Comprehensive reform is needed to prepare social care for future pandemics

The pandemic has left many politicians, commentators and the general public concerned about the need to address failings in – and funding of – the social care system. Today’s crunch meeting of the prime minister, chancellor, and the health secretary may have been postponed ^[1], but Boris Johnson is still reported ^[2] to favour reforming adult social care through a cap on care costs. While this would achieve the government’s manifesto promise, that “no-one should have to sell their home to pay for care”, it would not tackle the lack of resilience exposed by the pandemic.

A cap on care costs would insure people against catastrophic costs

A cap on care costs – originally proposed in the 2011 Dilnot Commission – would cap the maximum any person would spend on social care by setting an individual limit, after which point the state would pay for their care. There is no cap in the current means-tested system, and people must pay for their own care until they reach a ‘floor’ of assets (£23,500) at which point the state steps in.

The government has not, however, said how they will pay for this new cap or what level it should be. At any reasonable level, a cap would involve providing publicly-funded social care to more people, costing billions of pounds extra every year.

Some within government baulk at this cost, particularly as the cap on care costs will benefit wealthier people most, with critics dismissing a cap as not being ‘progressive’. But that is a red herring.

Any reform’s progressivity should be judged on who benefits and who pays, and the government could fund a cap on care costs through a progressive tax to make the overall reform package progressive.

The pandemic exposed the lack of resilience of existing state-funded care

A cap on care costs would achieve the government’s manifesto promise that “no-one should have to sell their home to pay for care”, but it would not address the lack of resilience that the pandemic exposed in social care. This fragility was well-known before the Covid-19 crisis took hold: in 2016 Exercise Cygnus, a government planning exercise for a flu pandemic, identified weaknesses in the ability of adult social care to handle a surge in demand during a pandemic; that sadly proved accurate.

During the crisis care providers were unable to prevent the spread of Covid-19 into care homes, a massive problem which tragically led to over 28,000 excess deaths ^[3] between 14 March 2020 and 2 April 2021. At the start of the pandemic, few care homes had infection control or isolation facilities, or technology to maintain contact between residents and families once face-to-face visits were banned. Owing to the low rates paid by local authorities for care before the pandemic, care homes reliant on publicly funded residents barely had any spare resources to maintain or modernise facilities. For example, nearly two-thirds of English care homes did not provide internet access to residents at the start of the crisis.

Likewise, many care staff worked multiple jobs at the start of the pandemic, which contributed to virus transmission. The Office for National Statistics found ^[4] that care homes employing staff working in different locations were more likely to experience coronavirus infections among both staff and residents.

To bolster the resilience of social care to make it better-prepared for future pandemics, the government will have to provide local authorities with more funding to spend on care or require care providers to maintain better infection control facilities or find another solution –implementing a cap alone is not enough.

Comprehensive reform would address catastrophic costs and resilience

If the government were just to implement a cap on costs, it would increase the number of people who would qualify for state-funded care but would do nothing to ensure social care is better-prepared for another pandemic.

Andrew Dilnot – the author of the cap proposal – has himself argued ^[5] that social care reform should encompass both a cap on costs and improvements to the existing means-tested system. If the government wants a social care system better able to respond to future pandemics, it must bolster the resilience of the existing system – and explain how that will be funded.

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1. Fury as Boris Johnson axes key meeting to fix care home funding crisis | Daily Mail Online
2. Social care reforms on the way: Boris Johnson and Rishi Sunak to hold crunch talks | Daily Mail Online
3. Deaths involving COVID-19 in the care sector, England and Wales - Office for National Statistics (ons.gov.uk)
4. Impact of coronavirus in care homes in England - Office for National Statistics (ons.gov.uk)
5. BBC Radio 4 - Today, 21/06/2021