This month, Bridgehead Communications managing director William Walter writes on Labour’s reforms to social care, the upheaval at the CQC and the continued difficulties unpaid carers face.

‘Not fit for purpose’

It seems impossible not to start with the groundbreaking interim report released a few weeks ago on the Care Quality Commission (CQC). Nor is it possible to understate how damning it is. Social care providers have been forced to wait far too long for ratings to be updated, and over half of all registration applications were over two and a half months old, more than double the previous year, to name a few.

Wes Streeting, health and social care secretary, declared that “the CQC is not fit for purpose” and has “been stunned by the extent of the failings of the institution”. However, the CQC’s shortcomings are unsurprising for many in the sector. Sam Monaghan, chief executive of Methodist Homes (MHA), feels that “there was a lack of proper consulting with providers even before the single assessment framework”, and that the organisation has become “uncontactable”.

This view was echoed by Nadra Ahmed, co-chairman of the National Care Association (NCA), who notes that the “CQC has moved towards a more remote way of working”, which he suggests has contributed to “this complete breach of trust in the organisation”.

The answer to how best to move forward from this is more uncertain. Some have argued that separating health and social care responsibilities would provide greater specialisation for regulators. But this is not a universal view. Ed Watkinson, director of Watkinson Consulting, with a history of advising the CQC, argues that such a move “would be a step back to pre-2008” and that, instead, “social care needs to be fully recognised for the important role it performs… under the umbrella of [the] CQC”.

Most providers want the existing system to work for them. For Care Campaign for the Vulnerable (CCFTV) founder Jayne Connery, restoring relations with the sector is essential. She said: “Prioritising stakeholder engagement, including input from families and carers, will ensure that regulatory reforms meet the real needs of those relying on care services.”   

Labour’s dashed ambitions for social care

With a new government elected at the beginning of July, many in the sector were hoping that the desperate need for greater political attention to social care could be realised. However, these hopes have clashed with reality. 

Chancellor Rachel Reeves’ spending audit involved the long-delayed and much-needed cap on social care costs being delayed indefinitely, despite Labour committing to it during the election campaign. 

The shock of the decision, as well as its impact, is enormous. Andrew Dilnot proposed a cap 13 years ago and has now said the government has “failed another generation of families”. Lucinda Allen, senior policy officer at the Health Foundation, notes that the cap proposed by the Conservative government, even by 2035/36, would have only cost around 2% of the current annual NHS budget.

When he was Prime Minister, Tony Blair declared he did not want pensioners to sell their homes to afford care. Almost 27 years have passed and, in that time, little has changed.   

An area of social care reform not yet abandoned by Labour is its manifesto pledge to introduce a new National Care Service. What this means in practice remains unclear. Allen adds that “a system more like the NHS” would be a significant change compared to the existing framework. However, in our interview with now Secretary of State for Work and Pensions Liz Kendall, she was at pains to stress that it would not be NHS 2.0, which begs the question: what will it be like?

Natasha Curry, deputy director of policy at the Nuffield Trust, stresses how difficult Labour’s plan is to judge without further detail. What she does support, though, are aims to standardise care. “I think there is merit in working towards a more consistent offer that addresses unfairness of local variation,” she said.

Most pressing of all is the shocking level of pay for carers working in the sector. “Care workers are among the lowest paid in the UK and more likely to live in poverty than other workers,” noted Allen. Sam Monaghan believes that delivering “fully funded fair pay” is essential to “address issues of recruitment and retention”.

Given vacancies remain at a staggering 131,000 and that demand for care professionals is only set to increase in the years ahead, attracting staff to the sector is crucial. Labour plans to address this with its Fair Pay Agreement for the industry. The success of this will depend on the commitment to fund pay rises. A fifth of local authorities face bankruptcy in the coming year, and the central government must finance any increase in staffing costs.  

Without Labour stepping up to the task and putting its money where its mouth is, fair pay in the sector remains little more than empty words.  

Silence on unpaid carers continues

Finally, one part of our social care system routinely ignored is the work done by unpaid carers up and down the country. This was an issue explored in detail by GoodOaks Homecare earlier this year. Labour has promised to review the carer’s allowance but committed to little else.

The position of unpaid carers is clearly challenging. “The recent ADASS survey found that the level of need among carers has increased with many reporting high levels of burnout,” said Curry. She adds that the Nuffield Trust’s research revealed decreasing support from the state to carers in recent years. The Health Foundation’s Lucinda Allen also notes that a new national carers strategy, promised for a decade, has never been produced.  

Given the value of unpaid carers, providing as much as £164 billion worth of care a year – the same as the NHS’ annual budget, more attention needs to be paid to making that care manageable. This starts with ending the thousands of pounds in fines issued to those claiming carer’s allowance. Supporting carers goes beyond the financial and gives greater flexibility and freedom, however.  

“As an unpaid carer to my mother Ellen for many years, I understand the critical role unpaid carers play in the social care system,” said Jayne Connery. She suggests that the new Labour government should provide respite care to give care providers the chance to go on holiday or even just a break from the exhausting work of daily support.

Whether this will make its way onto the political agenda remains to be seen. However, the need for greater government and regulator support, funding and direction is as clear as ever.