In the run up to the general election adult social care was heart and centre for all political parties. The reason was simple. The care system is in melt down and there is increasing unmet need and providers of care handing back contracts to local authorities and walking away because of lack of funds. Pressures in adult social care impact negatively on the NHS and this has major political ramifications because it is the NHS. The adult social care context has also to be understood against the background of Brexit and the implications for both the existing social care workforce and meeting future needs.
In truth we knew that the election would lead to either a Conservative or Labour Government so their manifesto promises were central to understanding how the real and current financial crises would be resolved.
The Labour Party manifesto set out the intention to establish a national care service for England. There would be an upper limit on contribution costs and promises to consult on a cross part basis how the funds should be raised.
The Conservative Party manifesto was quite specific about aged care funding and to raise the floor or threshold to £100,000 from £23,500. However, for the first time ever the value of a person’s home was to be included when means-testing for support in the home. People would be able to remain in their homes, but forced to release equity or defer payment until the house can be sold after their death. There was no ceiling on contribution to care costs. The Conservative Party manifesto commitments came to be known as the ‘dementia tax’ and saw the first ever u turn in a manifesto commitment.
The April budget before the election committed an additional £2 billion as supplementary funding to the improved Better Care Fund This is to be distributed as £1.01 billion in 2017-18, £674 million in 2018-19 and £337 million in 2019-20. This will stave off immediate crises over the coming months but falls a long way short of a sustainable solution.
We now have a new government and no clear and coherent plans that address the crises in social care. It has become such a toxic issue for this Conservative government and as it struggles to survive it is hard to see any other outcome other than the problem is kicked into the tall grass and out of sight. This is a catastrophe for all of us.
All governments are plagued by a myopic and shortsighted vision for the future of social care. The system players are caught up in the day to day struggles and fire fighting the challenges with some vague notion that somehow the system will continue and if needed fix itself. We are now closer to system collapse than at any other time in the history of the care system. And although new money is required it would be wrong to continue to fund a system that is passed its sell by date.
We need a system that is driven by new technology, data and information. We need proper workforce planning, properly funded illness prevention programmes and most importantly citizens having choice and control over their care, who provides it and where is provided. The system is over regulated adding to costs and burdens and is no longer fit for purpose either. Overall we are trying to meet social care needs in the 21st century with 20th century levels of funding and systems. There are too many short termism and vested interests that stand in the way of progress for people needing care.
So what are the answers that could lead us to the promised land and away from short term approaches?
We need an office for health and care planning and funding that transcends any one political cycle. With access to the data and information it will be able to plan for the workforce and determine just how much of GDP we spend on care whether as part of a wholly tax funded system or a joint citizen government funded system. The Dilnot proposals whilst not perfect remain the best option for a state/ citizen approach to paying for care.
Those eligible for publically funded social care should receive payments through the benefit system leaving the role of local government to provide social workers to support and encourage community capacity for all those eligible or needing care including self payers. Local Government can also take on a more dedicated role in illness prevention measures. Provision of care should be about helping people to remain independent and to do so with the use of new technologies including wearable technologies and home adaptations. The NHS and social care already work well together in some parts of the country and we should expect the worst to follow the best in making this happen. Primary care, secondary care and social care should be one system as this is what makes most sense to those who have to use the current arcane, convoluted and complicated pathways.
It is with a sense of sadness and inevitability for now that it is highly unlikely that there will be any cross party approach to the way in which future funding and planning might be considered. It is going to take a political visionary who can lift their eyes beyond the immediate to make it happen. The political make up of the current parliament does not lead me to believe that it will happen in this cycle.