Making social care visible and valued

Executive Summary

Care is an essential part of life. We all need care, not only when we are very young and as we grow older, but also at times throughout our lives. Most of us will also give care for varying periods of time. Social care is therefore fundamental to the health and well-being of our society as well as to the economy. Care takes place within relationships sometimes described as a ‘labour of love’ or a ‘duty’. For care to be safe for all concerned it must be a choice ¹ . Meanwhile, in an overstretched formal social care system too often care has become a ‘package’ of time-limited tasks, which do too little to support the well-being of people receiving care, or either paid and unpaid carers. It is an important sector of the labour market, comparable in size to the NHS. But after 14 years of cuts our current social care system is in crisis. This is harming people’s quality of life, damaging their health thus increasing economic inactivity, and putting pressure on other public services. However, cuts in social care services alongside benefits too often remain invisible to politicians until they negatively impact on other services, in particular the NHS. Women are the majority of those needing care, of social care workers and of unpaid carers, so they are bearing the brunt of this crisis. We urgently need a serious and sustained investment in and reform of social care, including expansion of formal provision, improvement in its quality and support for carers.

Impact of a market-based system

The origins of the current crisis in social care services can be traced back to the 1980s and the NHS and Community Care Act 1990, pre-dating both the financial crash and pandemic.

• Following the privatisation of residential and domiciliary services, the care workforce (80% female), became a significant part of the ‘gig’ economy, experiencing low pay and precarious working conditions.
• Staff vacancy rates reached 10% in 2022. Recruitment of migrant workers on one year-visas is not a long-term nor sustainable solution and carries high risks of exploitation ² .
• Reform of the funding of formal social care services has been in a state of flux since 2010. The new Labour Government plans to replace the cap and floor model, already postponed to 2025, with a new National Care Service at a date to be determined.
• Without these reforms, there are concerns that the lack of financial transparency in the precarious residential care market will mean that ‘increased funding may increase provider profit rather than increase the quality of the service’ ³ .

Cuts to funding

• Responsibility for funding social care sits with local government. Since 2010, local government funding from central government was cut in real terms by 26%, or 18% per person on average in same period ⁴ .
• Community health services were cut by 28% per person in the decade after 2013 when responsibility for funding was transferred from the NHS to local government ⁵ .

Increased needs and widening inequalities

• The UK population is ageing, and people are living more years in ill-health or disability. More people are needing care, but a considerable number of those are having their care needs unmet: we estimate prior to the pandemic this was the case for 1.8 million people aged 65 and over ⁶ .
• Needs have increased among those living in the most deprived areas. Their healthy life expectancy in 2021 was nearly two decades lower than those living in the least deprived ⁷ .

• Most (80%) of working age adults living with a major illness will be found in the most deprived areas, with fewer community health services.
• People living in the most deprived areas in England are more likely to be carers, and to be caring for longer hours than in the least deprived areas ⁸ .

Increased pension age

• Between 2010 and 2018, women’s state pension age rose from 60 to 65 years. The cost of the state pension scheme is based on the assumption that on average a person will spend up to a third of their adult life in retirement ⁹ . Women living in the poorest areas can expect to spend a third of their shorter adult lives in poor health including only 5 years in retirement ⁷ .
• More older women in poorer health and with caring responsibilities are now in the labour market. Neither social care services nor support for carers have yet been extended to account for this, putting additional pressure on older women’s health and financial circumstances.
• 1 in 4 women compared with 1 in 7 men aged between 50 and 64 have caring responsibilities. This means that raising women’s state pension age to equal men’s without increasing the availability of social care services has increased gender inequalities ¹⁰ .
• Between 2010 and 2020, if there had been no change to the women’s state pension age, the cost of state pensions would have been an additional £77 billion to the state ¹¹ . Part of the savings from increasing the state pension age for women should have been invested in the social care system, to support older women to juggle caring responsibilities with extended labour market participation.

Support for Carers

• Carer’s allowance (CA) is not fit for purpose. It is one of the lowest benefits in the system, currently £81.90 a week. Nearly 30% of those whose care responsibilities would entitle them to receive it are ineligible because of its complex interactions with other benefits received by those they care for. There is also a cliff edge earnings rule that penalises carers for having a paid job.
• There is evidence that caring whether paid or unpaid is associated with an increased risk of long-term ill-health, including long Covid-19 ¹² .

• Investment in policies enabling carers to combine caring with paid employment is low. Rights to one week of unpaid care leave and to ask for flexible working introduced in 2024 do not meet carers needs.
• Carers are defined as ‘economically inactive’ so their caring is not included in the Gross Domestic Product (GDP) because it is not paid. It is estimated that it would take 4 million paid care workers to replace their unpaid care, worth £162 billion per year. ¹³

What is to be done – ways forward

In the immediate term, we recommend the following measures to support carers and the social care workforce, which would in turn benefit people being cared for:

• WBG welcome the government’s announcement to introduce flexible working as the default, fair pay agreements in the social care sector, and an end to exploitative zero hours contracts.
• We also urge the government to address the low value of statutory sick pay as exposed by the pandemic.
• Carer’s allowance should be reviewed: WGB proposes doubling its amount, raising the limits on earnings and studying hours and replacing the cliff-edge earnings rule with a taper. Ending the punitive approach to repaying over-payments and the detrimental interactions with other benefits.
• Carer’s leave should be fully paid as a first step to support carers combining caring responsibilities with paid work.
• To protect their health, carers also need respite services, irrespective of any expectations to take up and stay in paid employment.
• Caring responsibilities should be considered alongside other protected characteristics under the Public Sector Equality Duty. Public bodies would then have to consider the impact of their policies and spending decisions on unpaid care.
• Recognise Covid-19 as an industrial disease for health and care workers as recommended by the Industrial Injuries Advisory Committee in 2023. This could be funded from the money to be recovered by the new COVID Corruption Commission ¹⁴ .
• The rise of the state pension age needs to be mirrored by an introduction of paid leave for carers ¹¹

The formal social care system also needs urgent and comprehensive reform to better provide high-quality care for everyone who needs it, turn care into a genuine choice for relatives and friends, and provide good pay and working conditions for its workforce:

• Market competition in the private sector coupled with local authorities purchasing time-limited ‘packages of care’ cannot deliver adequate short- or long-term social care services.
• Using a staged approach, replace the failing private sector models with in-sourced council provision based on co-produced models for domiciliary care services. During this transition, national standards will need to be applied to private sector provision together with setting and enforcing better pay and conditions for their workforce ¹⁵ .
• The creation of a new national body could work with local authorities to transform social care provision. It would set and enforce high standards of care provided by a valued workforce. A reformed and strengthened Care Quality Commission (CQC) should sit under it, alongside a new agency with responsibility for the regulation of the workforce ¹⁶ .
• WBG supports funding a Universal Care Service for all who needs it, funded out of a combination of progressive taxation and borrowing. Full recommendations and details can be found in WBG’s co-authored report with New Economics Foundation ⁶ . Central government grants to LAs should be based on up-dated formulae to take account of current inequalities between authorities.

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