A year ago, the IK government published their flagship policy “Next Steps to Put People at the Heart of Care”. It is full of noble intent that: “everyone who needs care in England will have outstanding, quality care that empowers them to lead fulfilling lives and have the greatest possible independence”, or “care workers will develop their skills and their careers, and will be recognised for those skills.” All excellent stuff. But om the midst of all this is an asmission from the Minister that:

“For decades adult social care has not had the attention, resource or support from government that it deserves.”

—Helen Whately MP, Minister for Health & Social Care

At present, social care is funded by government for people assessed as having significant care needs and limited financial means (assets below £14,250). People with assets of more than £23,250 pay for all their social care – and there is no limit to what they might pay. Every part of England is now covered by an integrated care board (ICB), as it has been in Scotland for a decade, were each of the 32 councils operates a joint board. 

Allocation of £2.1 billion in funding for England was specifically earmarked for supporting and improving adult social care and discharge, but has yet to achieve much.

According to The Health Foundation. one in seven people aged 65 and over face care costs over £100,000. Government only covers the costs of care for people with the highest needs and lowest means. Everyone else must pay for care themselves, get help from friends or family, or go without. 

1. Providing basic protection for all against some care costs, with a Scottish-style model of ‘free personal care’ in England, could cost an extra £7bn by 2035/36 
2. Protecting people with the greatest lifetime care needs against catastrophic costs, by introducing a Dilnot-style ‘cap’ set at £86,000, could cost an extra £3.5bn by 2035/36 
3. Introducing an NHS-style model of universal and comprehensive care could cost an extra £17bn by 2035/36. 

Successive governments have ditched or delayed plans to reform funding for social care, leaving people suffering unnecessarily. Tony Blair promised reform in 1997. A decade ago, the coalition government legislated for a Dilnot-style cap on care costs but its introduction was later delayed. In 2021, Boris Johnson announced that the cap would finally be implemented. But, in a case of history repeating itself, the government has since delayed the cap until 2025 – after the next election. Ultimately, progress will not happen without political will and leadership. 

According to The Health Foundation wid package of investment and reform in social care is desperately needed. 

“Despite the pressing need for change, successive governments have failed to reform the funding of social care, leaving a catalogue of broken promises, delays and abandoned manifesto commitments whilst people continue to suffer under a care cost lottery.”

— Charles Tallack, Director of Data Analytics, The Health Foundation

It may be because of eye-watering budget numbers involved that successive UK governments have balked at facing the issue. The common view among those working in social care is that they are underpaid for the work they do. The average social care salary in the UK starts around  £19,000, rising to £31,000, according to the government. That averages £12,38 an hour—not much more than minimum wage.

Currently, integration of Social Care with Health is proving to be something of a window-dressing sham on either side of the Border.

Each NHS trust has paid lip service to it, especially in efforts to reduce bed-blocking, But as as cash-strapped councils have sold off care homes to raise funds, the private care providers that dominate the segment have been motivated more by profit.

This alone provides a clue why true integration will be not just thorny, but also expensive. An indication where all this might lead can be found in the US, where the profit motive has long been king in both the health and social care sectors.

According to the Genworth Cost of Care Survey 2023 of care in the US, the most substantial cost increases occurred in home health aide and homemaker services costs. Inflation and the shortage of skilled care workers are the core drivers of increases in the costs of care services.

“Understanding long-term care options and the costs associated with care are critical first steps toward being prepared for whatever you want your aging journey to look like,” 

—Jamala Arland, President and CEO, Genworth

Their 2023 survey found that the costs of long-term care services have increased since 2022 as follows:

• Assisted living facility rates increased by 1.4% to an annual median cost of $64,200 (£50,156).
• The cost of a home health aide, which includes “hands-on” personal assistance with activities such as bathing, dressing, and eating, increased 10.0% to an annual median cost of $75,500 (£58,984).
• Homemaker services, which include assistance with “hands-off” tasks such as cooking, cleaning, and running errands increased 7.1% to an annual median cost of $68,600 (£53,593).
• The annual median cost of a private room in a nursing home increased 4.9% to $116,800 (£91,328).

Staff trainings and cost are the top barriers that impact a provider’s ability to recriot and train staff.

In the UK, the annual average cost of residential care is £39,480, and receiving nursing care in a care home costs on average £49,920. The US figures for these are already 27% and 84% more, respectively. These differentials do not arise, as might ne expected, from higher wages paid in the US, which are comparable to those in the UK.

The conclusion appears to be that, if the grafting of the public NHS onto a probate system is even feasible, the progit priority of care companies will drive the cost of social care toward that of the US. That will pose the dilemma of whether we are prepared to shoulder the costs. These will be high, whether paid in taxes or directly from your own wallet.

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