This post is from The King's Fund Blog
For several months the state of adult social care has rarely been out of the news, reflecting unprecedented public and political concern that the funding and delivery of essential services for older and disabled people has not kept pace with demography and changing needs. Even the independent Care Quality Commission warned that the system was reaching a tipping point. So it is not surprising that so far social care has eclipsed the NHS as a major political issue in the 2017 election campaign.
The road to social care reform has been long and winding, with 12 Green Papers, White Papers and consultations and 4 independent reviews in the past 19 years. So what hope do the manifestos of the three main political parties offer that the next government will achieve greater success than its predecessors?
There are some key similarities between Labour and Liberal Democrats in pledging more money, moving towards a single local integrated service, and seeking cross-party consensus on long-term funding options. Both parties also share a commitment to implementing a cap on the lifetime care costs faced by individuals. Both manifestos contain a welcome recognition of the workforce challenges that increasingly threaten the availability of good care. These big policy themes are familiar, with few signs of radical new thinking, especially about different models of delivery. But there are differences in where the money will come from, with Labour favouring more taxation of higher earners and companies and the Liberal Democrats proposing a 1 per cent increase in income tax and possibly a dedicated health and care tax in the longer term. It is not clear that the amount of new money offered by either party will be sufficient to deliver their aspirations as well as to address the immediate multiple financial pressures facing councils and care providers.
The water between these and the Conservative manifesto could not be more clear or more blue. Its most surprising feature was the complete abandonment of their flagship policy commitment since 2013 to implement a cap on lifetime care costs, instead inverting the policy so that people will be expected to spend down their own money – including the value of their property – until they are left with £100,000. This will benefit people with modest assets but offers no protection from catastrophic care costs. The other key proposal is to include the value of the individual’s home in assessing their financial contribution to care at home, bringing home care into line with existing policy for residential care. As well as ensuring policy coherence, this proposal addresses the issue of intergenerational fairness – why shouldn’t relatively wealthy baby boomers draw on their property and pension wealth to fund their care rather than relying on working-age people, who have borne the brunt of austerity? It will mean thousands of people paying more for home care but will be complex and challenging for councils to implement and risks unintended consequences. These might include discouraging people from seeking help, placing a greater burden on unpaid carers and driving increased use of hospitals and long-term care. The winter fuel allowance for pensioners will be means tested and the saving redirected to social care – an idea that is not without merit. But the absence of costings makes it hard to assess how much extra money will be raised over and above the extra £2 billion announced in Spring Budget. The claim that these proposals are ‘the first ever proper plan to pay for – and provide – social care’ stretches credibility, especially as the manifesto is silent about the care needs of working-age disabled people with less than £100,000, who are wholly dependent on council-funded services. The direction is clear – access to services will depend on a triple lottery of where you live, what you can afford and what is wrong with you (develop cancer or heart disease but not dementia and your house and savings will be intact).
The condition of social care in England has deteriorated further in the months since the sombre assessment of our ‘home truths’ report. Access to publicly funded care has been falling for over a decade, with at least 26 per cent fewer recipients in the past six years. There is £5.5 billion less in council care budgets than there was in 2009, and despite planned extra money the funding gap is set to rise to £2.1 billion by 2019. Instead of more tinkering at the edges, what is needed is fundamental reform not only of funding but in the way services are delivered to offer better outcomes for people and to tackle the mounting workforce problems facing the sector. All of the manifestos fall short in setting clear, credible and costed proposals that address the scale of these challenges.