Unpicking the health and care levy: considerations for social care

We welcome the planned introduction of a long overdue cap on lifetime social care costs for individuals in England, but there are a number of questions that need answering as we await the release of the Government's White Paper to follow later this year.

Long before the Covid-19 pandemic began, the future plans for sustainability and long-term reform for social care were hanging in the balance, with the country eagerly anticipating how the Government would bring about change. After plans were delayed and previous Governments choosing to overlook the sector-wide challenges, on 7 September 2021 the Government announced plans to introduce a health and social care levy to inject much needed funding into the sector. The announcement marks a record level of funding for both the NHS and social care, through a 1.25% increase in National Insurance, but how will this change in policy really benefit those most vulnerable in our society and their carers – and provide the dignity and peace of mind that they deserve?

Breaking down the ‘Build Back Better’ Paper

We tentatively welcome the plans introduced by the Government to support the health and social care sector, most significantly on the introduction of a cap on lifetime social care costs for individuals in England, which aims to prevent people needing to pay unprecedented costs for their care, now capped at £86,000. The paper states that “no eligible person starting adult social care will have to pay more than £86,000 for personal care over their lifetime”. This appears to make it clear that any care costs paid before October 2023 will not contribute toward the cap – meaning that many people who’ve already paid thousands towards their care will ‘start from scratch’ in working towards the new cap, but this isn’t explicitly confirmed. This is one of several areas found in the ‘Build Back Better’ policy paper that present unanswered questions, particularly around adult social care.

The pledge to increase the upper capital limit for means-tested support from £23,250 to £100,000 is likely to significantly increase the number of assessments adult social care departments will need to undertake. Local authorities will therefore need additional funding to manage this increase in demand – but is this factored into the new money being raised from taxation? In fact, of the £36bn announced to go to England over the next three years, social care is likely to see only £5.4bn, compared with £30.6bn for the NHS.

Much discussion has already taken place around the distinction between ‘personal care costs’ and any accommodation-related costs for those in care homes – and how this might be calculated, but another theme that needs to be considered is whether the Government intends to define what ‘personal care’ actually means. For example, many individuals’ care and support packages are wide ranging and can include support for eligible needs with social participation, accessing the community, accessing work, managing childcare and staying safe. On top of this, working-age adults’ care and support costs can make up around half of most local authorities’ expenditure on adult social care – and our analysis work over the years has shown that many care and support plans contain costs relating to ‘shared hours’, for example overnight support within supported living settings. Is this going to count as ‘personal care’?

There appears to be a significant focus within the policy paper on older adults (including the case study examples); we think this is a missed opportunity for the Government to demonstrate their understanding and commitment to supporting people of all ages with social care needs, which is hugely important.

Unanswered questions on top-up care costs

The biggest area lacking clarity at this point and highlighted within the plan is around top-up funding. The paper states that people can: “top up their care costs by paying the difference towards a more expensive service, but this will not count towards the cap”. For people living in independent community settings, a more expensive service could mean someone choosing to pay a higher hourly rate for better or more tailored care and support. It could also mean people choosing to purchase longer care visits than would be commonly commissioned through a local authority (such as one hour instead of 30 minutes). The Government is yet to set out how these top-up amounts will be calculated and monitored on an ongoing basis.

For self-funders who are assessed as having eligible needs, local authorities will need to be able to monitor progress towards the new cap, requiring a new way of determining the amount of funding these individuals would have received (for only their eligible needs) had they not been self-funding. Additionally, as needs change over time, technology will become vital for carrying out regular care reviews and monitoring changes in need over time. We have provided tools which facilitate a fair and consistent approach to support resource allocation for a large number of local authorities over the last 11 years and we can use our wide-ranging experience in this area to be part of the conversations that help shape the detail of the ‘Build Back Better’ policy.

Supporting unpaid carers for future sustainability

While the Government states within the paper that 5.4 million unpaid carers will have the support, advice and respite they need, there is no indication on how this will be implemented. In our work with local authorities, we see big differences in the way unpaid carers are assessed and provided with funded support; this needs to be actioned and prioritised by the Government. We also think that the care cap policy introduces a risk of unpaid carers who provide a proportion of support to those with high care needs, choosing to stop providing support when the care cap is achieved as there would no longer be a potential charge for replacing their support with paid care. This potential risk needs to be considered to ensure the long-term sustainability of the system and the quality of care given.

The Government’s latest announcement provides a much-needed funding boost for health and social care at a time when the sector needs it most. The plans outlined in the ‘Build Back Better’ Paper provide a useful platform to bring key changes throughout social care. However, this is only laying the initial foundation for change; there are a number of key questions that need answering around how the policy will work in practice, not to mention how much more additional funding social care will need on top of the £4.5bn outlined. We look forward to reviewing the White Paper to follow later this year and how we can all work together towards stabilising social care throughout England in the months and years to come.