As the parliamentary passage of the Personal Care at Home Bill draws to a close, it seems likely that from next October those with the highest needs should get their care at home (but not in care homes) for free.
Yet 2010 has already shown that a week is a long time in the politics of social care funding. Yesterday the Liberal Democrats changed their position on their promised universal care guarantee until it 'becomes affordable again'. For the Tories, free personal care at home was never on the agenda. So it seems to be a case of either free care for the few, not the many (Labour); for the many, when we can afford it (Liberal Democrats); or for no-one except the very poorest (Conservatives).
Three big question marks hang over the Personal Care at Home policy in its current guise. The first is whether it will be adequately funded – we have little idea about how many people are currently paying for their own care, and the assumptions of how much councils are expected to help pay for it through efficiency savings are becoming increasingly unrealistic.
The second problem is the risk that the system becomes even more unfair (and complicated) for those whose needs fall just short of 'highest' or can't be met at home. This will aggravate the existing inequities of means testing and the health/social care fault line.
But the third and most worrying question mark is whether providing free care for around 400,000 people could jeopardise wider funding reform affecting 1.8 million people who depend on care and support services.
The government's protestations that the Personal Care at Home policy is a stepping stone to further reform is hard to reconcile with its previous insistence that free care funded from taxation was never an option. It carried out two extensive public engagement exercises to embed the idea that, one way or another, we have to dig deeper into our pockets to pay for an ageing society.
There is some evidence that public attitudes do shift when confronted with the unassailable metrics of demographics, money and unequal divisions in wealth and property between generations. But the unexpected promise of free care at home, accompanied by a sudden conjuring up of £670million from central cuts and council efficiencies – without any apparent, real impact on existing priorities or reducing services services – sends an entirely contrary message.
The thankless task of realigning the individual's expectations of care with the public's willingness to pay has been thrown into reverse. Its most insidious consequence is to create the impression that so-called 'free care' of the elderly can be achieved without extra cost, difficult choices or contentious trade-offs. This is not an honest or respectful foundation on which to build the radical reform of care funding; we can't go on like this.