Why it’s time to prioritise Welsh social care and give it funding parity with the NHS

Steve Thomas 

As the dust settles on Boris Johnson’s new health and social care levy where does it leave Wales?

BBC Wales News rather casual analysis that we are receiving £700m “extra’ through the Barnett formula was correct but only by failing to register the huge contribution that Welsh taxpayers will make.

Equally some of the crude nationalism that emerged suggesting that this was “Welsh taxpayers paying for the English social care” completely missed the point.

Fundamentally, young people and low-wage earners across Wales and the UK are subsidising some of the wealthiest in society.

As the editor of the conservative magazine the Spectator asked: “Is this really the Boris Johnson definition of conservatism: a protection racket, where the tools of the state are used to extract money from minimum-wage workers and pass it on to the better off”?

In essence, the Westminster National Insurance (NI) announcement was a fanfare not a fully costed plan.

But politics moves on and the Welsh Government now has £700m over the next three years to invest. It is now time to do something very brave – in short clearly prioritise this money for social care.

Why should they do this? Across the UK the number of over 85s will double in the next twenty-five years. Furthermore, those over 65 (18% in 2018) will rise to one in four of the population before 2050.

Let us also not forget children’s services within social care. Many councils in Wales can pay up to £1m per annum to purchase specialist support (usually from England) for a single child. This for a young person with a vast range of needs that require dedicated support for every hour of the day.

On a broader level travel just five miles down the Heads of the Valleys Road between Brynmawr in Blaenau Gwent and Gilwern in Monmouthshire. By doing so the number of children and young people in living in severe poverty doubles to over 20%.

NHS waiting lists

Already commentators in England have dissected the NI rise for what it is; more money to deal with NHS waiting lists. Sanjiv Javid’s refusal to say how much of the extra funding will eventually be transferred across to improve the broken social care system speaks volumes.

We know that in cash terms the £12bn plus extra for social care and health in each of the next three years is £10.8bn on health (85%) and £1.8bn on social care (15%). However, health demographics mean that the NHS is a financial sponge, it will soak up all this money and come back more.

In Wales, NHS spending now accounts for over 50% of the Welsh Government budget, compared with 39.1% in 2009-10. Welsh Government spending on the NHS is heading ever upward.

The historical adage that “Prussia was an army with a state attached” can be amended in Wales to the danger of “a health service with a devolved government attached”.

The Future Generations Commissioner recent budget observations hold true. The NHS “sucking up an increasing share of the budget every year to treat illness, is at the cost of services which have a focus on keeping people well in the first place such as libraries and community centres, social care and leisure services”.

Before I am accused of being anti-NHS let me state that the NHS is a precious resource and the greatest achievement of the reforming 1945 Labour Government. Yet the assumptions on its foundation in 1948 were based on a life expectancy for males at 65% and females at 70. We now consider someone dying in their sixties to be relatively young.

This demographic aging explosion is largely being dealt with in Wales as a secondary care issue. A recent personal trip to the new Grange hospital near Cwmbran confirmed a disproportionately high number of elderly people in accident and emergency. Research shows that frequent use of A & E increases the risk of suffering adverse effects such as hospitalizations, functional decline, complications related to treatment and procedures, and suboptimal follow-up.

Worst place

When it comes to older people with dementia it is difficult to think of a worst place for them to be located than on an hospital ward. The National Institute for Heath and Care Excellence (NICE) recognises that “hospital admission can trigger distress, confusion and delirium for someone with dementia. This can contribute to a decline in functioning and a reduced ability to return home to independent living”.

Social care is the service that can achieve the core social value of keeping them in this familiar environment as well as any advance care and support plans. And yet the service has become synonymous with the word “crisis”.

Significant real-term reductions in local government spending through the decade of austerity have led to the emergence of a cheap and not at all cheerful commissioning system. Care Forum Wales now give a “cheapskate” award to Welsh councils where the variance between the highest and lowest weekly fee per person is more than £12,000 a year.

Councils alternatively point to savage real terms cuts over recent years of over 50% to services like leisure to protect social care budgets. As for the people who provide the service the social care workforce finds itself in a profession that is paid at lower starting rates than companies ranging from Amazon to Aldi’s. The recent example of Covid-positive Anglesey carers allowed to work because of labour shortages sums up the scale of the problem.

The future of funding for social must be driven by the findings of the seminal 2017 report on Wales by the Health Foundation (“The Path to Sustainability”). All Welsh Ministers have regularly thumbed this document for NHS investment decisions. But its key message lies in delineating the more significant financial problem of social care.

The report estimates that pressures on social care will rise by at least 4.1% a year between now and 2030/31, due to demography, chronic health conditions and rising costs.

Demand

This requires social care budgets to almost double by 2030/31 to match demand. This rate of growth is higher than that expected for the NHS, as social care is heavily concentrated on the frailest and elderly, often with co-morbidity, and a growing population of people with learning disabilities.

Welsh Government Ministers now have a clear choice. Like the Westminster Government they could choose to shroud the allocation of their £700m over three years in opaque ambiguity leaving the service and taxpayers fundamentally confused.

Alternatively, rather than a 15% to 85% allocation as in the English setting why not employ a parity funding criterion. As a starting point, 50% to the Welsh NHS and 50% to social care? In doing so also devise a scheme for raising revenue that is sustainable in the long term that does not penalise the young and low earners.

There are plenty of ideas of how to do this in Wales not least the insurance-based proposal of Gerry Holtham and Tegid Roberts to create a sovereign wealth fund with the over 50s making larger contributions.

A sustainable NHS entirely depends on a sustainable social care system, as care and support is essential in supporting people of all ages to live their best life as well as alleviating pressure on the health service. Also recognise that this crisis was brewing well before Covid 19.

The Welsh Health Minister Eluned Morgan has a commendable record proposing radical reform of social care and recognising the current system is broken. As it stands Cathays Park has produced enough social care strategies and plans to fill the National Library in Aberystwyth.

The NHS may well be the state religion but it’s time for some Welsh non-conformism on social care.