Total transformation

After years of dither, social care reform has finally risen up the political agenda and is the subject of serious discussion in parliament. The government’s health and social care bill – passed narrowly in the Commons – contains funding proposals for social care including a new national insurance levy and a cap of £86,000 on lifetime care costs. This was followed by the publication of the government’s Putting People at the Heart of Care white paper.

From Labour’s perspective, the government’s funding plans are clearly problematic. The cap means people in less well-off parts of the country will have to sell their home to pay for care while those in more affluent areas will not. The fact that government financial support will not count towards the £86,000 makes it an even less generous plan than had been previously thought.

While debates about the funding of social care are critical, we must be careful not to sideline an equally important part of the equation. Even if we created a completely just and sustainable mechanism for funding social care, that system itself needs transforming. The way that social care is provided, and the settings in which it takes place, need an injection of imagination.

We have got to articulate a proper vision for social care, fit for the modern day, and centred on prevention, keeping people healthy and independent for longer, and enabling them to stay in their own homes and connected to their local communities.

Currently, older people needing care have a limited choice between receiving this at home or moving to a care home. But what about an older person who wants somewhere with a little more support and care, but for whom a care home would be inappropriate?

Imaginative care options are beginning to emerge – but these need proper political backing. Shared Lives Plus schemes enable people to bring someone needing extra support and care into their home and family life, creating bonds across the generations, making care personal, and allowing people to thrive as part of the community. Around 15,000 people are already visiting or living with a Shared Lives carer.

Housing-with-care is also helping to straddle the binary between care at home and a care home. Through what are now called integrated retirement communities, older people can rent or buy their own apartment within a community that also includes 24/7 staffing, social care when needed, and communal spaces. The Chocolate Quarter near Bristol shows how these settings can be closely integrated with the local community; apartments sit alongside office space, a swimming pool, pottery and dance studio, cinema, restaurant and bar – accessible to all locals.

Again, housing-with-care is growing but not nearly fast enough – just 0.6 per cent of over-65s have the chance to live in this kind of setting, with provision in New Zealand, Australia and the US about 10 times higher. This is despite preventative options like housing-with-care being great for residents, who see improvements in health and wellbeing, and great for the NHS and social care system, with GP and hospital visits going down by an average of 38 per cent per resident. Win-win.

It is positive that the social care white paper has recognised new options like Shared Lives and housing-with-care, and provides some funding to support their growth.

But policy reforms are going to have to go far beyond funding for these new options to thrive. We need stronger regulation and for those working in these services to be better recognised.

The government will also need to overcome departmental silos. A clear route needs to be introduced in the planning system for building housing-with-care, and proper consumer protection regulation is required for the sector. This requires joint working between the Department for Levelling Up, Housing and Communities and the Department of Health and Social Care, which is why organisations including Age UK, the National Housing Federation and Care England have called for a cross-government taskforce to be set up.

Labour’s shadow care minister, Liz Kendall MP, has pointed in the right direction. Setting out the party’s vision for social care, she called for a ‘home-first’ approach by increasing the use of early help and technology to help people live independently and expanding the options between care at home and a care home. In a speech to parliament, she said sector-specific legislation was needed to expand housing-with-care.

What we now need is a full and proper cross-government strategy to realise the ambitions set out in the government’s white paper, so that social care reform is not just about a funding solution, but creating an imaginative system prioritising prevention, health, independence and social connection.

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