The Guardian view on the social care crisis: fix a broken system
Coronavirus has yanked back the veil that had obscured the crisis in social care. The unfairness, confusion and humiliation felt by people using the system is out in plain sight. The public intuitively grasps that something needs to be done. When Boris Johnson arrived in Downing Street, he claimed to have a plan to fix a broken system. If a week is a long time in politics, then last July feels like an aeon ago. Mr Johnson’s plan has yet to appear. The worry is that it has been swallowed up by the gaping maw of the pandemic.
That is why ministers should listen to the Commons health and social care committee. Last week MPs painted a picture, in England, of an underfunded system, stretched to breaking point, with a low-paid workforce who need more than clapping. The committee said, at a minimum, £7bn extra should be spent by 2023-24 on the system, with roughly 60% of the money used to cover demographic changes and lift pay in line with the national minimum wage. The rest of the cash would be used to introduce a cap on care costs to protect people against catastrophic bills, first suggested by the economist Sir Andrew Dilnot in 2011.
This is an “oven-ready” plan. MPs have set aside policy differences to make the offer digestible for the Treasury. Select committees in both the Lords and the Commons had argued for introducing free personal care to help people with daily tasks such as bathing and dressing. Parliamentarians are now more muted in their support for this policy, aware the £5bn price tag would be too large for the chancellor to swallow. The state should be more generous because we are all living longer. The consequent higher demand for long-term care exposes more people to the “lottery” of the system. It is becoming harder to argue, on ethical grounds, that the NHS will treat long-term conditions such as cancer for free while dementia can cost a sufferer the family home or life savings. The system is plainly malfunctioning when the elderly occupy hospital beds because of a shortage of care places.
The state is a crucial prop in the English social care system, providing private operators with a subsidy, via councils, that allows them to open their doors to rich and poor alike. Without adequate funding, local-authority-funded places in private care homes dry up. The upshot is, say experts, a growing divide: with only the very poorest and most incapacitated able to access council-funded beds in a shrinking number of care homes while affluent seniors buy spots in Florida-style retirement villages which come with private nursing care. Anger over such divisions may quickly turn into an electoral “grey-quake”.
Ministers cannot say they haven’t been warned. Yet a government solution remains elusive. There is little consensus, especially in the ruling Conservative party, on how the “in year” cost of social care should be apportioned between its current and future beneficiaries. Some Tories think government intervention is unpopular and hanker for more market-led solutions. Yet there is already a social care precept on council tax and there has been no revolt in the shires. The state is best positioned to pool risks and insure people against the catastrophic costs because it is impossible to tell who will need long-term care in old age. Other modern democracies like Germany and Japan have introduced levies on older workers. A wealth duty might also be another way of meeting the cost of a national benefit.
The select committee’s chair, Jeremy Hunt, was the longest-serving health secretary and the first ever health and social care secretary. In office he did win a significant increase to the NHS budget but he failed to do the same with social care. This was partly because, in the absence of a debate, social care taxes polled badly. But also because George Osborne, when chancellor, ducked the issue and Theresa May blew it up on the campaign trail. Mr Hunt, who lost the chance to lead the Tory party to Mr Johnson, has urged the government to keep its word and mend social care. No one would wish otherwise.
