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Social care policy lurched back into the news recently after a long spell of inactivity. A proposal from a former Conservative minister and a spending announcement from Labour arrived, punctuated – as a reality check – by a major care home company going into administration. Both contributions, however, show that social care policy is the zombie of modern policy debate, stumbling unsteadily around in circles.
The most original policy input came from former Cabinet minister Damian Green. He proposed that everyone should be entitled to a ‘good level of care’, funded nationally in the same way as the state pension. In essence this is an enhanced, more expensive version of the free personal care system that operates in Scotland (and was discussed extensively in our own publication, A fork in the road).
Free personal care has many advantages and one major disadvantage – its cost. With the Health Foundation, we estimated this at an additional £7 billion to introduce in England in 2020/21, rising to £14 billion by 2030/31. The cost suggested as an ‘approximation’ by Damian Green – a mere £2.5 billion for a more generous system – is therefore a substantial underestimation, perhaps stemming from confusion about the likely costs of providing free home care. Yet, if it were really possible to provide all eligible adults in England with a good level of care for an extra £2.5 billion, the problem might have been solved by now.
'Social care policy is the zombie of modern policy debate, stumbling unsteadily around in circles.'
There were other major problems with Green’s proposal, not least the focus on care homes to the exclusion of home care and the decision to ignore working-age adults, despite them comprising nearly 50 per cent of publicly funded expenditure. And though the paper sees a major role for private insurance, it is only for those might want ‘better food, a bigger room or more trips’ above and beyond the ‘good level of care’ to be provided by the state. Pre-funded insurance is a hard enough sell anyway, let alone for just this.
At the most generous analysis, the paper was an interesting idea heavily let down by the lack of analytical rigour. Its basic idea scores well on some of the five key attributes we suggest in Approaches to social care funding, particularly around equity, fairness and ease of use, but has serious problems around economic efficiency, value for money and, particularly, sustainability.
Despite pleas in the paper for a cross-party consensus, it drew a stinging response from Shadow Chancellor John McDonnell – a response described not unreasonably by the heath secretary, Matt Hancock, as ‘aggressive, partisan and entirely negative’. Perhaps this was inevitable when the report was launched in a local election week. Yet its central idea was far closer to Labour’s direction of travel – a national care service– than McDonnell appeared to realise or perhaps care.
Labour’s own policy announcement was less a clear policy and more a shopping list. Having committed to spend an extra £8 billion on social care during the next parliament, the party outlined what it would buy with this money:
£2.8 billion to increase the number of home care packages
£350 million of investment in workforce training
ensuring that the earnings threshold for carers allowance rises year on year, in line with the National Living Wage
£350 million per year to help people with autism and learning disabilities move back into the community from inappropriate inpatient units.
Each of these may be a good thing in its own right but merely putting them together does not create a coherent overall policy.
'Despite two decades of attempts by successive governments, there remains no clear long-term plan for reform and no clear path for developing one.'
It appeared in the same week that one of the UK’s major care home providers, Four Seasons, went into administration. No homes are under immediate threat and Four Seasons failure may owe at least as much to the structure of its finances as to the low fees it receives for the 75 per cent of its residents who are state funded. Yet it shows the extreme pressure the social care system is under.
The 17,000 residents of Four Seasons homes – and their families – could therefore be forgiven for wondering whether there has been any progress towards a fundamental reform of how we care for our elderly and disabled population. Certainly there is no sign of the long-touted Green Paper,only vague assurances that it is still being worked on.
Attention is now likely to turn to the upcoming Spending Review, which will help determine the amount of money local authorities have to spend on social care for the next few years. There is strong case for additional funding for social care, not least because delivery of the recent, much-vaunted NHS long-term plan is predicated on the assumption that funding will be enough to avoid putting ‘additional pressures’ on the NHS. Yet a key feature of that funding has been its short-term nature, meaning that local authorities – and of course, people – cannot plan properly for their futures.
Overall, despite two decades of attempts by successive governments, there remains no clear long-term plan for reform and no clear path for developing one. The zombie continues to stagger around in circles, not dead and yet not properly alive either.