding for support services to prevent carer breakdown in the short term.

“We look forward to engaging with the Government on the promised White Paper that will look at the information, advice and respite needed by carers. This must come with significant investment in carers’ breaks which are desperately needed.

“Too often, there is a financial penalty for choosing to care for a loved one. This needs to be addressed through a rise in carer’s benefits, particularly Carer’s Allowance, and Government must implement their manifesto pledge to introduce Carer’s Leave within the workplace.”

Carers must be included in hospital discharge process

“The £500 million promised by Government for hospital discharge from the end of September is welcome but it must work to ensure that carers are systematically involved, included and supported throughout the process.”

The National Care Forum responded:

Today’s announcement, for all the interest they will garner, do nothing to address the immediate crisis impacting on social care, especially enormous workforce challenges facing the sector. In a recent survey, NCF members provided detailed data outlining what is happening on the ground; colleagues are reporting high levels of vacancies, permanent staff exits at previously unseen levels with most leaving to join health services, retail and hospitality.

Jordan Glackin, healthcare partner at law firm, Shakespeare Martineau said: 

“Given our ageing population, we have expected for some time that the Government would either increase taxes or introduce a new form of tax to assist with the growing demand for and cost of social care. Both the NHS and private social care providers face immense pressure and are in dire need of further financial support.

“Increasing National Insurance Contributions (NICs) could be an essential move to protect the future of our healthcare system, however, far more still needs to be done. Further clarification is still required around how this will specifically assist and support social care providers and the wider sector. 

“With initial funds set to support the NHS, the social care sector is likely to continue battling with staff and resource shortages. There’s no way of predicting what could happen in the future and where the demand for the funds will lie, so the Government must implement a system that identifies pressure points and continues to monitor them.

“Clarification around who exactly will benefit from the funds is also needed. Will the increase in taxes be used to subsidise care needed for individuals? Will the eligibility criteria for those that are entitled to subsidised care be changed? Or are the additional funds from increased taxes being used to tackle the ongoing staff shortages? The Government must provide a clear outline of how the additional funds from the increase in taxes will be used to support the social care sector.

“One thing is for sure; the health and social care sector is in desperate need of financial support. Although more clarification is needed around what will take priority, the reforms do have the potential solve some of the problems currently facing the sector.”

Jon Wilks, CEO at the IHSCM says: 

“The Prime Minister’s announcement today is focused on the NHS, with much less focus on social care. Additional funding for the NHS is essential given the post-pandemic environment of increased wait lists and, certainly, the performance of the NHS during the pandemic is rightly a source of considerable national pride. So also should be the considerable efforts of the social care workforce and management during the same time.

Our members are frustrated by the statement. Additional funding, support and reform is needed urgently and any delay to this, let alone 3 years, will leave the sector in crisis and unable to meet care needs for people who draw on social care.

A White Paper on reform of social care has been promised for several years now, so the Government’s undertaking for the sector to expect the Health and Social Care Secretary to bring one forward later this year is to be welcomed. Meanwhile, a social care winter plan is still awaited. Our members have written to the government and to the Care Quality Commission to express their view that the situation in social care is currently unsafe. The majority of care providers are unable to accept new care packages and many are having to hand back existing ones. Many care homes are closed to new admissions and it is a fact that people are not being discharged from hospitals across the country as a result. It is impossible to expect the NHS to clear their backlogs without a strong and stable social care sector.

The IHSCM, based on figures from Skills for Care and anecdotal evidence from members, believes that current vacancies in social care are at least 100,000 out of a total workforce of around 1.6 million. This is before the effects of staff who are unvaccinated being obliged to be released from their jobs. The Prime Minister’s statement said little about workforce, particularly the prevailing situation whereby 52% of staff have no formal social care qualification, there is no formal workforce plan and median pay is well below the living wage. Without fundamental workforce reform, led by structural reform of social care delivery, this situation will prevail and will fatally undermine any effort by the NHS and social care to address waiting lists and boost delivery of social care to vulnerable people.

It is noted that several government ministers have talked about the new funding measures based on National Insurance increase being a fix for social care. It is the view of the IHSCM and its members that, until structural and workforce reform are part of a properly tailored strategy for social care, such talk is misguided.”

And in Wales;

A social care leader is warning that a number of care homes in Wales will close unless an extra £250 million in funding is used to fix the “broken” system and tackle low pay in the sector.

Mr Mario Kreft MBE, the chair of Care Forum Wales, was speaking after the announcement by Prime Minister Boris Johnson that he is raising national insurance by 1.25 per cent to end the “catastrophic costs” of social care.

The hike will also help fund a major drive in England to clear the massive backlog in operations and treatment caused by Covid-19.

As national insurance is a UK-wide tax, it’s estimated that Wales will receive between £250 million and £300 million in additional funding.

It will be up to the Welsh Government how they spend it.

According to Mr Kreft, it is a “once-in-a-generation” opportunity to fix the “broken” social care system in Wales.

First Minister Mark Drakeford had admitted before the pandemic that the sector was fragile and the finances had become even more precarious since the pandemic struck.

Among the main threats to care homes and domiciliary care companies were decades of chronic underfunding and a dire shortage of staff.

Pay levels were dictated by the formulas used by local authorities and health boards to calculate the fees they paid to social care providers.

Mr Kreft said: “Coming up with a way to properly fund social care has been the challenge of our age.

“The quest for an effective and integrated health and social care system has been going on for 30 years.

“What we have now is an opportunity to sort out social care which is incredibly important for so many reasons, including the fact that it underpins the NHS.

“Obviously, there will be additional money coming to Wales, presumably through the Barnett formula, but there is no reason for us to do the things that we  have always done.

