The social care system is on its knees: what is the Chancellor going to do?

This week's Spending Review and next week's Lords debate of the Care Bill provide the government with opportunities to start solving our care crisis.

On Wednesday millions of older and disabled people who rely on support from their council to get up, get washed and dressed and get out will be closely following the Chancellor’s Spending Review.

The social care system is on its knees.

Budget cuts to councils have seen them upping the bar for eligibility for support, with 83 per cent of councils now setting the threshold at a higher level. According to London School of Economics 69,000 disabled people have been pushed out of the system.

At the same time many are squeezing the support for those that are in the system. A Scope survey found almost 40 per cent of disabled people who continue to receive social care support are not having their basic needs met including eating properly, washing, dressing or being able to get out of the house.

The consequences are dire. Take away the preventative support and people fall into crisis.

It’s no surprise that there’s now a widening consensus that the crisis in local care is a factor in the pressures on A&E.

It’s also no surprise that there’s cross-sector and cross party backing for the Chancellor to use the Spending Review to invest in preventative social care.

Intriguingly on Friday there were strong hints that the Department for Communities and Local Government, while potentially taking a 10 per cent budget cut, could take responsibility for £3bn from other departments' budgets.

The momentum is there and social care looks set to be a crucial Spending Review issue.

But in case the Chancellor needs further convincing let me introduce Angela Murray.

Angela is an independent, sociable young woman who has a degree in psychology. She volunteers three days a week. She’s also disabled; she was hit by a car when she was two.

For the last ten years, she’s lived in her own home and has had support from her council to get up, get washed, get dressed, go to the toilet, cook, eat and shop.

But recently her social worker told her that her care was being cut from 20 hours-a-day to just three hours. Angela was given five days’ notice.

Angela described her new care routine as ‘depressing and undignified’. She had to be in bed at 9.30pm every night. She also lived off microwave meals because her 30 minute evening call didn’t give the carer enough time to cook for Angela as well as take her to the toilet.

Angela says if she has to live under that regime for the next 50 years, life would not be worth living. She’s fighting back: the local media have already covered Angela’s story and she has a solicitor on board fighting the changes.

The council, reluctantly, agreed to temporarily reinstate Angela’s old care package until a second reassessment, when her care package is likely to be cut again.

And while we’re at it, let me also introduce the 45,000 members of the public who have signed Angela’s petition calling on the Chancellor to invest in social care. It’s clear that Britain cares about social care.

Wednesday will be crucial. But it doesn’t stop there.

The following week the Government will publish its plans for deciding who is in and out of the social care system. This is critical.

The announcement will come as the Care Bill is debated in the Lords. The reforms seek to tackle the crisis in care by introducing a cap on costs, a new means-testing threshold and national eligibility to end the postcode lottery in care.

But the plans, as they are, will also raise the bar for eligibility to social care (see p32 of the White Paper). According to the London School of Economics (LSE) this will leave 105,000 disabled people outside of the system altogether.

If the Chancellor takes the opportunity to invest in social care, that cash needs to be channelled into a system in which disabled people are eligible for care before their situation has deteriorated into crisis.

Properly funded social care is now a ‘no brainer’.

Research by Deloitte has shown that investing in £1.2bn in social care for disabled people will result in a £700m return for central Government and £570m return for local Government and NHS, because it prevents disabled people falling into crisis and needing to access more costly support.

By acting decisively the Chancellor can go a long way to solving the social care crisis, protect A&Es, and save cash across government departments. It’s a triple win.

But the Government will only be able to claim that it’s solved the social care crisis once it has decided who is in and who is out of the system.

Richard Hawkes is chief executive of the disability charity Scope

Take away the preventative support and people fall into crisis. Photograph: Getty Images

Richard Hawkes is chief executive of the disability charity Scope.

FAYEZ NURELDINE/AFP/Getty Images
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Under pressure at home, Donald Trump will struggle to deliver what Saudi Arabia wants

Above all, the Gulf states want stability. Can this beleaguered US president bring order?

There is a nervous energy around Riyadh. Fresh palm trees line the roads from the airport, punctuated by a wall of American flags and corporate slogans: “Together we prevail.” All the street lights are suddenly working.

The visit of any American president is always a lavish affair in Saudi Arabia, but there is an optimism to this visit that evaded the Obama years and even the recent visits of Theresa May and Angela Merkel.

