The Observer view on the social care crisis
It beggars belief that the chancellor failed to mention social care once during his budget speech last Wednesday. For well over a year, there has been an overwhelming consensus that Britain’s care system for older people and disabled adults is on the brink of crisis. Yet Philip Hammond simply left it out. His omission has rightly attracted criticism from two former Conservative health secretaries in the<Italic> Observer</Italic> today.
Means-tested support for social care is provided by councils, which have seen government grants cut significantly in recent years. As a result, council spending on social care has fallen by up to 30% in some areas since 2010. Three independent health thinktanks have produced a joint estimate that Wednesday’s budget will leave a £2.5bn funding gap by 2019.
This will put huge pressure on the NHS, as people who can’t access care deteriorate and end up in hospital wards instead. And it will leave millions without the care they need. The number of people getting state help with the costs of their care has fallen by more than a quarter since 2011, while the charity AgeUK says there are 1.2 million older people who struggle without help to carry out everyday tasks such as washing and dressing.
That this leaves older people and their families in an intolerable position has not been enough to spur the government into action. An ageing population and the rising cost of providing care mean we should be spending more, not less. Yet we are further than ever away from a longterm funding solution.
A mix of short-term opportunism and political missteps has made social care increasingly toxic in the last decade. In 2010, Labour plans to introduce a charge on estates to fund a National Care Service were branded a “death tax” by the Conservative opposition. Earlier this year, ill-thought through plans in the Conservative manifesto that would have required individuals to run down all their assets, including their house, to £100,000 before state support would kick in, were labelled a “dementia tax”.
Instead of offering solutions, ministers are saying families need to do more for their older relatives. This is hopelessly insufficient: the increasing incidence of complex conditions such as dementia mean growing numbers will need professional support, not just care from their loved ones. Government has nothing to say on how families can square the circle of being expected to put off retirement for longer, with caring for elderly parents. The government has announced another consultation on social care funding . It’s the last thing we need. Since 1997, there have been no fewer than four independent commissions and five government papers on funding reform. We already have the answer: as a society, we need to be spending more to ensure people experience a humane end of life.
There are different ways to do this, but some are more racked with problems and injustices than others. Today, the Observer reveals the government has told local authorities it has dropped its plans to impose a cap on care costs in 2020. Good riddance. The idea was that people would be expected to cover their own care costs until they reached a cap of £72,000, and that they would insure themselves against these costs with private insurance.
But this plan was always flawed. Specialist insurers have warned the government there is no market for this type of insurance. Basic human psychology means people are reluctant to save for their retirement income, let alone pay to insure an outcome half a lifetime away that they simply hope won’t happen. Insuring for long-term care costs is also difficult because there are huge levels of uncertainty about what will happen to those costs decades down the line. At any rate, introducing a cap without properly funding councils to provide care for people who meet the cap is pointless.
This year’s Conservative manifesto proposal is deeply unfair. Why should those unlucky enough to develop care needs in later life have to meet the costs of care, while the luckier escape altogether? The proposal leaves the anomaly that someone who develops cancer gets the costs of their care covered by the state, while someone who gets dementia has to pay up themselves.
If anything, the case for funding social care along the same lines as the NHS is even stronger than in the case of healthcare. It would be expensive, but there are plenty of ways it could be collectively funded by affluent baby boomers; for example, through inheritance tax or a higher rate of income tax for high-income pensioners enjoying the fruits of overly generous final salary pension schemes that are funded by younger workers.
The real block is not money – it is a lack of political bravery. While Brexit ticks on, social care remains perhaps the most neglected aspect of our social infrastructure. There’s no greater emblem of the toxic stasis at the heart of this government than its failure to fix it.