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Social care often seems to be the forgotten sibling of the NHS. The UK clapped for NHS staff during the pandemic, which was truly deserved. But there was no applause for those at the front line of social care, the people providing care to some of the most vulnerable members of society living in residential care homes or nursing homes, as well as delivering home, day and respite care.
Social care reform appears at the end of Labour’s key election promises for the NHS in the party’s manifesto. It acknowledges some of the key issues faced by the social care sector, including staff shortages, lack of adequate training and the resulting lack of good quality care for many.
The manifesto also acknowledges that many children, adults, and older adults are not receiving the care and support they need. So what does Labour propose to do about this?
One key aspect of their social care reform proposal is to introduce a national care service. This is meant to be similar to the NHS, to ensure that people in need of care are able to live well and independently in their own homes for longer.
But what would this would look like? Would it mean a tax for everyone, similar to national insurance? Would it be an additionally embedded fee within our council tax, even though some of us already pay a social care fee within our council tax?
The idea of a separate national care service is good, and most likely exactly what is needed to ensure better funding of the sector. This is because social care funding is currently managed by local authorities, whose income from central government has been severely squeezed since 2010.
People can either fund care for themselves – if they have the financial means – or approach their local authority to receive social care needs and financial assessments. Often people are not aware that they’re entitled to apply for care support – or even how to approach their local council in the first place.
But those that do apply usually don’t qualify. Healthcare thinktank the King’s Fund reported that in 2021-2022 local authorities received 1.98 million requests for support. The majority of requests come from older adults. Of these, only 43% received some form of support.
So placing social care on par with the NHS by ensuring a better overview of funding into the sector may be beneficial to those most in need of services, and raise awareness of their entitlement to care. However, without details as to how this would be set up, run, funded, and governed, Labour’s proposals seem to be a wishful idea that hasn’t been fully worked through.
Besides funding, there may be a further hurdle to the creation of a national care service: social care is disconnected. Currently, services that provide day care, home care or residential care run on private or publicly funded models, with no connection between them.
This is in stark contrast to the NHS, where services all fall under the same organisational umbrella. The only mention in Labour’s manifesto to improve connectivity is between NHS hospital discharge and social care services. And where people go after hospitalisation when they still require care is indeed a serious issue in social care.
However, the manifesto fails to acknowledge the hurdles that need to be overcome to create a sustainable, long-term national care service.
One is the difficulties of working in the sector. It’s subject to low pay, low recognition, lack of training and no clear career pathway. Staff retention is mentioned as a key challenge for social care but this could be including improved by more training and better pay for the social care workforce.
It would have been great to have seen the manifesto focus on introducing qualifications for social care staff, which would allow workers to progress upwards and remain in social care. Unfortunately, many very good social carers are lost to other sectors because of low pay and a lack of progression.
Adequate pay and training aren’t the only barriers to staff retention, however. The Labour party has pledged to “work with Brexit” rather than rejoining the EU, which has significant implications for the social care sector. Brexit led to a substantial reduction in European social care workers coming to the UK.
The Nuffield Trust highlighted the severe impacts of Brexit on the health and social care workforce. Regulations introducing a minimum wage of £38,700 per annum and the restrictions on allowing care workers to come to the UK with dependants or other family members do not support the creation and maintenance of a diverse, well-trained and professional workforce in the UK.
Instead, the UK has significant workforce shortages. The latest figures show there were 1.79 million jobs in social care in England in 2023, of which 152,000 posts were vacant. This is more than the NHS workforce, which has around 1.4 million jobs.
Overall, it is good to see a focus on social care in the Labour Party manifesto, but the outline for reform is too brief. Although manifestos are meant to be succinct and highlight the key issues, Labour’s offering still leaves too many questions unanswered and may be perceived as a tick box exercise rather than a serious proposal for the reform of social care.
Clarissa Giebel receives funding from the ESRC, NIHR and the Alzheimer’s Society. This article is not supported by any research funding and presents Dr Giebel’s own views.
