Social Care: It’s Not All About the Money

Social care has reared it’s head again on the national stage and some money has been proposed starting in 2023 with the new Health and Care Bill which just had its first reading.

Firstly, what IS social care? Well, it can be anything. Some people call it tasks of daily living and, while somewhat banal, it is also extremely important. Let’s face it, the engineers and retailers have made life easy for us. We now have prepared meals to go into the oven, washing machines, dishwashers, and some of us even have robotic vacuum cleaners.

Who is eligible? Anybody who has a disability which prevents them from getting washed and dressed, shopping, putting a meal in and out of the oven, washing their clothes, linens and towels, managing their money or socializing. This could be a long-term condition, such as MS or dementia, or a short-term condition, such as a broken arm.

The Money Currently, people with savings of under £23,500 are eligible for support from the local authority. They may either take this in the form of a direct payment or the council can organise social care on their behalf.

The Dilnot proposal recommended capping the cost of social care for people with disabilities to £35,000 over their lifetime. This is essentially a wealth preservation proposal so that people going into care homes do not need to sell their houses to do so. The amount of the cap proposed last week with the first reading of the Health & Care Bill was £86,000 although, in reality, many people will not be able to come up with the amount to stay in a care home without selling their property as they are still obligated to pay “hotel costs* such as accommodation, food, etc. The government has seen fit to fund the new proposal with National Insurance contributions with a similar hike to dividends to prevent self employed people from avoiding the tax. This despite both the Liberal Democrats and Labour favouring a more equitable income tax increase.

Capacity Capacity is also a real issue and one that needs to be addressed. This is about getting people to do the care. In order to be a care worker, you need to be literate and numerate, have a clean enhanced DBS, a car for home care, and have passed the care certificate and signed up to the social care code of conduct. You must also be willing to support people and respect their dignity. It’s a difficult and challenging job. It can involve working with people who don’t recognise their need for support, driving down country lanes in the dark and cleaning up messes of all sorts. It involves an amount of responsibility. It can also be rewarding and fulfilling but not a job that everyone is willing to undertake.

Councils have reduced their obligations to critical and essential social care during the government’s austerity measures. This can be pretty grim for those who need it and, depending on their needs’ assessment, can be limited to the essentials of eating, drinking and personal care for those with limited funds or who cannot find a service which has capacity. This sometimes involves a care worker coming in to give a person a wash, change their pad and clothes and give them something to eat a couple of times a day. It is, in effect, no longer social care but a scaled back nursing service.

In order to address these issues, the government will need to look at home care and care home facilities, the training offered, how the workforce is supported and whether the system truly meets the needs of residents. I see nothing in the new Health and Care Bill which will change that. While there is now a narrative around older people not being seen after lockdown the truth is that most of the service provision for older people has been cancelled and very few programmes have started again. It is, therefore, no wonder that older people are less able to go out.
We can spend billions of pounds treating people’s health concerns but, unless they are fully engaged with life, we are just putting money into an ever-increasing black hole. Let’s hope that the government finds some way to putting some of money back into service provision and addressing the shortage of care workers both in the short and long term. Unfortunately, I believe that the new bill is too little, too late.

* Gillian Douglass is a member of Tunbridge Wells Liberal Democrats

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7 Comments

  • John Marriott 13th Sep '21 - 12:29pm

    Having spent many years when a County Councillor struggling with the provision of Adult Social Care I witnessed the gradual dismantling of council run facilities and the rise of largely profit based facilities provided by the private sector. Things like personal budgets helped to provide a veneer of choice; but this did not alter the fact that what we ended up with was ‘private’ residents of care homes paying over the odds to subsidise those residents with little or no independent means. This is and always was blatantly unfair.

    Now at last the government appears to be addressing the problem, however imperfectly in many people’s eyes. Just throwing money, our money, at the problem, while welcome, is not the only answer.

    Whether it’s extra cash for the NHS or residential social care, this has got to come with conditions attached. Sticking with social care for the moment, while I am all in favour of upping the wages and status of care workers, I am NOT in favour of the money going straight to care home owners and shareholders, or indeed on this being seen as an opportunity to raise fees without real justification. As for allowing local councils to find extra cash through a rise in Council Tax, that useless tool, based in England at least on early 1990s property values, generates pitiful amounts of money to cope with such problems as social care.

    As Gillian Douglass writes, councils, thanks largely to the austerity programme introduced by the Coalition Government in 2010, have mainly become ‘enablers’ rather than ‘providers’ of services of all kinds. It may now not be possible to bring many such services back ‘in house’, if that is even desirable. A partnership with the private sector can still work if the rules of the game are clearly defined and people are honest with each other.

  • Helen Dudden 13th Sep '21 - 1:55pm

    Adequate housing, and Accessible Home’s are severely needed.
    I’ve been talking to a local housing provider on the subject, and if anyone saw the TV programme last night on ITV, disabled people were most certainly not listened to.
    As a disabled person, I know the many failings that can be faced on a daily basis. Lack of appropriate dropped kerbs, often just box ticking. When is 1/20 difficult to understand. That’s the safe legal advice. Broken pavements, that are a fall hazard to anyone.

  • Jason Connor 13th Sep '21 - 6:14pm

    I agree with disabled people not being listened to. That is also the case for those of us who are physically unable to cycle, unable to walk too far so have to use cars for some trips like shopping but do what we can to be environmentally friendly, But unfortunately we are not being heard let alone listened to in the labour authority where I live where roads are local roads are closed off to their own residents. A council tenant neighbour of mine with a double hip replacement who has a need to use the car is also suffering. Broken pavements which I report on fix my street then months later aren’t fixed, that’s the reality of living in inner city labour wonderland for you. Too many homes in social housing are sub standard.

  • Graham Evans 13th Sep '21 - 11:19pm

    The new system will apparently entitle those who pay for their own care to be charged at the same rate as those cared for by local authorities. But there is unlikely to be enough new money to enable care providers to end the practice of cross-subsidisation without cutting standards. So an underfunded policy could end by reducing the quality of life for people in care homes.

    So what should the Liberal Democrats’ answer be?

  • Peter Martin 14th Sep '21 - 2:07pm

    @ Roger Lake,

    ” Pie in the sky?”

    Yep.

    If you want to have your windows cleaned you do need to see the job has been done before settling the bill. It’s probably not a good idea to pay the money up front universally and unconditionally.

    You’ll end up with dirty windows which isn’t quite as bad as having unwashed and uncared for elderly people.

    Having said this, the people who are doing the washing, whether it’s of elderly people or windows, do deserve a fair share of the national product. The avearge is approx £35,000 per person per annum in the UK and which includes everyone who doesn’t work at all – for whatever reason.

  • Helen Dudden 15th Sep '21 - 11:29pm

    It’s not only the elderly who end up in Care Homes, when, there is no where else, younger disabled people do as well.
    The system is broken with regards to dropped kerbs and the many broken pavements and many dropped kerbs are not the 1/20. Bus stops, is another often badly installed.
    I was told about a cycle path that ran along the side of a bus stop. You got off the bus than had to cross the cycle path to the pavement. A terrible situation for the visually impaired.
    Because of the very slow uptake on Housing for the Social Sector, where many of the better homes, have been sold.
    There will be some who need to use a car, e scooters and e bikes are not useful.
    There needs to be more to help those with disabilities, I can’t agree that Care Homes are the only answer for growing older. Homes need to be adapted, and better homes that could more easily be adapted. We have to get a more balanced approach.

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