“What we’ve seen in the pandemic is the Welsh Government taking a leadership role and looking at a much more centralised approach.

“As a result the funding and the support for social care during the pandemic has decided more centrally rather than through the 22 local authorities. That is a very good example of how we could do things more effectively in future.

“At the moment, the sector is blighted by a postcode lottery of different fees paid by different councils and health boards. What we need is a level playing field with a national approach which is what the Welsh Government achieved with their Covid support for social care.

“Fundamentally, we have an issue with the recruitment and retention of social care staff and this is something that needs to be addressed as a matter of urgency.

“As well has hanging on to our existing workforce, we need to be able to attract a new generation of social care workers.

“We have to change perceptions so that it is rightly seen as a profession to be proud of.

“It wasn’t that many months ago that we were clapping our social care workers.

“Today they are leaving the sector in droves so we have got to do something to stem that tide.

“In relation to funding, we need to look at social care as a value to society not a cost. It is something that enhances communities across Wales and provides succour and support for the most vulnerable people in our society.

“Social care is also a fundamental part of the foundation economy here in Wales so we can be clever about this and ensure we have a system that works well for our communities and can at the same time help the NHS function.

“We’re seeing real issues in our hospitals with people being unable to be discharged back to their own homes.

“One of the major problems is that we do not have the capacity in terms of the numbers of social care workers that we  need.

“I welcome this funding because we have had 30 years of shirking this very important issue – now is the time to settle down and get the job done.

“The problems with pay in the sector in Wales are caused by those who commission social care, the local authorities and the health boards.

“The responsibility rests squarely with them because each of the commissioned places is given a number of allotted hours.

“In North Wales, for example, the toolkit they use assumes half the hours are paid at the legal minimum wages.

and half of those hours are paid at the National Living Wage.

“The system is broken and it needs to change. Care Forum Wales will be trying to make this work with an effective, integrated health and social care system.

“Last year Care Forum Wales launched our 2020 campaign to ensure that people working in social care were paid at least £20,000 a year. This is a golden opportunity to make sure this happens.

“We need to ensure that working in social care is a profession to be proud of and to do that we need to be able to pay staff what they deserve and the providers are able to be viable.

“I that doesn’t happen the sector will come crashing down like a house of cards and providers across Wales will be forced to close their doors.”

Responding to today’s announcement on the NHS and adult social care, Anita Charlesworth, Health Foundation Director of Research and the REAL Centre, said:

‘The introduction of a cap on social care costs is, at long last, a positive and bold step forward. It will provide people with greater certainty about the future costs they need to plan for and help reduce the care cost lottery. But the funding announced today falls well short of what is needed to stabilise the current system and deliver the comprehensive reform that is so desperately needed. The proposals are less generous than those legislated for in the 2014 Care Act.

‘With the cap set at £86k, most people will be protected from catastrophic care costs,* but those with modest assets and high care needs will still risk losing a high proportion of their wealth in future. For example, an individual whose house is valued at £125k still risks losing almost half of their housing wealth whereas a cap set at £50k would have enabled them to retain two thirds. By comparison, a person with a house valued at £500k risks losing less than a fifth of their housing wealth. 

‘And a cap alone will not be enough to deliver the prime minister’s promise to “fix social care once and for all”. Today’s announcement does little to help the third of care users aged under 65 who rely on the quality of the publicly funded system. The government has parked decisions on wider funding and reform – much now rests on the forthcoming autumn spending review. In addition to the cost of the cap, further funding increases, rising to an extra £9.3bn in 2024/25**, will be needed to support the growing number of people going without the care they need, raise care quality, stabilise the provider market and improve the pay and conditions of those working in the sector. Without this, social care will continue to fail people who need it.

‘The government has announced significant new funding for the NHS, including £10bn specifically to tackle the elective care backlog. While this is a huge amount, the scale of the care backlog means that even with this funding, the waiting list will almost certainly be longer at the end of this parliament than it is now. To meet the 18-week standard by 2024/25 would have required closer to £17bn over this parliament. But money is far from the only challenge. The extra staff, beds and equipment needed to treat so many more patients in the coming years are likely to be the biggest hurdles to recovery. Given the lead times for training staff, targeted investment in the workforce is needed now. Otherwise, waiting lists are likely to remain very high for many years to come.

‘Overall, the funding announced for the NHS is not sufficient for an ambitious recovery programme. If COVID-19 continues to require enhanced infection control beyond this year, there is a real risk that the NHS will be forced to make very hard trade-offs between tackling the elective care backlog and delivering on the planned investment to improve primary, community and mental health services, while delivering services that are safe for patients and staff.’

Professor Martin Green OBE, Chief Executive of Care England, says:

“We have been waiting for a very long time for any concrete plans on the long term sustainability of adult social care reform and as such we welcome the Prime Minister’s announcement today.  We want to go through the plans carefully and it is our hope that social care will be rewarded and recognised rather than playing second fiddle to the NHS.  It is essential that money reaches the frontline.”

Speaking in the House of Commons this afternoon the Prime Minister outlined Build Back Better, Our Plans for Health and Social Care. 

Martin Green continues: 

“The sector needs help now especially after the many challenges that became even more acute during the pandemic.  We hope these plans will comprehensively address the issues across the whole adult social care sector, including younger adults with learning disabilities and autismRecruitment and retention of workforce, our best resource, is the most urgent issue at present and it is vital that any long term plans can be brought into play alongside immediate measures. Care workers are everyday heroes and have highlighted their value throughout the pandemic and need to be rewarded and recognised appropriately”.

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Boris Johnson earlier today at Excelcare’s Westport Care Home

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