An Insurance Funded Model Won’t Fix The Care System

By Philippa Shirtcliffe, head of Care Quality at Quality Compliance Systems (

In typical bombastic fashion, Boris Johnson set out an exciting new vision for the country. He compared a Covid-ravaged state to 1940’s Britain as he vowed to create “a new Jerusalem”.

There were many pledges but one of the most noteworthy was Johnson’s promise to repair a broken social care system, which is as we all know in desperate need of funding overhaul. While he elected to provide very little detail in his speech, Mr Johnson, dropped a large hint that the government could fund social care in the future with by switching to an insurance type model.

Speaking from a virtual platform, Mr Johnson, said “We will fix the injustice of care home funding, bringing the magic of averages to the rescue of millions. Covid has shone a spotlight on the difficulties of that sector in all parts of the UK, and to build back better we must respond; care for the carers as they care for us.”*

As Mr Johnson set out his future plans for the UK care sector, front- line care workers must have breathed a collective sigh of relief. Only three months ago, the Prime Minister angered and insulted the social care sector by blaming care homes and frontline staff for the spread of Covid. Now, it seems, he’s done another of one of his famous U-turns, and brought them back into the fold.

The beauty of speaking to a virtual audience of course is that there is nobody to challenge you. Take Mr Johnson’s rather opaque hint (and it was only a hint) to use an insurance style paradigm to fix the care sector, for example. If this is what he was indeed suggesting (and we don’t know for sure), in my opinion, it raises many more questions than answers.

Firstly, Michael Forsyth, chair of the Lords economics committee, conducted a root and branch study of care sector funding last year. The detailed report appeared to rule out an insurance funded model as the solution. So why re-introduce the idea as a viable option less than a year later? Have Mr Johnson and his team read Mr Forsyth’s report?

According to an article in the Guardian, “private insurance solutions”, which were “favoured by many” Tories was dismissed when “the insurance industry told the committee they wouldn’t work”.**

Instead, Mr Forsyth’s report concluded that the social care sector needed a much more radical overhaul – one which would be funded by the taxpayer and cost billions of pounds.

As someone who has worked in the social care sector all of their working life, I can say with some confidence that Mr Forsyth’s findings make much more sense. He concluded that local authorities need to be given bigger budgets, so that those in need – wherever they live – get free access to the basic care. This report of course was published before the Covid-19 Pandemic and it is fair to say that since then both the political and financial landscape have changed.

And so has the rhetoric. Since the Covid outbreak, commentators like to talk about “subsuming the care sector into the NHS” or to create “a closer union” between the two sectors. The first idea is as implausible as it is ridiculous. Why? Because the NHS and care sector are radically different organisations. One helps patients get better, while the other empowers people to live their lives. Secondly, the current care sector funding model is exceptionally complicated. It is disparate and fragmented and, therefore, it would not be easy for the NHS to seamlessly incorporate the care sector into its complex funding structure.

But, those who say that there need to be closer ties between the health and social care sectors are correct in their assumptions. The lack of communication between hospitals and care homes during the spring, for example, where some hospitals failed to inform care homes that the patients they were discharging had Covid, illustrates the needs for greater communication.

However, if the two are to forge closer links, the relationship must be allowed to develop on an equal foot- ing. If NHS Super nurses are drafted in to help care homes in the near future, they must understand that a care home is different to a hospital and that they need to work in lockstep with experienced NHS frontline care workers to ensure the home delivers the best results for its service users – even if it is the NHS, who pays for the nurses to be there.

Whatever solution Mr Johnson and his team opt for, in a Covid-ravaged economy, is likely to cost billions of pounds. But there are no easy answers. As Mr Forsyth remarked last year, “The people who are looking for some easy way out of this are in search of a holy grail which does not exist.”

Mr Johnson and his cabinet would do well to take note.

* The Guardian
Covid can change UK like ‘new Jerusalem’ of 1940s, Johnson claims
By Jessica Elgot and Heather Stewart
Tuesday, 6th, October, 2020

** The Guardian
Lord Forsyth: private insurance won’t fix the social care crisis
By Patrick Butler
Tuesday, 30th, July, 2019

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