Labour’s big challenge ahead of its National Policy Forum meeting next month is to distil four years’ of abstract theorising, and often worthy but complex ideas, into a clear quality of life prospectus, the so-called "retail offer" for voters.
A classic example is access to childcare. This is a nightmarish issue for millions of parents, fusing together worries over affordability and quality of provision for a service that now counts as a cornerstone of a modern welfare state. But at the other end of the age spectrum – and equally worthy of being counted as a retail issue for voters – is the cost, quality and accessibility of social care for adults.
The public is already convinced it’s an issue. According to a 2012 poll by Carers UK, nearly half of adults in England (46 per cent) knew someone in their family who needed care and support with basic everyday tasks like eating, washing and dressing. In addition, 89 per of voters didn’t think it was fair that older and disabled people paid for the costs of their care.
Yet a recent report by the King’s Fund, led by economist Kate Barker, found that patients with different conditions like cancer and dementia ending up "making very different contributions to the cost" because the free entitlements of NHS care clash with the means-testing of the social care system. In a telling phrase, she found that the mismatched relationship between the NHS and local authorities, who are responsible for social care, means that the current systems "rub up against each other like bones in a fracture." She recommended a single, ring-fenced health and social care budget, ending the current salami-slicing of care provision.
And sliced it is. Age UK’s recent Care in Crisis report found that since 2010, spending on social care has dropped by £1.2bn (or 15.4 per cent). This squeeze on the finances of the social care system leaves "hundreds of thousands" of older people who have "moderate" needs, like help with getting dressed, without any assistance from their local council. The charity reckons that nearly nine out of ten local authorities have now limited their threshold for supporting elderly adults to those with "substantial" needs.
The current system is a complete mess, resulting in a postcode lottery of provision, with all the associated worry this causes. The belief is that integration will iron-out differential performance and entitlements in the care sector and help to reduce costs, with a recent survey by accountants PWC finding that 85 per cent of council leaders and chief executives agreed that integration would improve care outcomes.
This is shadow health secretary Andy Burnham’s big idea. He has long championed greater integration, indeed, one of the high points of the 2010 Labour leadership campaign, (amid the bromides and false bonhomie) was Burnham putting this idea into the mix. Although largely a technical change, Burnham’s plan speaks to voters’ fears about the standards of care their elderly relatives will receive - and whether or not their savings will be spent paying for it - classic retail politics territory.
But Burnham’s plan is also important because it shows Labour grappling with the kind of real world problems it will have to face up to if the party wins next year’s general election. Governing effectively after 2015 depends on being clear about priorities, being willing to innovate in the way services are provided and make less money stretch further. And nowhere is this more pressing than in dealing with the future of social care.