There cannot be many adults in the UK who are unaware of the importance of social care. Whether they have encountered the issue through personal experience of supporting friends or relatives, or on the news, most will also recognise that meeting the needs of the growing number of people who cannot take care of themselves is a serious challenge. What fewer may notice is that the most common framing of the care issue, as primarily linked to ageing, longer life expectancy and rising numbers of people with dementia, is partly misleading.
In 2018-19, almost 300,000 people aged between 18 and 64 received council-funded social care in England (arrangements in Scotland, Wales and Northern Ireland are somewhat different). Most of this care went to people in their homes, and around 70% of those who qualified did so due to learning difficulties. This group made up around a third of the total and accounted for around half of public spending on social care. The social care crisis, as it is often called, is thus as much about disability as ageing.
It is also a crisis about children. In 2018-19, public spending on adult social care in England totalled £18bn. The children’s social care bill is a further £10bn, and represents a distinct though linked problem. Its distinctness lies in the nature of the spending: there is no equivalent in adult services, for example, to the £1.7bn spent on foster carers, or the budget for special needs education. The links include the impact of disability. Just as adults with physical or mental impairments need support with living, so also do children. Another link is poverty. Although disabilities affect people in all income brackets (especially in later life), there is a close connection between poor health and lack of money.
A review of children’s social care is under way. It has already been criticised for terms of reference that ignore “the harm of poverty”. Challenged on this last week, Caroline Dinenage, who was care minister until February, could only say that it is a “very, very complex issue” that ministers will return to when the pandemic is on a “more even keel”.
The dysfunctional market for social care, and the lack of funds to pay for it, are not the only injustices faced by disabled people. Benefit cuts have also caused serious harm, including death. The mortality rate among disabled people during the pandemic far exceeded that of the general population. The number with learning difficulties or autism in inpatient wards remains unacceptably high (2,055 at the last count), while the use of physical restraint is rising rather than falling. Earlier this month, the Equality and Human Rights Commission (EHRC) recommended that disabled people’s right to live independently should be strengthened by placing new obligations on councils, including in relation to housing.
That intervention was timely. Many disabled people say that they were better off when they had their own watchdog, but the EHRC has at least put some proposals on the table. After a year in which people with disabilities have suffered particular hardships, including prolonged separations from loved ones due to care home regulations, and with the NHS facing continued uncertainty and pressure on resources, ministers must stop the endless deferrals. Deficiencies in social care provision could affect any of us in time. Right now, they are hurting some of the most vulnerable in our society.