Making decisions about social care requires tough choices

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During a recent Institute for Government event, the former Chancellor George Osborne, spoke about social care. I held my breath as I wondered if he was going to join the long list of former politicians who get converted to the cause after leaving office. But no. Instead he spoke the unspoken about social care: ‘[The political consequence of fixing social care] is incredibly unpopular. It’s much more straightforward politically to keep kicking the can down the road.’    

Osborne’s argument was that someone has to pay for social care and it’s the choice of who that is deeply unpopular. His broad point was that now – and indeed for most of the past two decades – the political cost of not acting is less than the political cost of acting. But is he right?   

I think one of the more instructive ways to assess how the political calculation is made is to look at when reform did manage to cut through – what was it that shifted the dial on those occasions? The two recent examples are the coalition government’s decision to implement a Dilnot-style model, and Theresa May’s 2017 election proposals

On the coalition, let’s get my declarations of interests out of the way: in my previous life, I was a senior civil servant leading on social care reform. For the 18 months from the publication of the Dilnot Commission’s recommendations (July 2011) to the government’s decision to implement them, my team and I spent many months drafting endless papers for ‘the Quad’ (the four men steering the coalition – David Cameron, Nick Clegg, George Osborne and Danny Alexander), waiting for them to meet, to set the next policy and implementation question, to decide. I wasn’t in the room with the Quad, but did have a strong sense of the dynamics playing out as they grappled with the decision.   

One of the dynamics of a coalition government is not just who supports which policy, but what are the consequences of vetoing a policy? During the many twists and turns of the months of ‘Will they, won’t they?’, we started to get a clear sense not that either party desperately wanted to say yes, but that neither wanted to be the one that said no. Quite often we thought all the signals were that one party was lining up to say no, but when the moment came, it didn’t. The policy was being kept alive because neither party could be the one to say no to it. The political consequence of not acting was different if one side of the coalition could clearly position the other as the unfair blocker of a reasonable proposal. And eventually, the coalition committed to implementing a capped-cost model and legislated to do so in the Care Act 2014

There is no open debate about the quality of life ambitions we have individually and collectively for those who will need to draw on social care to live their lives, and the trade-offs involved in paying for this...

Theresa May’s experience was somewhat different – in essence the team around her that knew this was a controversial issue, but concluded that the Conservatives had such a comfortable political lead that they could make progress without taking the political hit. The surprise inclusion of a policy in the 2017 manifesto (broadly based on ‘floors’ – eg, the means test) was quickly dubbed the ‘dementia tax’ and local party candidates reported it was very unpopular. The judgement of the team in No10 was that they had the headroom to act without the political consequence being material, and assumed over time that they would get political credit for acting when previous governments had not. Obviously, the history books tell us this calculation was not correct.           

What does this tell us about now? You could conclude that the coalition experience tells us that cross-party consensus is the only way forward to shift the political calculation – but plenty of attempts to do this, some more serious than others, have shown that without the need to govern together, the incentive on the parties to genuinely work together is limited and the lack of trust between parties impedes progress. Another conclusion could be that with a majority of 80, the Prime Minister has the cushion to be bold and to act. But his majority is based on a new coalition within his party that hasn’t yet settled its shared vision on many questions of policy, and isn’t proving to always be united. And this Prime Minister has already abandoned a manifesto commitment

But I would conclude something else. You can change the political calculation by changing the question. One striking thing about the social care funding reform debate is how narrow it is – all the discussions are really about is what is the shape of the partnership  between the family and the state (is it a cap, free personal care, a floor?). There is no open debate about the quality of life ambitions we have individually and collectively for those who will need to draw on social care to live their lives, and the trade-offs involved in paying for this – and it’s there that attempts at reform fall. 

Government is about making tough decisions. But politicians shouldn’t be scared of talking to the public about what those tough choices are and being clear about the trade-offs...

Time after time over the past 20 years, research, polling and deliberative work with the public by think tanks and others has shown that when taken through the issues, the public want social care to be a partnership between the government and the state. They want the state contribution to be more generous. They know this will cost more money. But at no stage has government openly talked about where that money could come from, and what might the trade-offs be. Indeed, at every step, government has done whatever it can to avoid that conversation – with HM Treasury asserting that it and it alone decide these things. One of the more infuriating moments in my social care reform journey was being told in response to a popular reform option ‘Of course people like it, it’s a free lunch’ when at every stage in the preceding two years HM Treasury had refused to allow any debate or discussion about how to pay for the increased costs. And this is where Osborne has been wrong – refusing to allow for an open discussion and debate that allows people to understand the current social care offer, the options for a new and better one, and how that cost should fall on the individual family, the state and by extension the tax payer, has meant that the political calculation has got stuck.    

Government is about making tough decisions. But politicians shouldn’t be scared of talking to the public about what those tough choices are and being clear about the trade-offs, to support a vision for social care that we would all want for ourselves, our friends and our families. Only this kind of bravery will change the political calculation.  

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