Story updated 8 December
With just a few days to go until polling day, both major parties have set out their stall in relation to adults’ and children’s social care.
The Labour Party’s offer is much more extensive – and expensive – than the Conservatives’, but both parties’ manifestos leave many unanswered questions as to what they would do should they win power on 12 December.
This is despite care for older people and disabled adults ranking as the joint third most important issue for voters, behind only the NHS and Brexit, according to a poll last month from Ipsos MORI.
Community Care has taken a closer look at the party manifestos, published late last month, and unpicked what the two main parties are promising the social care sector in this election. While Labour provided a response to our requests for further detail, the Conservatives did not, so our analysis is limited by that.
Where is social work?
While social work never features heavily in party manifestos, the 2015 and 2017 Labour and Conservative manifestos mentioned the profession briefly. In 2015, both parties highlighted their support for Frontline – which started training children’s social workers through its fast-track programme in 2014.
In 2017, the Tories highlighted their record on investing in children’s social work – for example, through funding for the innovation programme, Frontline and social work accreditation – whereas Labour, echoing sector concerns about the emphasis on fast-track training under the Conservatives, voiced its support for all training routes. Also, in reflection of the shift in the party under Jeremy Corbyn, it set out its opposition to private sector companies or their subsidiaries running child protection services. This was a response to concerns that legislation allowing charities to take on the running of children’s social work services would result in private companies setting up charitable arms to do so.
Social work in past manifestos:
Conservative manifesto 2015: “We will continue to raise the quality of children’s social work, by expanding training programmes, such as Frontline, and creating new opportunities to develop the next generation of leaders in the field.”
Labour manifesto 2015: “We will continue to support Frontline and its innovative approach to training social workers…”
Conservative manifesto 2017: “Our investments in the social work profession and in successful, innovative programmes have given tens of thousands of vulnerable families the coordinated support they need.”
Labour manifesto 2017: “We will continue to support all training routes for social workers, including initial social work training provided within or accredited by a higher education institution. We will also prevent the private sector and subsidiaries of private companies from running child protection services.”
But none of the 2019 manifestos – not just Labour’s or the Conservatives’ but also the Liberal Democrats’, Green Party’s, Scottish National Party’s, Brexit Party’s and Plaid Cymru’s – mention social work at all. This is despite Labour and the Tories both setting out distinct policies in relation to nurses, teachers and police officers this year, including in relation to raising the numbers of staff.
The omission is likely to reflect a number of factors. The profession’s historic low profile and status relative to its public service counterparts means that that promising to create several thousand new social work posts does not carry the same weight with the electorate as doing the same in relation to nurses, teachers and police officers.
For the Conservatives, the social work policy blitz they carried out in the early part of the decade has likely run its course, whereas for Labour there are perhaps no eye-catching policy options in relation to the profession with which to tempt voters.
However, what it means is that the profession goes into the election without knowing what, if anything, will happen to it after the election.
But though social workers are not mentioned by name, they would benefit from Labour’s plans for a 5% rise for all public sector workers next April, the start of what the party intends to be a move towards restoring pay to pre-financial crisis levels following several years of caps and freezes. There are no commitments on public sector pay from the Conservatives.
Tackling adult care funding pressures
Both parties address key issues in adult social care funding – resourcing the current system and setting out longer-term reforms – but in radically different ways.
In relation to the current system Conservatives’ main social care policy is an extra £1bn a year for the sector for every year of the new parliament, which is due to run until the end of 2024. This matches what the government has provided for the coming year. If that funding is distributed based on their current approach, the money would be spent on both children’s and adults’ services. On past experience, councils have split this money fairly evenly between the two services.
Richard Murray, chief executive of health and care think-tank the King’s Fund, said: “The additional £1bn to give short-term boost to social care services for both adults and children is not enough to meet rising demand for care while maintaining the current quality and accessibility of services.”
Labour’s approach is much closer to the sector’s demands to address a funding gap between available resources and that required to maintain services that will reach an estimated £3.5bn by 2025, according to the Local Government Association.
The party said it would reverse these cuts and “provide additional care packages to support both older people and working-age adults living independently in their own homes”.
A spokesperson said would provide “160,000 more care packages through addressing the funding crisis in social care”. In 2018-19, 841,850 people in England received a long-term care package from their council, down by about 30,000 since 2015-16.
