If social care reform was a priority before Covid-19 hitting, then the pandemic has only heightened the urgent need for a new settlement. Of course, finding a funding solution is vital. The Health and Social Care Select Committee noted as much in their recommendation last week for an additional £7bn for social care, just as a “starting point” that would not address unmet care needs nor improve access to care. But funding alone will not transform our social care system in a way that meets the needs of an ageing population – no matter how much is spent.
That is because as well as deciding how social care is funded, we need to reflect on where social care is delivered. Currently, there are basically two choices in the UK: care at home or a care home. Both of these options are vital ones that will without question continue to play a key role in the provision of social care. Firstly, many people want to stay living in their own home for as long as possible for the independence that it brings, and so good-quality homecare is pivotal. And secondly, many people in the last few years of their life need a level of care that requires moving into a care home where they can receive 24/7 support.
But having these as the only care options for older people means we just cover both ends of what should be a wide and diverse spectrum. If an older person starts to consider whether the family home they have lived in for years is still right for them, and wants to move somewhere with a little more support and, if needed later down the line, care, should their only alternative really just be a care home?
Thankfully, other choices are starting to emerge in the form of “housing-with-care”. This middle option stands between care at home and care homes. It offers independence through older people renting or owning their own flat, while having 24/7 staff on site, the option of CQC-regulated social care if needed, and a wide range of communal services and facilities, from restaurants and bars through to gyms and activity rooms. It is often integrated with the wider area, attracting people of all ages to enjoy activities and events at what becomes a community hub.
The limited amount of housing-with-care in the UK has already shown itself to encourage an active, socially connected lifestyle and improve the health and wellbeing of residents – which reduces the need for GP and hospital visits and takes pressure off the NHS.
But “limited” really is the word when it comes to current housing-with-care provision. Compared to more than 450,000 care home beds, there are just 70,000 housing-with-care units. This means only 0.6% of over-65s have the opportunity to live in housing-with-care in the UK, whereas in countries like New Zealand, Australia and the US, the figure is at least 5-6%. That’s despite growing demand in the UK, and increasingly long waiting lists. Popularity is also rising among UK politicians, with 18 MPs and Peers signed up as official Parliamentary supporters for housing-with-care, and Labour’s Shadow Minister for Social Care, Liz Kendall MP, understood to be interested and supportive.
The key question for policymakers is: if funding alone is not going to transform social care in the way needed, what is? What policies will enable a greater diversity of social care settings to evolve, so that older people no longer have to choose between two extremes? Some key steps include clearly defining housing-with-care in the UK planning system (it is currently non-existent) so that it is easier to build, and introducing stronger consumer protection regulation for the sector. Work must also be done to ensure housing-with-care is affordable for all: two-thirds of current supply is affordable extra care, and this should be built upon.
But answering the policy question fully will require different Government departments to collaborate. Housing-with-care cuts across different departments: health and care integration likes with the Department of Health and Social Care, planning policy with the Ministry of Housing, Communities and Local Government, and consumer protection with the Department for Business, Energy & Industrial Strategy. The best solution is a new Housing-with-Care Task Force that cements cross-government working to recommend the most appropriate policy changes.
None of this is to say that with an expanded sector everyone will want to live in housing-with-care. Just look at New Zealand, celebrated as a world leader in housing-with-care: still just 5.5% of over-65s live in this setting. Most older people will continue wanting to live in their own homes for as long as possible, which is why adaptations to make existing homes more age-friendly, and building more new homes fit for all ages, is vital. Care homes will always have an important place for those with high-level needs in the last years of life.
Increasing the diversity of our social care system is about complementing existing options. It is about giving older people more choice. While solving the social care funding crisis is crucial, we must also pay urgent attention to where social care is delivered. The Government can ensure a brighter future for older people if it acts now.