Hancock keen to see shift towards domiciliary care

The Secretary of State for Health and Social Care Matt Hancock

The green paper offers an opportunity to improve the care system and provide better value for money with a shift from residential to domiciliary care, Matt Hancock has said.

Giving evidence to a group of peers, the health and social care secretary said he would like to see the UK mirror other countries, such as Norway, which has seen it move towards domiciliary care.

He said such a direction of travel would be good for service users in this country as domiciliary care is cheaper and people wanted to stay at home for as long as possible.

‘What we do know for absolute sure is more people go to residential [homes] than is clinically justified and domiciliary care, on average, is better and better value for money,’ Hancock told a House of Lords Economic Affairs Committee.

During the one-hour session on Tuesday (30 April), he spoke to about his frustration in getting the green paper published because of a focus on funding when a ‘whole load of other things’ in the sector needed addressing.

The committee was told the document would be ‘coming in due course’ but had been delayed because of Brexit, with his department still working on the document to ‘improve it’.

Hancock said the proportion of revenue that councils spend on social care had ‘significantly increased’ over the past few years partly because of more older people needing to access services and a ‘squeeze on council finances’.

Speaking about a ‘whole series of injustices’ in the system, the social care secretary said the distribution of risk across the population was ‘quite stark’. He said: ‘About 25% of people need no care costs at all because they just drop dead; about one in ten have care costs that are above £100,000 a year. That is the care costs, let alone the housing and residential costs element of it.

‘We all face this big risk. For a proportion of the population the state is always going to have to provide and rightly so, and it will. And for another portion of the population there is the current eligibility rules.’

He said some had to sell their home to pay for their care, with others saving for future care needs but some not, with the state helping them.

‘I see a series of injustices in this system,’ he said. ‘I would like to reduce those injustices and I’m pragmatic about how we get from A to B. We inherit the system we have with all sorts of peculiarities and imperfections and given the tricky political constraints in which we operate, I am keen to make as much progress as possible.

‘That means I am more attracted to options that build and directly improve on the system [rather] than ripping the whole thing up and starting from scratch. We don’t have a blank sheet of paper, we have millions of people who rely on the social care system every single day who need to be looked after and we need to make sure it works as well as possible.’

On a cap on care costs, he said that it would not be a ‘magic bullet’.

When questioned about figures released by The King’s Fund, which said 700,000 more care workers would be needed by 2030, Hancock said: ‘I’m naturally quite sceptical of figures projecting a long way into the future and then providing a high degree of accuracy in terms of employment because that is not the nature of the world.

‘We are going to need more people and train more people up, and we are doing a lot of work on that at the moment.’

However, committee chair Lord Forsyth of Drumlean told Hancock employees were ‘really struggling’ and were ‘very poorly paid’, with workers’ professionalism not being recognised.