How should we pay for social care in the long term?

This is the third think piece in the LGA's series 'Towards a sustainable adult social care and support system'.


Foreword by Cllr Izzi Seccombe OBE

Cllr Izzi Seccombe

As we get closer to the seventieth birthday of the NHS, it is hard not to be struck by the number of recent reports setting out the extent, and consequences, of the NHS’s funding challenge. One suspects these are at least partly motivated by a collective desire to ensure there is a sizeable cheque enclosed within the NHS birthday card.

This is not to downplay the seriousness of the NHS financial position. A year-end NHS provider sector deficit of £960 million – £464 million more than planned – amply demonstrates the severity of the situation. Nor is it to disparage ‘NHS70’. The NHS has earned its ‘national treasure’ status through seven decades of achievement and progress and it is absolutely right that we come together to celebrate that.

But one can’t help but wonder whether the clamour to influence the size of the Prime Minister’s promised ‘multi-year funding plan’ for the NHS will impact on adult social care’s own present – the care and support green paper – for its fiftieth birthday and the anniversary of the Seebohm Report, which laid the foundations for the model of adult social care and support we know today.

Without doubt, it’s a hard present to wrap. Previous proposals for fundamentally changing the way we fund care and support for the long-term have proved difficult to say the least. And that difficulty has led different governments down the path of pursuing a more incremental approach to adult social care funding: one off injections of genuinely new funding (albeit with tightening strings), funding transfers from the NHS, the reprioritisation of existing funding already committed to local government, and new council tax raising powers through the social care precept. These measures have helped keep the system afloat (alongside significant savings and reductions from within social care and the wider local government budget) but by their very nature they are not sustainable.

And that is what adult social care and support desperately needs: sustainable funding for the long-term.

Only when this is achieved can we look to the future with confidence, knowing that quality will be sustained and improved, the workforce will be adequate in its size, skillset and opportunity, the provider market will be stable and thriving and, most important, the needs of an increasing number of people will be met with services that support their wellbeing and independence.

So how should we pay for social care in the long-term? At a recent one-day LGA conference on the future of adult social care, speakers tackled that question head on. There were calls for a salary sacrifice scheme based on the model used for childcare vouchers, a pre-funded ‘later life care fund’, and the development of more products from the insurance sector. One thing was clear: a mixture of solutions is likely to be needed to take account of different people’s – and different generations’ – circumstances. Beyond that, speakers also began to identify some of the key questions at the heart of the debate about future funding arrangements. These included the need for fairness across generations, the need for any proposals to align with wider changes to local government funding overall, and the essential need to see funding in the round, taking account of funding for acute services, public health, community health services and social care and support.

This last point is particularly important. As Sir Amyas Morse, Comptroller and Auditor General at the National Audit Office, said at our conference, this is a debate about “power and money”, both between and for the NHS and social care. Sir Amyas argued that developing a sustainable financial model for social care will inevitably take place alongside similar work for the NHS. He called for strong dialogue into the NHS so that it doesn’t “pick favourites” and push for additional funding for elements of social care that save the health service money. The NHS needs to see things more holistically, Sir Amyas asserted, recognising the contribution that all of social care, public health, and local government make in taking pressure off the NHS.

In this sense, the challenge of proposing, and seeking support for, a solution or solutions becomes greater because in scope is the financial sustainability of not one, but two, systems. Closely interlinked for sure, but also fundamentally different in the way they are funded, managed and held accountable. But if the challenge is greater, so too is the opportunity. With the NHS turning seventy and social care (in its modern form) turning fifty, this is a chance to rediscover the spirit of those who designed and built these two vital services and help secure their future for the decades ahead. At this key moment, it essential that we recognise that the NHS is service that helps us when we are sick, but every other part of our health and care infrastructure helps us to stay well and is much more important to our overall, life-long wellbeing.

In this third publication as part of our ‘think piece’ series ahead of the green paper, six prominent colleagues, experts in their field, offer their thoughts on the future funding of adult social care and support. Some point towards solutions, others identify the questions that need to be addressed. All make the case for change and all – implicitly or explicitly – make the case for eschewing further piecemeal options and pursuing bolder solutions that are commensurate with the scale of the challenge ahead. I am grateful to them for giving their time to participate in this work.

Cllr Izzi Seccombe OBE

Chair, LGA Community Wellbeing Board