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All to play for with the Health & Social Care Levy

The Government’s new Plan for Health & Social Care merits a close read. Beyond the headlines about manifesto promises and levels of the cap on social care costs, it has some interesting detail which is to be welcomed.

 There is talk of a National Prevention Service; a White Paper for adult social care to be developed with care users, providers and other key stakeholders; a £500m commitment to help the social care workforce with support in professionalising and developing the workforce, mental health support and recruitment and a recognition of the importance of social care within local Integrated Care Systems, with mention of working together to produce  a comprehensive national plan for supporting and enabling integration between health and social care. It may be that finally, the there is an understanding of the critical role that social care plays in helping people to live their best lives, alongside the devotion to the key role that the NHS plays in saving lives.

Of course, this is early days and not all of the announcement is going to work; prioritising the funding of the NHS backlog over social care suggests that the interdependencies between the two bits of the system are still not fully grasped. It cannot be that only £5.4bn of the estimated £36bn will go to social care, especially when it is clear that social care needs additional £7bn now to keep going, as determined by the Health and Care select committee amongst others.

Thinking about the cap on care costs, whilst the ambition to protect people from catastrophic care costs is clearly laid out, the devil will be in the detail of how the system actually will work, and no doubt local authorities are dusting off their plans for how to manage ‘care accounts’ to track spend up to the cap, wondering how the split between care & accommodation cost will work and lobbying hard for more of the £36bn to put such a system into place.

And of course, unless there is a radical reshaping of what a fair price for care actually is, none of these announcements will bring more investment into the provision of care.  The plan to ‘tackle persistent unfairness in the social care system’ by ensuring that ‘self-funders are able to ask their Local Authority to arrange their care for them so that they can find better value care’  will only work if Local Authorities radically increase the price they pay for care, to reflect the full costs of care with a properly sustainable, fair price for care. A fair price for care must be met by the state when commissioning care on behalf of people, with a clear framework established for a fair price for care which ensures good quality, sustainable care wherever you live. Otherwise we will be looking at large scale provider collapse.

The warm words about Integrated Care Systems putting people who use health and social care at the centre of the services that they use and joining up health and social care services need to be backed up by a truly integrated approach to health and care, with social care as an equal partner in that system – the Health & Care Bill needs significant amendments and the social care providers need to be funded to be at that top table, as all other partners are.

And of course, the announcement today does nothing to tackle the immediate workforce crisis (see our recent survey) in social care and the DHSC’s Winter Plan offers the opportunity to take some immediate action such as a retention bonus to care staff which is not taxed and not subject to Universal Credit rules, an increase and extension to the Infection Control and Rapid Testing Fund to the end of March 2022 and a wholly flexible Workforce Capacity Fund now to support immediate recruitment & retention challenges & upskilling/ training.

But taking it all in the round, today’s announcement is a bold move and, from our not for profit perspective, there is all to play for to make this levy work properly for social care, both now and longer term.

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