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Wednesday, September 29, 2021

Boris Johnson’s care crisis ‘band-aid’

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LONDON — Boris Johnson’s winning the politics of England’s care crisis — but those at the sharp end want to see the receipts.

The U.K. prime minister this week gambled on a politically-risky tax hike to address a decades-long crisis in social care, which offers day-to-day support for elderly and vulnerable adults but is under severe strain amid rising demand and chronic under-funding.

Westminster observers say he’s dodged “real trouble,” and he’s earning plaudits for starting to tackle a problem that dogged his predecessors. Yet those working in the care sector — and some in Johnson’s own party — fear his big spending pledge will do little to calm a perfect storm of staffing problems already hitting those meant to lead the turnaround. And they question whether the amounts of money promised will do very much at all.

The announcement itself was carefully managed, with a drip-drip of briefings to the press about the national insurance rise and soundings-off from critics in the week before parliament returned, so that when it eventually landed on Tuesday, the backlash was not as fierce as many had expected, even among those inside government.

There was no fierce or sustained anger from the Conservative back benches after Johnson’s statement in the Commons on Tuesday, and opposition Labour leader Keir Starmer’s attack during a regular session for MPs to question the prime minister on Wednesday fell somewhat flat. Johnson was able to say in response: What’s your alternative? 

A government official said: “I thought it was going to go down a lot worse. If the old bigwigs like the Damian Greens of this world had put forward an actual proposal, we could have been in real trouble. And they didn’t. It was just kind of whining and whinging.”

The same official claimed a hotly anticipated reshuffle of Johnson’s ministerial team — rumored to be due this week — was put on hold in part because no serious revolt materialized and therefore there was no need to terrorize the rank-and-file.

Away from Westminster, however, representatives of the care sector are less convinced Johnson’s made much headway in confronting the underlying issues. And it’s the immediate concern about staffing that they say should be at the top of his list.

“We have a social care crisis right now, and it can’t wait for people to draft [a promised white paper], and then delay any funding and any staffing changes for another two years,” said Jeremy Richardson, chief executive officer of Four Seasons Health Care, which runs a major chain of social care providers.

Care workers already face low wages for highly regulated work. They spy better opportunities in other sectors. They face mandatory COVID-19 vaccinations. They’re grappling with the loss of EU colleagues who left after Brexit and didn’t come back. And they’re stuck with an immigration policy that precludes most overseas care staff.

It’s little wonder that turnover in the sector stands at around 30 percent for care workers and 40 percent for nurses. Mandating vaccines alone — a move designed to better protect a population particularly hard hit by coronavirus — has contributed to 40,000 unfilled jobs, Richardson said.

If Johnson’s care plan goes some way to outlining how staff will become “professionalized,” it does not, say those in the sector, get to the heart of its retention dilemma. “We cannot run on those levels of turnover. We need stability,” David Behan, chair of care home provider HC One, told the BBC Wednesday.

The government pledged “further reforms to improve recruitment and support for our social care workforce” and there’s a white paper due later this year on its plans. But in the meantime, policy analysts see a void where some of the details should be. Johnson, said the Institute for Public Policy Research think tank, has “ducked [the] question of reforming the structure of social care, including higher workforce pay and quality of services.”

Natasha Curry, deputy director of policy at the Nuffield Trust think tank, said there’s now a race against time to keep a “flexible workforce” committed to the profession. “As we head into winter, care workers often head into retail,” she said, illustrating that if they can find better working conditions and pay elsewhere, they will switch jobs. “We went into the pandemic with 112,000 vacancies at any one time,” said Curry. Today, “that figure is rising.”

Richardson, of Four Seasons, urged ministers to get a move on. “My plea to government would be to get the white paper done as quickly as possible, and make sure [changes] get actioned as soon as possible.”

Uncertain cash

Much of Tuesday’s announcement focused on how the tax hikes themselves will work. But there’s concern the actual amounts offered to the care sector won’t be enough.

The Institute for Fiscal Studies calculated that the sector will receive £1.8 billion a year for the first three years of the new plan — but around half of that could then be swallowed up by a new £86,000 cap on the amounts care residents have to personally pay toward their care. The cap kicks in in October 2023 and replaces a system that currently has no cap and often forces people in England to sell their homes to foot the bill.

With half a billion pounds over three years also ring-fenced for workforce training, much less is left than providers had hoped for, even if ministers have promised that more of the annual £12 billion tax haul generated will come the care sectors’ way in three years’ time.

The government is allocating much of the immediate cash to tackling a major backlog of treatment that’s built up in the National Health Service during the pandemic. Once that is resolved, they say more funds will be diverted to social care.

While such promises are welcome, the care sector wants firmer guarantees. The eventual diversion of funds is not explicitly mentioned in the care plan published this week, nor in a government motion passed Wednesday authorizing the new tax.

“Politicians generally have a habit of saying one thing and then either doing something else, or not following up, so my confidence levels at the moment are not high,” said Richardson of Four Seasons. Former Care Minister Norman Lamb, an ex-Liberal Democrat MP, observed how money given to the NHS can be virtually impossible to then take away.

Political fix

Still, Johnson can breathe a sigh of relief at how the week has played out. Prime ministers from Tony Blair onwards have struggled to find the right moment to launch their preferred solution, consigning it to the “too difficult” box. 

Johnson’s immediate predecessor Theresa May watched her 2017 manifesto go up in flames after a social care plan to have people with a certain amount of assets pay for care in their own homes was swiftly labeled a “dementia tax,” playing a key role in her loss of a Conservative majority at that election. A former May adviser reflected this week that, despite good intentions, the idea had “poisoned the well” on social care reform for years.

Johnson set the essay question anew when he promised a plan to fix social care on his first day as prime minister, but it took a backseat during the crisis management of the pandemic. Robert Colvile, who has published papers on the subject and co-wrote the Conservative manifesto, observed that the prime minister would get points simply for confronting it. 

“This has been sitting there for approaching 20 years now. Someone needed to grasp the nettle,” the Centre for Policy Studies director said.

Alistair Burt, a former care minister and Conservative, agreed: “It’s perfectly obvious that there’s more to do in terms of detail, but the fact that he’s bitten the bullet on this is worthy of recognition.”

The swift introduction of a parliamentary vote on the new levy also helped neutralize any concerted effort at rebellion and placed MPs in the binary position of either voting for or against action on social care. Only five Conservatives voted against the measure in the end, although a further 37 did not take part.

This is not to say Johnson’s gambit is invulnerable. A snap YouGov poll showed voters pretty evenly split on its merits, with 44 percent in favor and 43 percent against. That could change as the reality of higher taxes sinks in. And while it’s not enough to give the government a headache for now, the depth of feeling among some in the party may yet be cause for concern.

One Tory ex-minister said: “It’s fundamentally un-Conservative on a whole number of levels. It’s a tax on work, which benefits those who have not worked for that capital at the expense of those who have.”

And they added: “It won’t fix the problems. It doesn’t raise enough money. It’s basically a really good band-aid.”

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