The Institute for Fiscal Studies has said that Labour’s plans involve increasing annual funding for the current system by £3.5bn a year – equivalent to the LGA’s estimate of the future funding gap.
Building a consensus on long-term reform
In 2017, the Conservatives promised a green paper on reforming adult social care would be published that year. But well over two years, and multiple delays later, it remains unpublished.
The party also seems to have rowed back from a promise it issued in the Queen’s Speech in October to “bring forward substantive proposals to fix the crisis in social care to give everyone the dignity and security they deserve”, including “setting out legislative requirements”. By implication, such proposals would be published within a year.
Instead, the Conservative manifesto argues that, because social care is a “long-term problem” the party will “build a cross-party consensus to bring forward an answer that solves the problem, commands the widest possible support, and stands the test of time”.
It continues: “That consensus will consider a range of options but one condition we do make is that nobody needing care should be forced to sell their home to pay for it.”
While the manifesto set no timescale for this, nor any details about how the Conservatives would go about this, the Conservatives subsequently said it was something they would do in the first 100 days of being re-elected.
This will be no easy task in the context of the deep animosity between the two party leaderships, though Labour shadow health and social care secretary Jonathan Ashworth told Sophy Ridge on Sky on Sunday 8 December that the party was prepared to talk.
Murray said that “cross-party talks without a concrete proposal are unlikely to deliver meaningful reform”.
“Despite making a similar pledge to bring forward reform in 2017, social care funding has once again been put back in the too difficult box,” he said.
Murray added that viewing the debate only in terms of older people not being able to sell their homes was “disappointingly narrow framing of the problems in social care”.
Home sale pledge ‘of little help to younger adults’
A similar concern is found in the Association of Directors of Adult Social Services’ statement on what the next government should do for adult social care, published last month. “Removing the requirement to sell your home to pay for care will do little to help many working age disabled people who haven’t built up assets over time like many older people have,” the statement said.
The Institute for Fiscal Studies (IFS) has interpreted the Conservatives’ commitment as meaning that they would remove housing wealth from the current means-test for long-term residential care. Under this, a person must, other than in specified circumstances, pay the full cost of residential care if they have more than £23,250 in assets including their house, if they own it.
The IFS said: “Whether this is even a step towards fixing the system is debatable though, as it could mean unfair differences between people who hold more of their wealth in their house and those who hold more of it in financial assets – such as those who have traded down, or have been renting. It could also cost several billion pounds, which is unaccounted for.”
It is also unclear how any such scheme would relate to deferred payment agreements, which prevent many people from having to sell their homes while they’re still alive, by providing them with a loan to fund their care levied against the value of their home.
It’s available for homeowners, living alone, who have savings and capital of less than £23,250, not including the value of their home. The homeowner must sign a legal agreement with the council to confirm the money owed will be repaid when their home is sold.
Labour’s free personal care plan
Again, Labour plans to go much further in relation to long-term reform. Its flagship policy is to introduce free personal care for people over the age of 65, which will cover help with daily tasks such as getting in and out of bed, bathing and washing, and preparing meals, in people’s own homes and residential care. This would cost £6bn a year, equivalent to a third of local authorities’ current gross expenditure on adult social care.
There is currently no timescale for it to be extended to younger adults, whose care accounts for half of councils’ social care spending, an omission which think-tank the Nuffield Trust labelled a “missed opportunity”.
When asked about plans to extend the policy to younger adults, a party spokesperson said: “Labour will look closely at this in government.”
As well as the restriction on the policy to older people, ADASS also raised other concerns about it in its statement on the election: “Free personal care will also make it sound to the public like care is free; however, this will not cover accommodation/hotel costs, which are a very substantial cost and would need to be paid for. It also risks creating a hierarchy within disability, whereby physical care needs are prioritised above mental health needs.”
In terms of other reforms to care funding, Labour would also put a cap on care costs so that no one has to pay more than £100,000 to their care. This has an echo of the £72,000 cap on care liabilities that the government had planned to introduce in 2016, under the Care Act, before dropping the policy in 2017.
Richard Murray, chief executive of The King’s Fund said: “Free personal care and a cap on personal contribution to care costs won’t solve all the challenges facing social care services, but the policy would represent a significant step towards a fairer system and bring it more in line with an NHS that is free at the point of use”
Labour has also suggested it would amend the current eligibility criteria for adult social care, set out in regulations under the Care Act.