Yet, there are two distinct parts to this trip – Trump’s first overseas engagement as president – that will determine its success. The first is relatively straightforward. Trump will sign huge defence contracts worth billions of dollars and offer trading opportunities that allow him to maintain his narrative of economic renewal for American businesses.

For the Saudis, too, these deals will fit into their ambitious project – known as Vision 2030 – to expand and diversify their economy away from its current dependence on oil revenues. Both parties are comfortable with this type of corporate and transactional government, enjoying the gaudy pomp and ceremony that comes with the signing of newly minted deals.

The more complicated aspects of the trip relate to its political dimensions. As the Middle East continues to convulse under the most significant turmoil to envelope it since the collapse of the Ottoman Empire, what Gulf leaders desperately want is the re-establishment of order. At its core, that is what will define Donald Trump’s visit to Saudi Arabia – and the Saudis are optimistic.

Their buoyancy is borne of shared regional interests, not least curbing Iranian influence. Ever since the Arab uprisings in 2011, Tehran has asserted itself across the Levant by organising hundreds of proxies to fight on its behalf in Syria and Iraq. Closer to home, too, the Gulf states accuse Iran of fomenting unrest within Shia communities in Saudi Arabia’s eastern provinces, in Bahrain, and in Yemen.

All of this has left the House of Saud feeling especially vulnerable. Having enjoyed an American security umbrella since the 1970s, Obama’s pursuit of the Iran deal left them feeling particularly exposed.

In part at least, this explains some of the Kingdom’s more frantic actions at home and abroad – including the execution of prominent Shia cleric, Sheikh Nimr al-Nimr, and the war in Yemen. Both are really about posturing to Iran: projecting power and demonstrating Saudi resolve.

Trump shares these concerns over Iranian influence, is prepared to look the other way on Saudi Arabia’s war in Yemen, and is deeply opposed to Obama’s nuclear deal. Riyadh believes he will restore the status quo and is encouraged by the direction of travel.

Just last month Trump commissioned a review of the Iran deal while the US Treasury imposed sanctions on two Iranian officials. Saudi Arabia also welcomed Trump’s decision to launch cruise missiles against a Syrian military base last month after Bashar al-Assad used chemical weapons in the town of Khan Sheikhoun.

These measures have been largely tokenistic, but their broader impact has been very significant. The Saudis, and their Gulf partners more generally, feel greatly reassured. This is an American presence in the region that is aligned to their interests, that they know well and can manage.

That is why Gulf states have rushed to embrace the new president ever since he first entered the Oval Office. Saudi Arabia’s deputy crown prince, Mohammed bin Salman (colloquially known simply as “MBS”), already visited him in Washington earlier this year. The Emiratis and others followed shortly afterwards.

A spokesman for Mohammed bin Salman later described the meeting with Trump as an “historical turning point” in relations between the two countries. A White House readout of the meeting baldly stated: “The President and the deputy crown prince noted the importance of confronting Iran's destabilising regional activities.”

Now that Trump is visiting them, the Saudis are hoping to broker an even broader series of engagements between the current administration and the Islamic world. To that end, they are bringing 24 different Muslim leaders to Saudi Arabia for this visit.

This is where Trump’s visit is likely to be fraught because he plans to deliver a major speech about Islam during his visit – a move that has seemingly no positives associated with it.

There is a lot of interest (and bemusement) from ordinary Saudis about what Trump will actually say. Most are willing to look beyond his divisive campaign rhetoric – he did, after all, declare “I think Islam hates us” – and listen to him in Riyadh. But what can he say?

Either he will indulge his audience by describing Islam as a great civilisation, thereby angering much of his political base; or he will stick to the deeply hostile rhetoric of his campaign.

There is, of course, room for an informed, careful, and nuanced speech to be made on the topic, but these are not adjectives commonly associated with Donald Trump. Indeed, the pressure is on.

He will be on the road for nine days at a time when pressure is building over the sacking of the former FBI director James Comey and the ongoing investigation into former national security advisor Michael Flynn’s contacts with Russia.

It is already being reported that Trump is not entirely enthusiastic about such a long overseas programme, but he is committed now. As with almost everything concerning his presidency, this extra pressure adds a wild air of unpredictability to what could happen.

Away from the lucrative deals and glad-handing, this will be the real standard by which to measure the success of Trump’s visit. For a relationship principally defined by its pursuit of stability, whether Trump can deliver what the Gulf really wants remains to be seen.

Shiraz Maher is a contributing writer for the New Statesman and a senior research fellow at King’s College London’s International Centre for the Study of Radicalisation.

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