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16 May 2008

A desperate need for care reform

We are all living longer, and care provision must be central to Brown's social justice agenda, argue

By Gordon Lishman

This week Gordon Brown made it clear that Labour regards the reform of care and support for older and disabled people as lying “at the heart of our ambition to create a fairer Britain”. He has stated that he wants reform to be based on the principle of progressive universalism. This immediately raises a dilemma – how to give more help to everyone, while ensuring that assisting the poorest remains the priority?

The current social care system is a disgrace and is badly letting down many older people and their families. Brown’s announcement of a public consultation is therefore very welcome and we hope it will lead to radical reform.

While the situation is already grim, for many people missing out on the support they need it will rapidly get much worse. Within the next 25 years the number of people over the age of 85 and the numbers with dementia will both double. Most of us are likely to have more years of healthy life than earlier generations, but many will also suffer longer periods of disability towards the end of life.

Money is clearly tight for both the government and individuals, but reform of the care system cannot wait until the economic outlook improves. It will cost billions of pounds a year just to patch up the current system. Although there is room for improving efficiency within the system, these sums cannot be found by making better use of the money already being spent on care.

Unsurprisingly, the debate is often framed in terms of who will pay. However, if people’s needs are the starting point for this debate, the central issues are the poor quality of care they often receive and whether those who most need it can get any state help at all.

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Based on Age Concern’s experience, two issues will therefore be particularly important. Firstly, driving up the quality of all types of care and secondly designing a system that is clearer and can be trusted so that people can plan for potential care needs in later life.

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Although there is a long way to go, the government has already introduced policies designed to drive up quality, through minimum standards. The new ‘personal budgets,’ aimed at putting people in control of their care, are also seen as a means to raise standards.

The one thing that the government has made clear is that care and support will not be free for everyone. News that people should prepare for possible future care needs as well as a long retirement is unlikely to be welcome, but it is a reality that we all need to face. Whether it will be left to the individual to plan as best they can through the private market, or whether there will be some sort of state-sponsored mechanism for risk pooling, is likely to be hotly debated. For now, the government has simply said that “we must avoid overstretching families and individuals and believe it is worthwhile exploring how every adult could contribute in a way that insures them against very high costs of care and support”.

Care reform will be a serious test of the government’s ability to meet the needs of society as a whole while furthering social justice. It will require a new partnership between individuals and the state, but delivering the necessary changes would enable older people to retain their dignity and exercise their rights and control over their everyday lives. The prime minister is right to place this ambition at the heart of his aim of creating a fairer Britain.