The state of social care in England and the case for a comprehensive social care strategy

This briefing describes the key findings from Nuffield Trust research and analysis on social care over several years. It outlines the definition and context of social care, the current range of dire problems, and makes recommendations to address these, building a thriving future for the sector as a vital public service. We suggest urgent, immediate actions as well as the shape of successful reform in the long term, and look at how adult social care can work better with the NHS.

The full briefing is attached. The summary of it is as follows:

• Thirty years of inaction, despite endless commissions and reviews, have left adult social care beset by multiple serious problems. Hundreds of thousands of people face unlimited costs, or going without the support that could enable them to live fulfilling lives, resulting in distress and pressure for them and their families.
• These problems are worsening. The waiting list for an assessment of their social care needs has climbed to 400,000. Local authorities are facing overspends and the number of vacant staff posts remains well over 100,000.
• Fixing one problem at a time will not work. Raising wages for care workers without more stable funding will mean bankrupt care agencies or fewer employees. Increasing eligibility for care without addressing workforce vacancies will only mean more people left on waiting lists. Comprehensive reform is needed – implemented gradually, but following a long-term plan.
• The government must begin immediately. There needs to be a stable multi-year funding settlement for councils as promised in the Labour Party Manifesto, filling the immediate black hole in budgets (estimated to be £2 billion next year), with enough funding to cover a genuine fair pay deal for social care workers. The minimum wage must be properly enforced for care workers.
• The course for reform and improvement must be set by a narrative which shows social care as a pillar of national infrastructure, which enables a better life for millions and a more functional society and economy. A rapid diagnostic exercise similar to the Darzi review for health could build urgency and the case for change. Trust between local and national government, which is shattered, needs to be rebuilt.
• In the coming years, a phased plan should steadily build a strong and thriving social care sector. This needs a clear, consistent and fair division of costs between the individual and the state, and consistency in who qualifies for care. Germany and Japan implemented these at the core of successful reforms.
• The government should then build on a fair pay settlement to create a sector pay scale so that people are rewarded for staying, building skills and experience. As other countries have shown, a national schedule of fees can enable social care providers to stabilise financially, invest for the future, and improve with new ways of working that keep people living full lives.