Human cost of social care scandal and reform inaction – Ros Altmann

The care system has been neglected for far too long and remains the poor relation in our national health system. Here’s why:

NHS was prioritised over care homes and home care services, putting frail lives at risk: The current artificial separation between NHS and social care meant care homes and home care services did not receive adequate supplies of PPE, as the NHS was prioritised.

Social care was relegated and neglected, with care homes or home care being used as hospital overflow services, when so many Covid patients were prematurely discharged from hospitals, putting lives at risk.

Social care must be properly integrated and funded, with parity of esteem alongside the NHS, to treat those with care needs with the dignity they deserve.

Some 28,000 people relying on social care at home died last year in England and Scotland: Overall numbers of deaths for those receiving home care in England increased by 50 per cent in the year to March 2021 over the prior year and the numbers in Scotland increased by 70 per cent.

This was not related just to Covid, with the majority of excess deaths being from non-Covid causes. The stark figures suggest a failure of social care services through the pandemic, with fragmented domiciliary care provided by private sector, councils, charities and NHS trusts, but no joined up oversight.

Care Quality Commission figures show that deaths at home in 38 English councils doubled last year and in 10 areas the number of people dying tripled.

Tens of thousands of excess care home deaths last year: The enforced early discharge of elderly patients, regardless of Covid infection, endangered the lives of care home residents and their dedicated staff. Care homes reported tens of thousands of excess deaths last year.

This is about both funding and organisation – a radical overhaul of both is essential: The pandemic has highlighted the neglect of social care services relative to our NHS, which points to the need for proper integration between all parts of the system.

But there are also failings in funding as well. Social care is funded on a short-term basis and councils are given money which is not ring-fenced for care. The most draconian of means tests governs whether councils will pay or whether these vulnerable people must pick up the huge bill for their care.

Taxpayers cover all the costs for millionaires with cancer who are treated on the NHS, but widows with dementia lose their life savings to pay for their care. Some of those who died were ejected from hospitals and then forced to pay thousands of pounds for the last few weeks of their lives in care homes which could not cope with the Covid overflow.

What can be done?: There is no silver bullet here, the decisions will all be difficult, but if we count ourselves as a decent country, we must look after the most vulnerable.

There are several vital elements to social care reform, which the Government must grasp. It has a huge majority, there is cross-party agreement that a solution is urgent and we have just seen the failings cost thousands of lives. This must never happen again. If not now, when? And what are the possible solutions?

National system of basic social care paid for by all – similar to principles of pensions: Everyone should pay something whether or not they need care – with a national system of contributions towards care costs, along the lines of our pension system.

If Beveridge was designing our National Insurance system today, he would undoubtedly have included provision for care of elderly people within the pension. It is time to bring the welfare state up to date. This could require a one per cent levy on everyone’s income, including older people, but the money will have to be found.

Incentives for private provision on top of State basic care – Care ISA, Care Pension, National Equity Release scheme: The State can provide a basic care service, but everyone could then be incentivised to provide more money for themselves.

This would include savings incentives to help people build up money for care, just as we have done with pensions and perhaps even included in auto-enrolment. For those no longer working, a social care levy may be needed to ensure all will pay something, but there is also the potential of encouraging those already in their later years to allocate some of their ISAs as a Care ISA fund.

Others could be offered the chance of tax-free pension withdrawals to pay for care earlier.

Baroness Ros Altmann is a Tory peer and former Pensions Minister.

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