Community health
Making sense of social care and our Government’s failure to fix it

By - Integrated Care Journal

The social care crisis is not new, and neither is the promise to fix it. In 1997, former Prime Minister, Tony Blair repudiated a society in which “the only way pensioners can get long-term care is by selling their home”. Twenty-one years later, on 24th July 2019, current Prime Minister Boris Johnson declared: “My job is to protect you and your parents, or grandparents from the fear of having to sell your home to pay for the costs of care”.

The need to reform social care funding has been an issue for successive governments. An array of funding models have been considered, but these considerations have failed to translate into meaningful change. Budgetary concerns have continued to take precedence above genuine efforts to improve social care. The labyrinthine nature of the system has not helped, as a lack of public understanding of what social care actually does has meant political pressure to fix it has remained largely absent.

As a result, the means-test limit for eligibility for local authority funding support has remained frozen at £23,250 since 2010. This means that if care home residents have total assets that amount to less than £23,250 (including the value of their home), only then will the state contribute to the costs of their care. Even then, these individuals are expected to contribute their income and their pension towards these costs.


The story so far…

In 2010, the Labour Government proposed that we fund a “National Care Service” using a comprehensive funding model based on the principle of shared social insurance. Under this model, everyone would be eligible for free care when they need it in return for paying a contribution into a state insurance scheme. In terms of how the public would be asked to contribute, it was suggested that everyone over retirement age be required to pay between £17,000-£20,000, either at retirement or upon death, into the scheme. This proposal was denounced as a ‘death tax’ by the Conservative party in the lead up to the 2010 General Election.

After Labour lost the 2010 General Election, the Conservative and Lib Dem coalition cast aside these proposed reforms in favour of a new Commission on Funding of Care on Support, chaired by economist Andrew Dilnot. Tasked with assessing the options for funding care and support, the Commission made a number of proposals, these included: introducing a more generous means-testing threshold (from £23,250 to £100,000), introducing a cap of £35,000 on care costs (after which, the state will pick up all ongoing costs) and introducing a national threshold for care eligibility. The £35,000 cap was introduced under The Care Act (2014). However, the introduction of a more generous means test was indefinitely postponed in July 2015 by David Cameron’s incoming majority Government, who cited the “time of consolidation” as reason to defer these reforms.

After retiring out of the public eye, the issue of funding made its next appearance on the pages of the Conservative party manifesto for the 2017 General Election. Here the Conservative Government announced it would publish a Green Paper containing new proposals for long-term care funding. Among these proposals were an absolute limit on what people would need to pay for care, a single £100,000 limit in the means-test and the inclusion of property value in the means-test for those receiving domiciliary care. The latter proposal was subject to intense criticism and dubbed the ‘dementia tax’ by The Alzheimer’s Society, as it would have seen most homeowners who receive government contributions towards their homecare ineligible for continued support. As such, the proposal was quickly retracted by the Conservative party.

The Green Paper, scheduled for release in the summer of 2017, is yet to see the light of day. This has become something of a tragic convention within the health and care sector – at a Public Policy Projects reception in 2019 NHS England boss Sir Simon Stevens jokingly pondered “where is Matt Hancock’s green paper!? ”. Two years on and we are still waiting for the answer.

Despite Prime Minister Boris Johnson’s early declaration “to fix the crisis in social care once and for all”, the Government has remained remarkably silent on the issue of social care.


What now?

At present, free access to social care is limited to those with the most acute need and the lowest assets. The figures are startling. Those who are not eligible for publicly funded services are exposed to extremely high costs of residential care, with approximately one in 10 people aged over 65 facing care costs of over £100,000. The social care system is not fit for purpose. Research by Age UK has found that more than 1.5 million older people are living with unmet care needs. If the Government fails to act, this number is set to rise to 2.1 million by 2030. With the number of young adults requiring disability support set to rise by 34 per cent between 2017 and 2027 and the number of individuals aged over 85 set to double between 2016 and 2041, the social care crisis could soon turn into a catastrophe.

We urgently need a practicable solution to social care funding that is accessible, inter-generationally fair and locally accountable. And, if the history books are anything to go by, political feasibility will need to be its defining characteristic.

 

Public Policy Projects is exploring the issue of social care in more depth in its State of the Nation report The Social Care Challenge: Implementing a Connected System. For more information on this project, please contact charley.hacquoil@publicpolicyprojects.com.

References available upon request.


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