We need to talk about adult social care

The manifestos have been launched, the debates are underway, but when it comes to the question of care provision, nearly all the focus is on health and the NHS. When he became prime minister in 2019, Boris Johnson claimed to have an ‘oven ready’ plan for social care, nothing substantial happened, and too little has been heard since from politicians.

Studying the manifestos does not bring enlightenment. Yet this is an issue that not only affects all our lives, it is also closely linked to the problems of the NHS and the delivery of good healthcare free at the point of access. The best social care is vital: underpinning improved health, and reducing calls on emergency services and the need for expensive treatment, by enabling preventative measures, early diagnosis and interventions.

If hospital patients have a known source of care, with which they feel confident and settled, then as soon as they are ready to go home there will be far less delay in discharge, or ‘bed blocking’ (an unfortunate phrase that implies blame).

The current state of adult social care services in the UK can only be described as fragile: over 150,000 staff vacancies, greater reliance on expensive agencies, and care providers struggling to improve staff pay and conditions against very tight local authority budgets. Yet no political party seems willing to both prioritise the sector and commit to it in its own right.

The Conservative Party manifesto offers four pages on this topic overall, but only two short paragraphs on social care. These are highly aspirational, but do not say whether the funding settlement to local authorities will be increased. Nor do they address the issues of staff recruitment to fill the yawning gap.

Finding and training UK candidates is not grounded in any costed plan, and elsewhere the manifesto has much more to say about deterring legal immigration in general (by reducing family rights), than about the immediate impact of this policy on care provision.

Labour: ‘Build an NHS Fit for the Future’

Labour offers a much more substantial 12 pages under its ‘health’ heading, of which two are devoted to social care reform. Most importantly, it wants to:

“Create a National Care Service, underpinned by national standards, delivering consistency of care across the country. Services will be locally delivered, with a principle of ‘home first’ that supports people to live independently for as long as possible.”

The manifesto also includes the intention to “enhance partnership working across employers, workers, trade unions and government and establish a Fair Pay Agreement in adult social care”.

Both these aspirations could improve outcomes and save money by creating a more stable, long-term workforce and shifting the focus onto health prevention. But at this stage the policy needs proof of concept and funding allocation. Although they say that their overall policy on health is “fully funded”, this is not broken down to address social care change.

Liberal Democrats: ‘Care’

The Liberal Democrats have stated their intention to focus on social care, and they devote a manifesto section to this, separately from their ‘health’ section. Their approach is far stronger on detail, with a number of recommendations to improve the status and conditions of care workers, a section on supporting people to age well, and greater recognition of unpaid carers than the previous two manifestos.

Like Labour, they want more national consistency and strategy for social care. However, it is not clear how they would fund their recommendations or “provide consistent, predictable funding for free personal care”, as in their costings, social care is wrapped into health spending, with no indication how it would be protected from the needs of the hungry NHS.

The Liberal Democrats launched a specific ‘mini-manifesto’ on social care on 25 June

As a limited company with registered member fees, whose major shareholder is also its leader, Reform UK operates as a business. This may be why it has specifically chosen to offer a ‘contract’ rather than a manifesto. “Delivered by people with a real track record of success”, it promises to “repair our broken public services” at the same time as greatly reducing taxation, and making savings on, for example, utilities infrastructure.

It offers only one short paragraph on social care, with reform pledged ‘in the first 100 days’ based on “flexibility, tax incentives, VAT breaks and less waste”. They say that this will require “more funding”, but none is allocated to it, in the way that Reform have specifically allocated funding to some requirements, such as fisheries.

What are the views of sector and policy bodies?

Finding any of the manifestos online will also yield a substantial list of commentary on each sector policy, such as the Institute for Fiscal Studies (IFS) analysis of the main manifestos in terms of costs and funding. The IFS have also provided a budget and spending analysis for the health and social care policies of the Conservatives and Labour.

Insofar as social care is concerned, major players who “represent millions of people and billions of pounds” in the care sector have published a ‘Joint Statement to National Party Leaders’, co-ordinated by the Local Government Association. They urge party leaders to talk more about adult social care in the run-up to the general election, and to talk about it “with hope and ambition”, recognising how important the sector is to everyone’s lives, and “turning off the doom-loop of ‘crisis’ and ‘collapse’, the view of people drawing on care and support as inherently ‘vulnerable’, and the presentation of people’s support requirements to live a good life as ‘demand to be managed’”.