It is becoming almost a badge of honour for attempts at reform of adult social care to be attacked as a ‘dementia tax’. This week, the Labour leader Keir Starmer told the House of Commons that the government’s proposals were a ‘working-class dementia tax’, echoing the attacks on Theresa May’s 2017 reforms (a ‘dementia tax’) and the 2010 Labour Party manifesto proposals (a ‘death tax’).
'The revised version of the government’s reforms changes a crucial detail of the planned £86,000 cap on lifetime costs, making them much less protective for people with lower-value assets – hence ‘working-class dementia tax’.'
The problem for the government is that the attacks on the current reform proposals are essentially fair. The revised version of the government’s reforms changes a crucial detail of the planned £86,000 cap on lifetime costs, making them much less protective for people with lower-value assets – hence ‘working-class dementia tax’. It is no surprise, then, that the change united the opposition with a significant number of Conservative backbenchers to heavily reduce, if not overturn, the government’s majority when the House of Commons voted on the amendment. The measures will continue their progress but can expect some severe scrutiny in the House of Lords.
While the unexpected change to the cap has dominated the debate in recent days, other aspects of the governments proposed reforms have tended to be overlooked. This is unfortunate because, if funded properly, they are a significant improvement on the current system. The government plans to extend state support on adult social care to people with assets of less than £100,000 – a big step forward from the current, miserly £23,250. And, as is the case now, for people needing home care the assets to be counted will not include the value of people’s homes, just their savings. While this has gone under the radar amid the huge arguments about the cap, many more people should now benefit from subsidised care at home for their eligible needs.
The government has also floated other, useful reforms in September. They include a proposal to end (or limit) the unfair situation whereby people who fund their own care often pay much higher rates than those who are state funded. There are also promised measures around workforce training and wellbeing, and around support for family carers.
'The vision is critical because it will – or should – set out clearly what the government wants from adult social care...'
In addition to questions about the adequacy of the funding for these measures, the acid test will be whether it fits within a coherent, credible vision for adult social care, which the government has promised to set out in the White Paper due to be published imminently. The vision is critical because it will – or should – set out clearly what the government wants from adult social care, thereby providing the sector with the clear goals and direction that have been lacking for so long.
The King’s Fund has produced its own vision for adult social care which, in effect, sets a test for the government’s one. It is based around four principles that, combined, lay out an ambitious but achievable future for the adult social care system in England:
Do the reforms ensure that people can get the services they need where they want them? At the moment, there are wide gaps in service availability and high levels of unmet need.
Do the reforms ensure that people have control over the services they are using? At the moment, there is limited information for people to use to make decisions, power often lies in the hands of service commissioners rather than users, and there is limited scope to challenge poor services.
Do the reforms ensure higher-quality services? At the moment, while most services are good, there are too many poor services that fail to improve and there is a desperate shortage of care workers (a long-term workforce plan is urgently needed).
Do the reforms give more people access to state-funded support? The government’s planned reforms will help here, despite the regressive changes to the cap, but should go further. There is also a need for much wider access to basic support (for example, handypeople), advice and information, and services to help people get back on their feet after illness or a hospital stay.
Only with the publication of the White Paper will we know the extent of the government’s vision for social care and whether it meets these tests. And only when we see the resources that will be committed to achieving that vision will we know whether the vision is attainable.