It is getting on for a quarter of a century since the first in a list of Prime Ministers said that social care was an urgent issue that needed addressing. That was Tony Blair, and all of his successors would agree. The problem is that none of them has actually met words with action.
It is not for want of trying. Under Gordon Brown Labour produced proposals for a National Care Service, which foundered under its funding proposals which were dubbed a “death tax”. David Cameron put into the 2014 Care Act a version of the Dilnot proposals which proposed a cap on total individual payments for care, and a floor below which people’s assets would not be touched for care payments. Shaky Government finances meant it was never implemented. And in 2017 a new version of this from Theresa May was called the “dementia tax” and destroyed her lead in the polls.
But the problem is still with us, and later this year we are promised a sustainable solution with the Comprehensive Spending Review, which was delayed from last year by the pandemic. Of course it is Covid which has shone a fierce light on residential social care, drawing public attention to it in a way which has never happened before, and which could scarcely have happened in more tragic circumstances. The only sliver of consolation from the awful death toll has been the new consensus that we can’t go on putting sticking plasters on an increasingly fragile system.
There are many problems to be solved but the root of them is funding. The Health and Social Care Select Committee estimates that £7bn extra is needed to put the system on a sustainable footing. How you raise that money is the most intractable problem. If you raise it all from taxation or National Insurance, working age people will be paying for their own care and the care of their parent’s generation, which seems very unfair. So more promising are models which have a mixture of extra public spending and more contributions from individuals, whether through an insurance system or through a Dilnot-style model.
Variations on these models can be played, and I have argued in a paper for the Centre for Policy Studies that we should look to the pension system for an example where universal state provision can be successfully supplemented by private savings. This has the added political advantage that pensions are not a matter for serious dispute between the main parties, so a long-term consensus can be achieved.
But even when the Government comes to decision on how to find the extra money needed (and let’s hope it is taken away from council tax, which is not a suitable tax to fund care) there are other intractable problems. In no particular order they include.
- Workforce planning. How do we find thousands of extra workers, which demographic change will demand, and how do we create a proper career structure for them?
- There is so much available which would improve the daily lives of those receiving care, but no discernible strategy for using it.
- If we built differently we could keep far more people in their own homes for longer, happier in themselves and less expensive for the system.
- Integration with the NHS. We are promised new Integrated Care Systems, but they must ensure that they are not simply another way of the NHS using social care to solve its own problems.
This is a formidable set of challenges. But 25 years is already too long to have reached a decision about how to tackle them. This absolutely has to be the year for action.