Tough call on social care costs

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This year's general election could be the first in which social care is a key campaign issue. Everyone agrees that sorting out the wicked issues of paying for care needs consensus. But electioneering is about conflict, demanding that each party demonstrates loudly how different they and their policies are from each other.

So the collapse of private, cross-party talks aimed at establishing a political consensus, and the welter of misunderstanding and mutual recriminations that followed, should not come as a great surprise given the proximity of polling day.

The recent care summit attended by Andy Burnham, Phil Hope, Norman Lamb and a wide range of stakeholders was a worthy attempt to salvage a shared understanding of what needs to be done – but was impaired by the absence of the Conservatives. A forthcoming report from the Health Select Committee should add to this understanding. But the parties still have some questions to answer before they finalise their offers to the electorate.

For Labour, all eyes will now be on the promised White Paper. But how will this reconcile ministers' increasingly evident preference for a comprehensive funding option (ie a compulsory charge for all those over 65 with the means to pay it) with the disconnected policy of free personal care at home for those most in need (as set out in the Personal Care at Home Bill currently before Parliament)? Will the Conservatives strengthen their inclination towards voluntary insurance by bringing forward new proposals to cover the costs of care at home to sit alongside their plans to help people insure against the cost of residential care home fees? And does the recently announced Lib Dem commitment to a cross-party commission mean yet more delay and just another worthy tome for the bookshelf?

The biggest risk may be the temptation for the incoming government to put care funding in the 'too difficult' box. In our forthcoming report – an update of our seminal Wanless Review of Social Care Funding in 2006 – we will argue that the necessity for reform has never been greater and that the imminent squeeze on public spending is a reason to promote change, not an excuse to postpone it. Indeed, having ratcheted up public expectations over recent weeks, to allow the opportunity for reform to slide would mean reneging on what is now a clear commitment to action, whoever forms the next administration.

After the political noise and heat of the election campaign has faded, there are many points of agreement that could form the basis of an all-party roadmap for reform: that funding should be shared through a partnership between the individual and the state; a shift towards a national entitlement based on what people need rather than where they happen to live; recognising that a substantial chunk of care costs will always have to be met through general taxation (because many people have limited financial means); and that a new funding settlement could also include a place for voluntary insurance so that people can cover their own contribution to their costs. Certainly, if we have the choice of insuring our pets and mobile phones, denying people the option of protecting their assets from care charges seems perverse.

So although the political debate is generating fault lines between the parties, in reality the funding choices are not 'either-or'. The policy options are not simply a choice between voluntary and compulsory. Ultimately the costs of care and support will be paid for through a variety of means including taxation, people's own income and wealth and different kinds of insurance schemes. Finding the right mixture will be a key challenge in achieving a political meeting of minds – but don't expect this before the election.

This article first appeared on the Public Finance website.


Alan Long

Comment date
31 March 2010
A compulsory scheme, with an emphasis on keeping people at home, with access to funds from the NHS, provide the right ingredients for a care plan that will work. Local authorities and PCTs should take the opportunity of the 'Big Care debate' and the launch of the White Paper to look carefully at how to achieve more for less. And this means commissioning services in an integrated way between care, health and housing, based on achieving long-term health outcomes, as opposed to saving pounds and pence per hour.
Alan Long, Mears Care

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