End the dithering: time to fix social care

14 Aug 2020 Nick Garbutt    Last updated: 14 Aug 2020

Pic: Unsplash

When the history of the pandemic comes to be written the most disturbing chapter of all will be devoted to the plight of the old and the vulnerable.

There will be inquiries and investigations and finger-pointing and excuses and pleas for mitigation.

But what cannot be denied is that at its root is a system of adult social care which is not working and on the verge of collapse. Politicians and policy-makers have known this to be the case for more than two decades, yet we are still waiting for change.

We were first warned of the looming crisis in 1997 when the Royal Commission on Long Term Care was set up in the early days of Tony Blair’s first government. Yet it and other reports both instigated by government and undertaken by a range of think tanks have not led to the change required.  

This is not merely a failing of government either at Stormont or Westminster. It is a collective failing and its history is not just of those in power not doing the right thing, but also of oppositions undermining efforts to fix the problems for their own short-term political gain.

All this has been compounded by an almost universal lack of understanding of social care amongst the general population. There is a widespread belief that social care, like health care is free at the point of delivery. It is not. Therefore it was all too easy to misrepresent policy initiatives that would have improved the current position as malign.

Reform of adult social care has proved impossible to date but if ever there was a time to put this right it is now.

In Northern Ireland the report Power to People provides an excellent (albeit uncosted) route map however full progress cannot be made in isolation: NI does not have the requisite tax-raising powers to be able to generate the additional revenues required.

Meanwhile the crisis deepens.

The Royal Commission set up by Blair reported back in 1999. Some of its proposals were implemented in Scotland but the government rejected it on cost grounds. A second Royal Commission on Funding of Care and Support was published in 2011.  It recommended lifetime social care charges and a more generous means-test for receiving care. However nothing happened. The Conservative government said it was “not the right moment to be implementing expensive new commitments such as this”.

In March 2017 the May Government announced a new Green Paper which would set out options for the future financing of social care.

A number of options for inclusion in the Green Paper were confirmed by the Government or reported in the media at the time, including a more generous means-test limit, a cap on lifetime social care costs, insurance and other ideas.

It was originally due for publication in summer 2017. This was the first of five Government-set deadlines for its publication that have been missed.

The current official position is that it will be published “at the earliest opportunity”.

However there are signs that the British government is getting close to formulating some kind of plan.

In his first speech on being made Prime Minister Boris Johnson said: “ I am announcing now – on the steps of Downing Street – that we will fix the crisis in social care once and for all, and with a clear plan we have prepared to give every older person the dignity and security they deserve.”

That was just over a year ago, and although no plan has been produced there have been a number of stories in the media in the past few weeks that things are starting to happen behind the scenes.

The most contentious aspect of social care reform to resolve is how to fund it. And Johnson’s government will have to grapple with the following:

The extent to which social care should be funded by those who receive it or the taxpayer. And within that where the balance should lie and whether that should vary according to peoples’ income or age.

Then there’s whether reforms should cover residential costs of care and if not how to protect people from catastrophic costs of care which could mean them losing their homes or entire savings. At the same time there is also a need to ensure fairness between generations so that young people are not bearing a disproportionate burden in the early years of any new scheme.

These are important issues, best resolved by parties agreeing to work together to resolve.

These are contentious issues even within the Conservative Party which is internally split and still smarting from the 2017 General Election “dementia tax” fiasco.

Health Secretary Matt Hancock was appointed in July 2018 and whilst in office has given a number of indications of his preferred direction of travel.

In a Commons debate in October 2018 Health Secretary he said:  ““some people propose the answer that the taxpayer should simply fund everything, but I do not think that that is a valid solution.”

And in February 2019 he was reported as having a serious falling out with then Prime Minister May about her proposals to put a cap on lifetime care charges of £100,000 to protect those affected from financial catastrophe. According to the Daily Telegraph: “Mr Hancock reportedly told the Prime Minister that “he is ‘concerned’ that the cap, which he says could cost up to £3.4billion, is being included in a forthcoming green paper … [and] it ‘confers a significant benefit to the well-off at the expense of the general taxpayer’, adding that ‘raising taxes is likely to be the most promising choice to fund this’.”

The paper stated that this illustrated the depth of the divisions over social care at the highest levels of government.

Hancock himself would like to see an insurance model introduced. He told the Commons in the same 2018 debate he was “attracted” to an “insurance and contribution model” for paying for social care by individuals, and added “there are many different potential details in how such a model can be delivered”.

And more recent press speculation suggests that he is in favour of a system which kicks in when people reach the age of 40. This is how social care for older people is funded in Japan.

This may well be the case but it does not seem to be a solution attractive to Boris Johnson who is reported to have rejected an insurance solution.

If attempts to gain consensus amongst the Tories have proved difficult enough, moves to move forward with all-party support have foundered due to the toxic atmosphere around Brexit. After months of saying that a Green Paper was imminent Hancock appeared before the Commons Health Select Committee in July of last year. Ben Bradshaw MP demanded to know why it had not been published. Hancock replied: “Because we have not been able to find a way through that would get the sort of cross-party support that is hugely helpful for projects like this.”

To compound all this there’s not even consensus around what should be covered by reform: social care for older people or social care for all adults (expenditure for people of working age is actually higher than for the old.)

However it would appear that Hancock will not be devising the plans.

In 2017 Theresa May set up a cross-departmental group to oversee the Green Paper. It included a range of experts including several from the voluntary sector. This work was led by Cabinet Minister Damian Green, effectively her number two. However by 2018 responsibility had shifted to the Department of Health. This caused concern from many outside experts who argued that an individual spending department would not have the same clout. Shifting responsibility would also cause further delays. And publication was, in fact, delayed.

Fast forward to July 2019 and Johnson’s maiden speech promising to fix the system once and for all. 

In the interim the Financial Times has claimed that the Green Paper (a consultancy document) has been dropped altogether and will be replaced with a White Paper which will spell out the government’s plans.

Last week the Guardian reported that Johnson had brought in David Cameron’s former policy advisor Camilla Cavendish to finalise government plans.

The paper reported that she believes that social care should be free at the point of need, just like health care. What we are yet to find out is how this will be funded.

There seem three options: a dedicated tax (a bit like the TV licence), general taxation or a Japanese-style insurance scheme.

Whatever the choice it will be a defining moment both for Johnson’s government and our future well being. 




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