Momentum for reform social care in England after the sector suffered during the pandemic risks being lost due to Government delays, a new report has warned.
Now is a “pivotal moment in the history of the care system”, a health think tank said as it laid out the issues faced amid the outbreak and spread of coronavirus and what lessons must be learned.
The Nuffield Trust said the pandemic had shown up the “underlying fragilities” in the social care system and “forced this issue to a point where it is impossible to ignore”, as it insisted there is a “huge amount of learning” that must be understood and harnessed.
But, in a report published on Friday, it noted that, since beginning its research which focused on the first four months of the pandemic response to May 2020, some key elements of the plan for sector reform have been delayed.
Underlying issues of low pay and unstable contracts continue to be a problem and need to be addressed to ensure the sector can better withstand future shocks— Nuffield Trust
The Government has faced criticism for the decision to push back long-promised social care charging changes to October 2025.
These include an £86,000 cap on personal care cost contributions and an expanded means test which is more generous than the existing one, that had been due to come into effect from October 2023.
The announcement last month that social care workforce funding is to be halved from a previously-pledged £500 million was also branded a betrayal by charities, unions and other political parties which accused the Government of broken promises.
The Nuffield Trust report, based on interviews with sector experts, and workshops with social care stakeholders including people who use care and policy documents, found that “one of the core weaknesses with the official response to Covid-19 was a fundamental lack of understanding about social care at the heart of Government”.
The trust identified what it described as a “range of deeply rooted systemic issues” in social care, including unclear roles and responsibilities among levels and areas of government, which it said affected the co-ordination and timeliness of the response to the pandemic.
The authors said there was a “lack of deep understanding of the social care sector” among those leading the pandemic response which resulted in measures and guidance being “insufficiently sensitive to the diversity and complexity of this vast sector”.
It also highlighted that a “reliance on sporadic injections of funding” in the previous decade rather than sustained investment meant the social care sector faced the pandemic in a position where it had only “patchy data, limited spread of technology and innovation and a residential care estate that was not fit for purpose”.
While noting that improvements have been made since, including a bolstering of social care capacity at the Department of Health and Social Care, and the establishment of the social care taskforce in summer 2020 and the subsequent winter plan for 2020/21, the report said longer term planning is needed and certain problems remain to be fully tackled.
Despite the pain endured during the pandemic, we now have the ominous sight of reforms being yet again delayed— Natasha Curry, Nuffield Trust
The report stated: “Underlying issues of low pay and unstable contracts continue to be a problem and need to be addressed to ensure the sector can better withstand future shocks.”
It said positive progress made during the pandemic must be “embedded and built on” and noted that, while the Government’s White Paper on adult social care reform is a “starting point in the process of building an improved system”, it “stops short of triggering fundamental reforms”.
The authors stated: “Since undertaking this research, the Government has announced that it plans to delay some key elements of its reform plan.
“There is a real risk that the momentum that has gathered around social care reform will yet again be lost.”
Natasha Curry, deputy director of policy at the Nuffield Trust, said: “Despite the pain endured during the pandemic, we now have the ominous sight of reforms being yet again delayed.
“As the Covid-19 Public Inquiry begins to reflect on the tragedies we saw, I hope one positive legacy might be that we will realise how much we need strong, healthy social care services, and act accordingly.”
Report co-author Adelina Comas-Herrera said that, as part of the same project, researchers will look at experiences in other countries to highlight how lessons can be learned.
“We now have an opportunity to learn from this international experience to strengthen the English social care system to address long-standing structural problems,” she said.
In order to deliver more personalised, ‘wraparound’ care, we need a properly supported, funded and sustainable social care sector working alongside the NHS— Miriam Deakin, NHS Providers
“We are seeing how countries such as Ireland, Finland and Spain are using lessons from the pandemic to reform their care systems.
“Our research shows that social care in England needs a system-wide reform to be able to respond not just to emergencies, but to the implications of longevity and competition for workforce with other sectors.”
Miriam Deakin, director of policy and strategy at NHS Providers, said that to withstand future challenges the social care sector urgently needs funding and reform “to address severe workforce shortages, unmet need, quality of care, innovation, and digital and data improvements”.
She said: “In order to deliver more personalised, ‘wraparound’ care, we need a properly supported, funded and sustainable social care sector working alongside the NHS.”
Social care minister Helen Whately said: “We are committed to learning lessons from the pandemic and are investing up to £7.5 billion over the next two years to put social care on a stronger financial footing, help reduce waiting lists and alleviate workforce pressures.”
