Prime minister Boris Johnson announced in September this year that National Insurance would go up by 1.25 per cent to provide extra funding for the social care sector. However, with the NHS budget likely to grow amid its multi-million-pound recruitment drive, will the social care industry see enough of the extra £12 billion promised?
There has long been a disparity between the NHS and social care sector in terms of budget. The Department for Health and Social Care has been allocated £212.1 billion in 2020/21, up from £150.4 billion in 2019/20, which is to be divided between the NHS and care homes.
Most of this budget goes to NHS England and NHS Improvement for spending on health services, while the rest is allocated to other national bodies for spending on other health-related functions such as public health, training and development of NHS staff, and regulating the quality of care.
The NHS budget this year, The Guardian reports, was £136 billion. In comparison to that, the Kings Fund reports that local authorities spent just £23 billion on adult social care in 2019/20. In real terms, this is only £100 million higher than what was spent on social care in 2010/11.
In an effort to provide the stricken social care sector with a much-needed cash boost, in the chancellor’s September announcement the government promised £12 billion of extra funding for the Department of Health and Social Care for each year between 2022/23 and 2024/25, with the corresponding rise in National Insurance of 1.25 per cent to pay for it.
Under the proposals, half of the extra money raised per year will be spent on social care by 2023, before the full amount is devoted to the care sector in 2025. In theory, the NHS then reverts to its normal budget beyond 2025.
By that point, the Resolution Foundation estimates that a staggering 40 per cent of all day-to-day government spending will be going on health and social care, up from 28 per cent in 2004. If that is eye-watering, rather gallingly there are also concerns that with NHS England’s budget set to grow in this timeframe, it could easily absorb any extra funding that was intended to go to social care, meaning that the sector will be no better off.
Research economist Ben Zaranko explained: “The extra funding provided for the NHS will result in spending growing at 3.9 per cent a year between 2018/19 and 2024/25, which is the same rate of growth as was planned between 2018/19 and 2023/24.
“History suggests these plans will be topped up further. That could leave little, if any, of the tax rises available for social care.”
As Zaranko points out, NHS England’s budget is estimated to grow by 3.9 per cent per year in real terms up to 2024/25. However, if it is to grow faster than planned - for instance by as much as 5.3 per cent - it would equate to an additional £5 billion being spent on the NHS by the end of the current parliament on top of the chancellor’s funding promise.
The Conservative think-tank, the Institute for Economic Affairs [IEA], has said that the NHS’ recent multi-million recruitment spree and higher wage offerings to plug skills shortages will bake a higher health service budget into the system, meaning that money intended for social care will inevitably be absorbed by the health service.
Economics fellow at the IEA, Julian Jessop, believes that the cash boost within the chancellor’s announcement could even go entirely on NHS recruitment and leave nothing extra for the social care sector.
“There is a risk that a temporary increase in spending on the NHS, to fix a temporary problem, becomes baked into the system, particularly via higher pay,” he told The Daily Mail.
“Without fundamental reform, the NHS is black hole which will swallow any money spent on it, leaving nothing extra for social care.”
Although health secretary Sajid Javid has insisted that extra money will be diverted to social care, industry operators are sceptical.
Cornwall Care CEO Anne Thomas said that the NHS swallowing up the extra funds would only be the cherry on the cake for a “forgotten corner” of the health and social care sector.
“Unfortunately, this doesn’t come as any surprise,” Thomas said. “There is no strategy for social care and no workforce plan for a sector suffering with crippling staff shortages, whereas millions of pounds are going on the NHS’ latest recruitment campaign. When will social care be recognised as a vital part of the health and social care system?
“Less than one per cent of newly recruited nurses at this time work outside the NHS, and the entire of that one per cent does not come to the social care sector. That one per cent must spread across the entire sector outside of the NHS. The current ‘no jab, no job’ policy leading to care workers being dismissed for not taking up the Covid vaccine only exacerbates the issue.”
To further illustrate the state of social care funding, a study carried out by LaingBuisson in 2020 showed that residential care homes for older people in England currently need to charge fees of £696 to £849 per week to generate a sustainable return, while nursing care costs between £969 and £1,075 per week to run sustainably.
However, English local authorities paid on average only £596 for residential care and £764 for nursing care per week, indicating a continued shortfall in care funding. It also means that care homes remain dependent on premium fees from private payers to generate sustainable levels of income.
