History of UK Social Care

Can you start by providing context into the UK social care industry over the last decade?

I think it’s a great topic and I think the social care sector within the UK has changed enormously over the last 10 years. It’s seen a real sea change. Ten years ago, social care was by and large provided by the state via local authorities. But as a real focus on public spending started to happen, post the financial issues in the market in the late ’80s to early ’90s, it forced local authorities to start thinking hard about money. They found that social care was something that was actually very expensive for them, not just providing care but providing support effectively for bricks and mortar because that was expensive, providing residential homes. What started as a trickle—inviting private sector partners to help them support—turned into a flood. You end it with the position now, where just over 90% of social care in the UK is provided by the private sector and social care now includes residential care, care for people at home, adult care, and childcare. 90% is provided by the private sector, which is a fact that few people realize. That in itself has brought growing pains as we’ve seen the switch.

Over those years, we’ve seen an increasing polarization between healthcare and social care. Healthcare is effectively defined as acute care that’s provided by the state through the NHS, and social care is ultimately provided by the state but through local authorities and then into the private sector, where 90% of it is provided. The differential is that healthcare is free at the point of requirement, so you go to the NHS and it’s free; you don’t have bills. However, social care has become means tested. It all boils back to how much money is ultimately in the pot for government-funded social care. Increasingly, we see local authorities use models of means testing, and increasingly those criteria for people to qualify for state funding and social care have been increasingly difficult. We’ve seen a swing; we’ve seen polarization between health and social care. We’ve seen a swing in terms of the provision of social care to the private sector.

What we’ve also seen on the supply front is that labour has become increasingly scarce, and that’s really due to poor staff planning at a government level. It’s been very poorly done over the last few years which has created a real shortage of qualified nurses, doctors, etc. This has driven payrates up for a period, but within the healthcare NHS sector, and it’s left social care lagging behind, fighting for scraps for labour. Labour has been difficult.

There have also been very public failures in social care. There has been an increase in regulation to meet those failures. You’ve got increasing regulation; you’ve got a scarce labour force; and you’ve got an increasing level of demand because you’ve got an aging population and therefore a lot of the social care projects—about 60 billion pounds of it, that’s the size of the market—relates to the care of the elderly people, whether residential or in their own homes. So, there’s been quite a sea change over the last few years with increasing support from the private sector.