Our care and health system in the United Kingdom is in crises. What does that mean in practice? More individuals with significant care needs are screened out of the system, more people who want to die at home die in hospital, more care and support services close down and the staff shortages in the sector keep on rising.
There is a broad consensus that the crises is strongly linked to a shortage of money in the care and health system and there are not enough staff. The Department for Health and Social Care has an endless list of hollow platitudes about how much extra money is and has been put into the system. Whilst money has been put into the NHS it is below the required 4% and local government have had their budgets decimated since 2010.
The government has now decided that we should have a Green Paper to cover the issues of funding age care. It is not clear what their plan is for funding services for working age adults who require social services. Green Papers are government consultation documents that allow those inside government and parliament and outside individuals and bodies to share ideas with the government on its policy or planned legislation. Let’s be clear that a Green Paper is not a commitment to action. It is worth reiterating how nothing has been done for the last twenty years despite proposals to improve the system.
Thanks to the House of Commons Library this timeline since 1997 sets out the inaction.
- 1997, April – the Labour Party makes a manifesto commitment to establish a Royal Commission on long-term care for the elderly;
- 1997, May – Labour Government elected;
- 1997, December – the Royal Commission is established, chaired by Professor Sir Stuart Sutherland;
- 1999, March – the Royal Commission publishes its report:
– recommendation of free personal care (following assessment of needs) funded by general taxation;
– recommendation of a more generous means-test of £60,000 in 1999 prices (about £95,500 in 2016 prices) in respect of people funding their care relating to living costs and housing;
- the idea (although not recommended by the Commission) of a four-year cap on paying social care charges;
- 2000, July – the Labour Government published its response in which it:
– rejected the idea of free personal care;
– uprated the main means-test parameters to take account of inflation, but did not implement the Commission’s proposal for a significantly more generous means-test;
– gave no response to the cap idea;
– accepted a number of other proposals by the Commission, including free NHS nursing care for care home residents, and a three-month disregard of the value of the home for those in care homes;
In 2002 the Scottish Government accepted the proposals and implemented free personal care.
- 2009, July – the Labour Government published a Green Paper proposing that a “National Care Service” be established;
- 2010, March – the Labour Government’s White Paper proposed a two-year cap on paying for social care from 2014, and free-at-the-point-of-use social care for everyone at an unspecified point after 2015, with an independent commission to be established to consider how the policy should be funded;
- 2010, May – Coalition Government in power;
- 2010, July – the Coalition Government established the Commission on the Funding of Care and Support chaired by Andrew Dilnot, to consider a partnership model between individuals and the state and how people could choose to protect their assets, especially their homes, against the cost of care;
- 2011, July – the Commission published its report, and its recommendations included:
– a £35,000 lifetime cap for paying for social care for over 65s;
– lower, tiered, caps for those aged 40 to 65 years;
– a lifetime cap of zero for anyone who either entered adulthood with an existing care and support need, or who developed an eligible need before 40 years of age;
– a lifetime cap of zero for anyone who had been in residential care for at least two years before the cap was introduced;
– a more generous means-test, with a new upper limit of £100,000, but the lower limit remaining at £14,250; a standard rate for services other than social care provided in a care home (e.g. accommodation, food) “in the range of £7,000 to £10,000 a year”;
- 2015, May – Conservative Government elected;
- 2015, July – the Conservative Government announced the postponement of the introduction of the reforms, including the cap and more generous means-test, until April 2020;
- 2017, May – during the General Election, the Conservative Party stated it would publish a Green Paper to include proposals on social care funding reform;
- 2017, June – Conservative Government elected as minority Government.
We have had twenty years of obfuscation, prevarication and inaction. The reality of this is negative impact it has on individual well being for those who need care and support whatever their age. Many of those who led or contributed in significant ways to the last Green Paper on funding social care are involved again this time. You will be forgiven if you harbour cynical thoughts that it will be different this time.