Back in the ‘too difficult’ box: social care and the manifestos

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With concern about care for older people and disabled adults now the third most important issue for voters behind only the NHS and Brexit in the latest poll from Ipsos MORI, we now have the detail of social care pledges from the three main English parties. Labour and the Liberal Democrats have published their manifestos and the Conservatives have announced their social care policy. Do they make for happy reading around social care?

All three parties recognise that the current system needs some serious cash injections to keep it going after years of austerity that have negatively affected local government funding. However, the level of detail from the different parties makes it hard to know if we are comparing apples with apples. At a first glance, it looks like the Liberal Democrats and Labour are committing to funding increases that would provide some funding certainty and breathing space. This funding would help, we believe, to undo the consequences of a decade of funding squeezes in the sector. The Conservatives appear to be the least generous, with their promised funding shared between children’s and adults’ social care – but it might be that more detail about the full package of funding will appear in the manifesto itself, as the amount promised so far is not enough to meet rising demand for care while maintaining the current quality and accessibility of current services.

'All three parties recognise that the current system needs some serious cash injections to keep it going after years of austerity that have negatively affected local government funding.'

For all the party pledges, the devil here will be in the detail, which isn’t always clear from manifestos and articles in the press. What will the sector be expected to fund through these increases, in addition to meeting rising demand for adult social care due to demographics change? Any increases to the National Minimum Wage will bring welcome extra cash to the social care workforce but will increase costs of delivery without increasing the relative attractiveness of a job in the sector. Both the Liberal Democrats and Labour propose changes to zero-hour contracts which – while obviously beneficial for staff – will come at a cost. The Conservatives expect their £1 billion per annum to fund not only increased demands on existing services, but ‘better infrastructure, technology and facilities’. Hmmm, all of a sudden it looks like those promised billions risk being stretched too far. And what the overall local government funding position will look like is also critical in assessing whether the funding for social care will be adequate.

On long-term funding reform, only Labour have come to the party by offering a concrete policy solution, rather than the promise of unspecified ‘future reform’.

Both the Conservatives and the Liberal Democrats offer different versions of ‘kicking the can down the road’. The Liberal Democrats suggest a convention on the future of health and care funding, including considering a hypothecated tax for health and care. They say that their starting point will be cap on cost, and they also (elsewhere in the manifesto) commit to free care for those at the end of their life. The Conservatives’ propose cross-party talks, with their red line being that older people should not have to sell their homes to pay for care. As we have said before, this is a disappointingly narrow framing of both the problems in social care and the ambitions for a solution. It would perhaps be an understatement to say that cross-party consensus has not been a feature of our recent politics, so conventions and cross-party talks without a concrete proposal are unlikely to deliver anything useful on social care funding reform.

Labour have confirmed their policy from their party conference – free personal care for those over 65 with lifetime costs capped. Their health and care team deserve praise for being the only team prepared to put their neck on the line on a politically contentious area and propose a policy. Is it a perfect policy? No. But no policy is perfect. However, it is a good start and could be a decent foundation to build from to develop an innovative social care system supporting people’s rights and independence. The experience from Scotland tells us that free personal care is possible, and from our work with the public for Fork in the road we know ‘this option was relatively well received’. The most obvious omission is provision for working-age adults – Labour only express their ‘ambition’ to extend free personal care services from older people to working-age adults. This omission would be relatively cheap to rectify because this population is already heavily dependent on public funding.

'There’s little to reflect that social care is a sector with the potential to add so much value to individuals, communities, and ultimately our economy and society.'

Finally, on the broader vision for social care, all three parties struggle to offer a positive vision for people needing care and support, and the sector that supports them, backed up by action. There are positive words about the workforce, but a lack of detail as to how the aspirations of having a better paid workforce can really be achieved in a mixed market. There’s a general feeling sitting behind the policies that social care is seen as a collection of traditional services that need to be provided to people, rather than thinking about people’s rights and independence, encouraging innovation in service design and delivery. There’s little to reflect that social care is a sector with the potential to add so much value to individuals, communities, and ultimately our economy and society. In this sense, it feels like a missed opportunity to imagine a different future for people needing care and support.

When the election was called, I said that, for social care, a credible policy would need to cover immediate plans for significant additional investment to support quality and reduce unmet need, and firm plans around how to introduce a new funding system. It’s disappointing that only one of the three main parties have credible plans to address both issues.

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