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Is it now time for a national social care service?

As care homes emerge from the worst of the first wave of the pandemic, bodies representing owners, staff, residents and their relatives have all urged Boris Johnson to deliver on the pledge to fix social care that he made on the steps of Downing Street after becoming prime minister 11 months ago.

COVID-19 has left the social care system in a critical state. Of the 43,000 deaths directly linked to the coronavirus, around a third have been in care homes. With the total number of people living in care estimated at 330,000 in the last census, that means about one in 20 residents has died after contracting the virus.

Meanwhile, vulnerable residents are being forced to find new accommodation at short notice.

Closure of care homes

Many staff who survived the pandemic are now facing job losses as care homes shut down, hit by the rising cost of protective equipment, increases in the minimum wage and extra cleaning, set against lower income.

This is despite the government giving local authorities £3.2bn to help care homes. The problem is only £500m has so far been paid out, with some councils close to technical bankruptcy. Ministers have set up a taskforce in an attempt to persuade councils to part with the cash.

It beggars believe that the government does not insist on ringfencing such urgent funding.

National social care service

Senior care leaders are calling for urgent reform of the way Britain’s elderly population is looked after with the creation of a new national service. Christina McAnea, assistant general secretary of the union Unison and a member of the taskforce says: “We have to learn the lessons of what went wrong. That means quick change, not a new commission. We know the problems. We just need some proper decisions to be taken. We’re calling for a national care service, but we’re not precious about it – whether it’s part of the NHS or standalone or some other body. We’re saying that somebody has to take control of this.”

Every party has said how important social care is, and every one of them has kicked the can down the road

Now is the time for reform

Vic Rayner, executive director of the National Care Forum, said: “It is the right time and it has to be now. There is an absolute hunger in the sector for serious reform.”

She said the NHS’s new capacity tracker, which gives live information about the availability of beds in care homes, plus new data collection by the Care Quality Commission and the Office for National Statistics were “components of what we need to make up a centralised system of information” for ministers to understand what was happening in care.

“The fact that nobody anywhere could tell you how many people were in receipt of care tells you everything you need to know about the value placed centrally on care. The COVID lens has given us an opportunity to pull ourselves together.”

The experience of people in care has varied widely from region to region. In some areas, such as Somerset, partnerships have developed, with different bodies trying to integrate hospitals, care homes and home care staff. In others, the divide between health and social care has been stark. Councils in north-east England threatened to withhold funding unless care homes accepted confirmed COVID-19 patients.

Homecare workers left to fend for themselves

Dr Jane Townson, chief executive of the UK Homecare Association, said some homecare providers – who delivered assistance in people’s own homes said: “I was talking to a group of providers in Oxfordshire recently. They provide homecare into an extra care housing scheme. First of all, the social workers vanished. Then the housing managers vanished, and the cleaning company vanished, and the Care Quality Commission vanished, and the district nurses vanished. And the only people left were the homecare workers – the lowest-paid people of all. But they are the ones that were in every day to look after people.”


The pandemic has brought to the attention of people the important role played by social care workers in caring for people. But at the same time revealed a chasm between the organisation of the NHS and social care. A chasm in particular that is demonstrated by the lack of information about those who receive social care and the way social care is funded.

The dearth of information at the beginning of the pandemic, that may well have led to the death of residents in care homes, and the non-ringfencing of funding to local authorities resulting in the closure of care homes. Surely, if there ever was a time for reform it is now. Whether the call for a national social care service is answered is not the issue, what is needed is a properly co-ordinated and funded social care service in line with that of the NHS.

We must not forget the valuable contribution made by home care workers who continued to provide care when others were not prepared to take the risk.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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