The health service is usually a dominant concern in any general election, but few would have predicted when this snap poll was called that it would be eclipsed by the less glamorous issue of social care.
The Conservatives put it centre stage. Even as I write, Theresa May is frantically distancing herself from her manifesto, Forward, Together, which states that, under the next Tory government, people will be compelled to repay their own care costs posthumously until their estates have been depleted to a “floor” of £100,000. May’s hasty “clarifications” now speak of public consultation to decide the level of a “cap” on an individual’s contribution to their care – the same cap that the Tories had firmly ruled out just days earlier.
So, was this merely an unfortunate gaffe, the result of a little hasty, late-night manifesto-writing? That’s certainly the line we are being fed. But does the episode in fact give us a rare insight into the Conservatives’ unspoken intentions for our public services?
Take the state of social care. No one doubts there is a crisis; commentators estimate it would take between £3bn and £4bn to put it right. That is a sum remarkably close to the £4.6bn that the Association of Directors of Adult Social Services estimates was cut from local council social care budgets over the term of the coalition government. A similar picture appears in the NHS and in the education sector. Across the board, public services are being deliberately starved of funds.
Budgetary constraint is, of course, a helpful tool for improving efficiency and reducing waste. But the debacle over the manifesto pledge suggests that the Conservatives are playing a different game. With careful fine-tuning – back in March, the Chancellor, Philip Hammond, announced a social care top-up of £2bn over three years – the Tories have been keeping public services in a state of permanent stress but at the same time not allowing them to implode, an outcome that would have calamitous political consequences.
This perpetual sense of near-crisis – enough to cause cries of pain, but not enough to lead to everything falling apart – generates fertile soil in which to sow new ideas. But a House of Lords select committee report on the long-term sustainability of the NHS and adult social care, published in April this year, unequivocally favours continuing the present model of taxation-funded, universal health care that Britain has enjoyed since the foundation of the NHS.
The report quoted Jeremy Hunt, the Secretary of State for Health, who said this was “probably the choice that is closest to what most British people want”. You can almost hear the gritted teeth. How do you change the settled public conviction, such that people begin to entertain other options? Answer: by running services that are constantly failing.
The misjudgement in Forward, Together was to do with the current fertility of the soil. Despite carefully orchestrated headlines in the Daily Mail and elsewhere, praising Theresa May for being prepared to take the tough decisions necessary, we evidently have not been softened up for long enough to be willing to accept that general taxation can’t continue to provide high-quality social care. So, a hasty retreat.
Ideologically, however, the Tories believe in low taxation, minimal state involvement and the primacy of private provision. If we are indeed about to enter another full-term Conservative administration, we must be prepared for five more years of sustained near-crisis in our public services.
Periodically, we will see new ideas for “solutions” floated – top-up health insurance schemes, measures to increase the proportion of care costs met by individuals’ private funds. At some point, the Tories calculate, the soil will prove receptive enough, and the seeds of a very different Britain will begin to sprout and grow.
This article appears in the 31 May 2017 issue of the New Statesman, The Labour reckoning