Faced with unprecedented challenges, the UK and Scottish governments are both taking bold steps to address the state of both health and social care.

While Boris Johnson has shown he is willing to renege on a key election promise to raise revenue, Nicola Sturgeon has risked the wrath of Scotland’s councils by stripping them of responsibilities as she looks towards wholesale redesign to create a national care service.

Despite the Prime Minister having boasted that his government was finally taking on an issue that governments had dodged for decades – social care reform – care still looks set to be the poorer relation.

Analysis of the proposals from the Resolution Foundation shows that while £25bn of additional funding will go to the NHS over the next three years, only £5.4bn will go to social care. All this as other departments face cuts of £16bn a year by 2024-25, according to the Foundation.

Despite such a confident claim from Mr Johnson, scant details have been released on whether the way in which care is delivered will be reformed.

Unlike in Scotland, the emphasis appears to be about finding additional funding for existing systems rather than creating new structures. No mention, for instance, from Mr Johnson of any change to the role of England’s councils in organising care packages, and no suggestion so far, that social care might, as in Scotland, extend beyond adult social care to include children’s services, community justice, alcohol and drug services, or the creation of a new social work agency.

Private insurance alone will not be relied upon because demand would be too low for insurers to offer an affordable price, he explained. The Prime Minister also dismissed a universal system of free care for all as “needlessly expensive when those who can afford to contribute to their care should do so”.

Instead, England will look to set a limit on what people can be asked to pay. The Prime Minister added: “We will be working with the financial services industry to innovate and to help people insure themselves against expenditure up to that limit.”

Currently in England there is no standardised system of care fees, leaving many subject to a ‘postcode lottery’ as demand has been steadily rising.

Far more details were set out when it came to the NHS.

Addressing MPs on Tuesday, Mr Johnson said he wanted to carry out “the biggest catch up programme in the NHS’ history” and increase capacity in England to 110% compared to pre-pandemic levels to deal with the covid backlog.

A similar commitment was made in the Scottish NHS recovery plan last month – though a pledge to achieve this within one year was quietly ditched by Scottish ministers amid claims it was “unrealistic”.

Instead, the Prime Minister focused on how much money will be made available to tackle the “catastrophic fear” he said so many experience of “losing everything” to pay for social care.

In Scotland however, recent conclusions of an independent review of adult social care spurred the government to formulate more detailed proposals for a National Care Service – and to go further than even the review was recommending.

Consultation on the government’s plans is currently underway, which include taking children’s services, community justice, alcohol and drug services and social work elements of mental health services, out of the hands of councils and into the remit of a new National Care Service. Responsibility for managing GPs’ contracts would also move from the NHS to a National Care Service.

While Mr Johnson’s plans place a cap on what people will pay for care, the First Minister has pledged to abolish non-residential care charges entirely, funded with an additional £800m for over the next five years. Charges for care home accommodation - energy, food and cleaning, for example, will remain.

Issues with recruitment and retention linked to low pay persist across the UK.

The UK government has talked about the need to pay care workers more but has not yet gone so far as the Scottish government, which yesterday committed to introducing national bargaining and has said it will bring in a national wage for care staff.

Under the UK government proposals, which would come into effect from April 2022, National Insurance and the tax on share dividends will go up by 1.25%. From October 2023, no-one in England would have to pay more than £86,000 for care over their lifetime.

In England, the state will fully cover the costs of care for anyone with assets of less than £20,000, and those with assets between £20,000 and £100,000 will receive some means-tested state support.

Under the Barnett formula, some £1.1bn annually of the £36bn that the changes will bring into the Treasury over three years will be handed on to Scotland, rather less than the additional spending the Scottish Government has committed to the NHS Recovery Plan and setting up the National Care Service.

Ms Sturgeon did assure MSPs earlier in the week that any additional money from yesterday's tax rises would not be diverted to other areas of spending.

Across the UK, the promise to raise tax on share dividends has done little to diffuse the significant backlash that Mr Johnson’s proposals have prompted, including from the Conservative backbenches.

During a statement to the House of Commons, Boris Johnson said the decision to raise National Insurance was “difficult” but that to have instead raised borrowing to meet the costs of care would have been “irresponsible”.

The Scottish Trades Union Congress has labelled the Prime Minister’s tax rise a “declaration of war” on working people, and young taxpayers particularly.

Despite this, MPs have voted 319 to 248 in favour of the 1.25% point rise in National Insurance for workers and employers to help fund health and social care. 

Mr Johnson said a white paper on the integration of health and social care would be introduced to the UK Parliament later this year – a point at which more details may emerge on whether the government intends to follow Scotland and intervene in the mechanics of how care is delivered and by whom.

 

Read more: FM signals national bargaining in NCS; Christie’s clarion call can’t wait another decade; Insight: The discovery of hindsight in social care; Comment: Is a deal with private hospitals inevitable?; What can England learn from Scotland on integration?

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