In this post Juanita Elias, one of the Commissioners involved in the PSA Commission on Care offers her thoughts on yesterday’s Spring Budget.
Chancellor Philip Hammond’s first budget saw the government make commitments to make £2 billion in funds available for social care over the next three years. This was a significant development especially considering how Hammond had been widely criticised after his autumn financial statement which failed to make any mention of the NHS or Social Care. Indeed the criticism faced by Hammond from local government, social care providers, key charities and think tanks alongside the political opposition was palpable. In certain respects then, this appeared to be an embarrassing about turn in government policy – but is that really the case? Or are we looking at business as usual when it comes to issues of social care?
More money for the sector is something that must, of course, be welcomed. The fact that this funding is not linked to last year’s introduction of the council tax funded social care levy is a positive development – since this served to distribute care funding via a postcode lottery in which those local authorities with the highest proportions of older people are also those that have significantly lower council tax revenue bases. It also appears that this is not money that is being syphoned off from elsewhere, although we will have to see what conditions are attached to this extra funding.
Nonetheless we must raise the concern that many other have also raised that this is still not enough. Such are the numbers of people living with unmet care needs, does this funding constitute more of a sticking plaster? Bold thinking is required about how to manage the care crisis long term. The government promises in the budget that it will ‘set out proposals in a green paper to put the social care system on a more secure and sustainable long-term footing’. We also know that parliament is currently undertaking a review of social care and integration – but concerns are consistently raised that unless funding for social care is properly ring-fenced within integrated health budgets and these budgets themselves receive further funding, then social care will become a ‘Cinderella service’ – or the service that always has to simply get by on whatever funds are made available. Furthermore, it also seems to be the case that the government can easily ignore/fail to respond to the findings of this inquiry. This and previous governments have an established history of kicking the can down the road so to speak when it comes to addressing the issue of the consistent underfunding of social care. After all, we have been here before. The 2011 Dilnot commission sought to address the issue of NHS funding, commitments that were taken up in the 2014 Care Act but never actually implemented. Other sensible proposals such as the 2014 Barker commission have simply been ignored. So what will the proposed green paper actually do?
Reflecting on Hammond’s budget, we also need to consider the way in which social care is consistently framed merely as a ‘problem’ for the NHS. Spending on social care certainly promises to free up NHS beds – but at the same time, missing from such a simplistic equation, is any notion of a right to be cared for, of any underpinning vision in which care for older people is seen as a central component of living in a just and fair society. The care crisis is not simply a crisis for the NHS, it is also an everyday crisis – one in which many many older people are simply denied the opportunity to live well into old age and their carers (both paid and unpaid) struggle to ensure people’s care needs are met. A focus purely on social care as a crisis for the NHS also means that we lose sight of how this crisis has gotten so bad in the first place. Part of the story here is about successive government’s failing to implement long term funding solutions for the sector – but there is more than merely this at work – what we identified in our report Towards a New Deal for Care and Carers was that gendered norms of caring (the idea that someone, usually a female family member) will step in and do the work of care actually makes possible these years of government neglect. Foreign investors might leave an ailing steel or car plant – but how easy is it for family members to abandon those that they love? Why does there appear to be little willingness on the part of the state to step in and support carers in times of need? Care then, is socially necessary labour that is widely undervalued and overwhelmingly performed by women. Caring for older relatives is important work, and yes, it is also often rewarding work – but it is, at the same time, difficult, backbreaking, labour with little respite which serves to lock many women out of higher paying work opportunities. As we found in our report, the difficulties of navigating a complex care system places further stresses and strains on those doing this work.
An Age UK commentary prior to the budget made the important distinction between social care (that is, personal care for those unable to care for themselves) and other forms of care (from friendship through to local services such as lunch clubs and day centres) – and suggested that there was a tendency in government thinking for the latter form of care to be seen as some sort of replacement for the former. This is an important point; the ‘big society’ will not save social care. At the same time these two forms of care must be seen as linked. Unpaid carers and older people seeking to navigate the social care system are doing so at a time when their ability to access information is becoming ever more difficult. Library and day centre closures for example are the inevitable outcome of the cuts to local authority budgets at a time of social care crisis – but such places often serve as important hubs for the accessing information about help available to older people and their carers. So let’s also talk about how austerity has impacted those community based services that enable older people to live fulfilling and meaningful lives.
In the current context, any funding for social care is of course welcome. But at the same time, we have to shift the conversation in ways that acknowledge how we cannot as a society rely on families to pick up the slack. Comments by Government care Minister David Mowat in January that families need to do more, show that government thinking in this area has not shifted. On a budget that took place on the same day as International Women’s Day, it shouldn’t be forgotten that asking women – and it is indeed usually women – to take on more and more of the burden of unpaid care is something that is at odds with the attainment of gender equality and what Teresa May suggested back in July 2016 when she stood on the steps of Downing Street and said that she would strive to deliver ‘a county that works for everyone’.