But as the focus of debate around social care reform remains firmly on a potential cap on care costs, there is growing concern that carers are being forgotten. As new data recently showed in stark detail, carers are being asked to do more while at the same time seeing their access to support cut back, and this will have far-reaching consequences.
It’s easy to forget that the social care workforce in England is made up of two parts. There is the paid care workforce, which is around 1.5 million adult social care workers. And then unpaid carers, which are up to nine times as many – between 7 and 13 million in England alone. Although the majority of unpaid carers in the UK are adults, up to 800,000 are children aged between 5 and 17.
Carers assessments in England – which are the route to getting essential help like respite services for carers – have dropped by 13% in 2020/21 compared to the previous year. In some places, carers assessments have worryingly dropped by two-thirds. It means many carers are not getting the support they deserve, and need to carry on caring.
Carers are being asked to do more, but at what cost?
It’s hardly surprising then that two-thirds of all directors of adult social care are seeing an increase in the number of individuals coming to councils with needs that are a result of carer breakdown, illness or unavailability.
This points to the often-fragile nature of care-giving arrangements, and raises questions about the sustainability of policy choices that rely heavily on unpaid carers to prop up a failing social care sector.
While it’s tempting to view unpaid carers like these as ‘free help’, that is dangerously short-sighted. The price is paid mainly in the loss of health for carers – something that isn’t on the Treasury balance sheet for social care reform.
Among those providing more than 50 hours a week of unpaid care, this comes at a cost that is equivalent to the loss of 18 days in full health for every year spent caring. What this means for carers is more days spent living with pain, anxiety and poor health, leaving many unable to work or take part in everyday activities with family and friends.
And expectations on carers are growing. Seven in 10 unpaid carers have done more during the Covid crisis – on average an extra 10 hours caring each week.
These costs to carers’ health that come from being asked to do more – an impact that can be measured in physical burden, emotional burnout and financial stress – must not be swept under the carpet. And, while many costs may be difficult to measure, poorer health among millions of carers is likely to eventually have a very tangible impact on the NHS budget. It will mean greater need for health services, which will only add to the pressures felt by GP practices and hospitals.
Learning the lessons of the pandemic
Social care services were already falling short before Covid, but the impact on unpaid carers was largely invisible. What the pandemic has done is enable policy-makers to see much more clearly the cost to unpaid carers’ health when formal social care is not available or is restricted. Those lessons must be learned.
The focus of social care reform over the last decade has been firmly centred on funding – which is important, but only one part of the policy discussion that is needed to get social care right.
Conversations about social care reform must take on board important lessons about the consequences of tight eligibility criteria that leave many people stranded without the care they need. With around 3,000 requests for social care declined by local councils in the UK each day, it’s unpaid carers who are often left to pick up the pieces and take on this work instead.
Putting more of the work of caring on to the shoulders of unpaid carers risks significant harm to carers’ health and that important message needs to be taken on board in current debates. As does the human cost borne by unpaid carers of delays in action on social care reform.
With the pandemic leaving many carers exhausted and pushed to breaking point, is this really how we want these unsung heroes to be treated?
Paddison C (2021) “Plans for social care reform must not leave unpaid carers out in the cold”, Nuffield Trust comment.