One year after Boris Johnson promised to fix social care, we're still waiting

Covid-19 has not only exposed the long-term structural weaknesses in social care, but also a lack of grip on policy during the pandemic. Social care too often has seemed an afterthought

Adult social care in England needs fixing, and has done for decades. Even before the pandemic, increasing numbers of vulnerable people were unable to access social care and care homes and providers were at risk of financial collapse. Covid-19 has ruthlessly highlighted the scale of policy neglect that the sector has experienced under successive governments, which have failed to come up with much needed reform.

This Friday marks exactly one year since Boris Johnson declared in his first prime ministerial speech that he would “fix social care once and for all”. These were welcome words. Many of us hoped for more access to quality care for those who needed it, better pay and conditions for care workers, greater public investment in the care sector and fairer funding. Little progress has come about since the promise was made.

Understandably in the last year the government has been distracted by managing Brexit, a general election and then the pandemic. But Covid-19 has not only exposed the long-term structural weaknesses in social care, but also a lack of grip on policy during the pandemic. Social care too often has seemed an afterthought.

The government’s adult and social care pandemic action plan was published on 15 April, almost a month after country-wide social distancing measures had been introduced. Another month passed before a dedicated fund to support infection control in care homes was introduced. In contrast to the NHS, the too little too late approach to policy in social care has meant inadequate protection of the most vulnerable people in society. There have been more than 25,000 excess deaths amongst care home residents since the crisis began, approaching half of all excess deaths in England. Staff working in social care are have among the highest death rates from Covid-19 of any occupational group.

For sure, social care is more complex in many ways than the NHS. There are circa 20,000 social care providers, many of which are privately owned and very small. Care staff experience low wages, with a quarter on zero hours contracts, and high turnover rates – there are 122,000 vacancies across the sector as a whole. Unlike the NHS, care is commissioned locally, mainly via local authorities and private individuals. Data on care and the health of individuals to understand what is happening in the sector is patchy and undeveloped compared to the NHS. Trying to influence the sector to act at speed in an emergency is inherently more difficult than in the NHS, which has a clear hierarchy and means to influence change.

How to fix the system? Clearly there are immediate lessons from the first wave of coronavirus such as ensuring adequate PPE and test and trace facilities for staff and care residents, and immediate investment to support local authorities and social care providers.

But this is the moment for a fundamental and new, long-term strategy, not piecemeal tactical fixes. What does good care for our most frail look like? We need a vision, and a comprehensive package of reform. Only this, and investment, will address the now glaring levels of unmet need.

Money and reform are also needed to create a financially viable care market, which pays carers a fair wage – 90 per cent of care workers in England are currently paid below the real living wage. For this to happen, there must be greater recognition and agreement between people and the state about the need for a fairer funding system which protects people against the high costs of care.

This week also contains another anniversary – it is ten years since the Dilnot Commission was established to tackle this issue but shamefully the commission’s recommendations have never been enacted, despite legislation being “oven ready” on the statute books. 

Governments tend to dislike long-term policymaking, preferring short-term steps linked to an electoral cycle. But now is the moment to think big, show leadership, and deliver with competence, once and for all.

Dr Jennifer Dixon is chief executive of the Health Foundation