The care home population in England that had to be sustained during this funding shortfall in 2020 was 418,710. As of May 2021, there were 15,009 care homes in England, including 10,905 residential and 4,104 nursing homes, on whose shoulders the responsibility fell to cater for that population.
In comparison, the base line cost for someone to spend 24 hours in a hospital bed is around £400, and treatment costs the patient and their family nothing. Between April and June this year the NHS had 123,707 overnight beds available spread across more than 850 hospitals.
Thomas continued: “Laing Buisson studies show that the average cost for care home fees each year to the resident and/or their family was just under £35,000 per year [£34,944]. It is a staggering amount to pay out and yet the industry is still underfunded due to insufficient public investment and the NI increase won’t make the issue any better.
“Wages in social care also remain low. If we told you that NHS staff were having to rely on food banks like some in our corner of the industry do, I imagine the response would be somewhat more vocal.”
Thomas is exasperated with the situation in the social care sector, especially so given that the industry at large has gone above and beyond during the pandemic, and that the NHS needs social care to function.
“We’ve heard so many anecdotes of excessive waiting times and backlogs within NHS services. An elderly man with a broken leg waited seven hours for an ambulance, another man needing surgery to remove a cancerous tumour has had his operation cancelled multiple times, ambulance crews have been sat outside hospitals for hours with patients, and the wait for A&E assessment and admission is taking as long as 14 hours for some.
“I am also aware of a people in Cornwall lying in hospital for longer than 70 days waiting for a package of care or a care home placement, and we cannot take them on because we are understaffed. The damage done for staying in hospital longer than necessary can be disastrous, with elderly people proven to suffer increased risks of falling, sleep deprivation, higher possibility of catching infections, and sometimes mental and physical deconditioning. Despite this, nearly 350,000 patients spend periods of over three weeks in acute hospitals per year.
“The reason hospitals are being overrun is because we are underequipped to the point where we can’t take patients ready to leave hospital. If we were able to take them on, we could not only help with the wellbeing of these patients and help them regain independence more quickly, but also social care could free up as many as 1,800 NHS hospital beds across the country by being able to take on discharged patients. But we cannot.”
The county of Cornwall in particular has experienced major issues with patients unable to leave hospital because carers and care packages are unavailable. On October 13, staff said that more than 284 patients, including at Truro's Royal Cornwall Hospital, were medically ready to leave but had nowhere to go.
Going on to highlight the immense amount of public recognition and reward for NHS staff, Thomas also questioned why personnel working in the social care industry have not received the same warm treatment.
She said: “Social care has more than done its part in holding together the UK’s pandemic response. Staff have worked back-to-back shifts, lived in caravans, put their own health and wellbeing at risk and put the people they look after before the wellbeing of their own families. Our staff are also exhausted, and while NHS staff are being offered free concerts, store discounts and the health service’s emblem is emblazoned on sports team shirts across the country, there is no similar recognition for the social care sector.”
With social care at breaking point and the National Insurance increase showing little prospect of providing respite, Thomas believes enough is enough and change must be forthcoming.
“Mandatory Covid jabs have resulted in loss of personnel and there is no extra money to pay staff if the projections of the NHS budget increase are to be believed. There is no sign of any extra provision for social care even with the NI hike and the industry needs help.”
Thomas believes that volunteers could provide a short-term answer to help the industry in what is a “tough” environment for recruitment, where people “are not really interested” in taking up roles in care.
Indeed, the staffing crisis at Cornwall Care has become so severe that the provider has been forced to streamline its offering of services and reduce the number of people under its care; a move which has also seen the organisation sell off its head office in Truro and make a small number of staff redundant.
“This is not just a cry for help from Cornwall Care, but from all providers across the county,” Thomas said.
Thomas added that an influx of volunteers would "release skilled staff to do the care that's needed" and free up beds to help hospitals.
“Volunteers in social care carrying out simple tasks such as helping people to eat,, administration, cleaning and keeping the residents’ company will help everyone who is trying to receive care from the NHS,” Thomas explained.
“If the public wants an ambulance to be available next time they dial the emergency services, then social care needs to be provided for. Without it, the whole system fails because the NHS is overburdened. As it is, we are playing a game of snakes and ladders where all the ladders keep being taken away.
“But who is our Marcus Rashford? Who is championing our cause? There is nobody. This has to change.”
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