The Labour manifesto promises to “develop eligibility criteria that ensures our service works for everyone, including people with dementia”. When asked what this meant and how they were planning to change the criteria, a Labour spokesperson repeated the pledge in the manifesto with providing additional detail.
Children’s social care policies
On children’s social care, there are similarities between the parties’ positions, though again Labour’s plans are more ambitious.
On funding, the Tories will provide additional resource for children’s social care through its extra £1bn a year for the sector as a whole. While Labour does not make a specific funding commitment on children’s social care, it is pledging to provide an extra £5bn a year for local government by 2023-24, excluding its adult social care commitments, which should see significant resource siphoned into children’s services.
Meanwhile, both parties have pledged to carry out a review into the care system. This seems sensible in the context of widespread concerns over a lack of capacity in the system, following the 25% rise in the number of looked-after children since 2008, leading to large numbers of out-of-area placements and young people being placed in unregulated, and sometimes unsafe, settings.
However, there is little detail from either party over what their reviews would consist of. The Conservatives say they want to“prioritise stable, loving placements for children in care, adoption where possible or foster parents recruited by the local authority”. Prioritising adoption was a key plank of government policy during Michael Gove’s tenure as education secretary from 2010-14; however, since he left the post the numbers of adoptions have plummeted from 5,360 in 2015 to 3,820 in 2018. It’s not clear what the Conservatives would do to reverse this, nor where they stand on the role of connected carers or residential care.
Labour provides marginally more detail on its review, saying it would consider a central register of foster parents and the regulation of currently unregulated semi-supported housing placements for young people.
There are also similarities in the parties’ pledges relating to preventing children coming into care in the first place.
The Conservatives say they would “improve the Troubled Families programme” – which seeks to “turn around” families with multiple problems – and “champion family hubs” to provide “intensive integrated support” to “vulnerable families” so they can care for their children. While family hubs – an expansion of the children’s centre model – have been championed by the children’s commissioner, among others, the Conservatives have provided no detail on how such provision would be expanded and with what price tag.
Labour promises to “rebuild early intervention services and replace the Troubled Families programme with a Stronger Families programme”, which will be designed to provide long-term support to prevent children going into care. Again, this is the extent of the detail provided, though the party does have clear funding commitments to increase funding for youth services by £1.1bn a year by 2023-24 and provide £1bn to open 1000 Sure Start children’s centres.
Mental health and learning disabilities
Both parties are intending to reform the Mental Health Act 1983 as was recommended by the Independent Review of the Mental Health Act.
The government pledged to do this at the time of the review’s report (December 2018) and in the Queen’s Speech. But the Labour manifesto gives more detail of what they would do, saying they would implement the recommendations of the review in full, whereas the Tories say they will legislate so that patients get greater control over their treatment and receive dignity and respect, reflecting key themes in the review.
Meanwhile, Labour said it would double annual spending on child and adolescent mental health services. The Conservative manifesto has no reference to increasing spending in this area.
Both parties are saying they will support more people with learning disabilities or autism to move out of hospitals and be supported in community settings.
Labour says this will be facilitated by their increased spending on social care and the Conservatives by providing £74m over three years to provide additional capacity in community settings.
Labour is also promising to spend £2bn on modernising hospital facilities to “make them more suitable for people with mental health problems and reduce the use of inappropriate, out of area placements”.
When asked to elaborate on this, a Labour spokesman said: “Many people who need inpatient mental health services are stuck in outdated dormitory style wards and the mental health estate has been described as some of the worst estate the NHS has.”
He continued: “Labour will ensure more people receive care in modern hospitals that are suitable for them and where needed this will mean more beds in areas that are sending patients out of area.”
Possible election outcomes
There would clearly be big differences between the outcomes for social care under a Labour or a Conservative government, with the former promising a much greater degree of change and much more funding.
However, experts including the Institute for Fiscal Studies have questioned whether Labour would be able to raise the sums from taxation they require to finance their ambitious spending programme and whether manifesto is a realistic prospectus for a five-year term or more of a longer-term vision for changing society.
Also, while the large Conservative lead in the polls appears to be shrinking somewhat, on average, the range of likely election outcomes range from a large Tory majority to a hung Parliament that allows Labour to form a minority government.
Whether this scenario would allow Labour to put into practice its radical programme carries a very big question mark.