Social Care: The Undervalued Bedrock of Britain’s Health System
By Nadra Ahmed CBE on behalf of the National Care Associaton (www.nationalcareassociation.org.uk)
If 2025 has proved anything, if further proof was needed, it is that the priority in the minds of ministers is firmly fixed on our beloved NHS. Despite a crumbling infrastructure both physically and in human resources, the NHS continues to attract funding to paper over the ever-widening cracks, with investment made available as and when needed. The same applies to primary care with GP’s, who are funded to support every initiative that they need to lead on, social care attracts no such attention sadly. Some changes and savings will be made through the merging of supported bodies, but the reality is what is needed is a complete route and branch reform programme across the organisations to make it fit for purpose and to rebuild trust in a service envied by the world across many generations.
THE MYTH OF A ’BROKEN SYSTEM’
It has become increasingly obvious that there is a focus on ‘reforming’ social care, based on a deeply held belief that it is broken and so needs ‘fixing’; to the point that it has become a regular and almost compulsory election promise by every party. Once elected amnesia sets in, and the progressive response, by successive governments is to announce a commission! This Labour government sadly, did not deviate from the norm: we have moved from a firm plan by Labour on how they were going to achieve it, to the announcement of a Commission led by Baroness Casey who will fully report in 2028. The cynic in me wonders if this has the potential of enabling a further period of inaction for another parliament. This will follow from the previous four decades of commissions with the same remit and pretty much the same findings. Meanwhile, the inequalities increase. Am I cynical or a pessimist? I feel that I have always been an optimist, because I see what social care achieves every single day by changing and supporting the lives of those who may have lost hope. As an optimist, I always believe that there is hope that a politician with conviction and understanding will emerge to break the cycle of inactivity.
However, I believe it is important to examine the evidence about the ‘broken social care system, which needs fixing and the move towards the vision of a National Care Service. The reality is that the term ‘social care’, which supports over 1.5 million individuals needing care and support, is misleading in this day and age. The reality is that we no longer exclusively deliver social care to the strictest meaning of the term, which was primarily to tackle loneliness or self-neglect; it is now delivering care and support which mimics a hospital model, but without the clinical staff.
‘NEW’ TASKS
Over the past four decades we have seen a steady but consistent transference of health care tasks to social care services, without any additional financial investment from central government and with the NHS retaining the funding to deliver those ‘new’ tasks through social care. Very quickly these additional tasks become expectations and subliminally the sector continues to respond in the best interest of the people we care for. The impact of this over time has steadily changed how a care service must operate. Indeed, very often we see inspections of services expecting a much more clinical and sterile approach but still expecting the ‘homely’ support for individuals.
It is essential that Social Care, as a sector, in its own right, is acknowledged as the bedrock of our health system. The importance of understanding its value and role has been lost in the narrative of politicians and commentators alike who want us to believe that it is a ‘broken’ system. A system which is so ‘broken’ and so must carry the burden of blame at every turn for the failings of healthcare. In my view there is a lack of any real evidence to justify this narrative, and the reality is what needs fixing is sustainable funding.
Our sector has moved at rapid pace from being a home for those who were lonely or needed care and support at the early stages of physical or mental health challenges, to those who have complex health care conditions needing regular and consistent monitoring. We have gone from people choosing our services and walking into them to arriving by ambulance. The fact is that we create and develop services daily, which were once delivered in long stay geriatric and specialist wards, costing the state thousands of pounds, at a third of the cost in many cases. One week’s stay in a hospital for an individual is more than £2700 whilst local authority commission care, for the same individual averages between £700 – £900. It is important to understand that staff in a care setting will carry out the same tasks as an Health Care Assistant and more; social care workers are trained to administer medication, as an example, which in a hospital setting would be carried out by a nurse, and yet the value of their duties as a care worker is seldom recognised.
Diversity of Options
In the 1990’s the sector took on the call for delivering care and support in people’s own homes in what was seen as a cost-cutting measure by the government of the day. This was a diversification opportunity for providers and for many others it enabled growth in the sector with new entrants. As a new delivery model, it enabled choice for those who had minimal care needs, to remain in their own homes for longer. Local Authorities and providers embraced the concept, but it soon became obvious that the costs, in a like-for-like model, were going to be greater with hospital admissions beginning to rise steadily especially through the winter months. This led to winter planning becoming a central part of government strategy.
I believe that diversity of options is a key component of choice – it enables people making crucial decisions to have sustainable options for their care and support based on assessed care needs. For that reason alone, it is key that all services across our sector are within the mix, creating a patchwork quilt of care and support in social care in the best interest of those we support. The importance of choice is often lost in current process driven discussions, which is one of the failings of the system drivers for both local and national government. If real choice and control were put into the hands of those receiving care services, we would see a more positive perception of care.
The need for a confident and competent workforce began to rise with homecare coming into the delivery and the need for social care to respond to ever more complex support packages.
Entrepreneurial providers used every opportunity to invest in their services with training and education: workforce skills stepped up a notch too, the skills matrix for social care provision and delivery grew. They were supporting people with complex care and health needs, so their training needs were enhanced to meet and ensure quality service delivery consistently. Importantly, expectations of our sector began to rise, not only from stakeholders but also the public. Navigating your way around the care system for those seeking care and support for the first time became ever more sophisticated.
Local Authority commissioning regimes came under strain and despite warm words, processes and budgets took precedent over person centered care. Central government funding was woefully inadequate, but sector change needed to happen to ensure that care and support delivery was fit for 21st Century and beyond. The irony is and remains that expectations of the social care sector as a whole have increased but successive governments chose not to invest in it, recognise it or acknowledge the value of a sector that is worth over £68 billion to the economy.
EMBRACING NEW INITIATIVES
Social care providers continue to invest with every new initiative they embrace which enhances delivery of care. Digitalisation has been recognised as one of the many new ways of working and our workforce have had to not only learn how to use it effectively but also ensure they keep up to date with it. We continue to evolve and create services to support people with complex needs, but real term investment in social care from government declines with every announcement. We face increased costs from every piece of legislation passed and face workforce challenges at the whim of the Home Office at a time when it is a substantial challenge.
This year will bring further chances by virtue of the Employment Rights Bill, and this will undoubtedly have an impact on providers across the sector. The funding required to enable a positive change will rest with the government’s commitment to ensuring and enabling it. They have to understand that delivering quality care for vulnerable members of our society should be a priority not a by product of propping up a health service which has become ever reliant of regular handouts to make it sustainable.
The cycle is tiresome and disingenuous. It is no wonder that trust and confidence in politicians is at an all-time low throughout the social care sector.
