When you hear the word “crisis” used in British politics, it’s usually Brexit and climate change that come to mind. But away from these crises, we’re ignoring a far less glamorous emergency in England – the cost of social care. And by ignoring it, we’re letting our government off the hook.
Social care is a – perhaps damagingly bland – term for the care you are entitled to outside of the health service. It covers children’s services, social workers, foster care, help for people with disabilities and long-term physical or mental health conditions, and provision for the elderly.
You may never need to come into contact with social care services; or you may rely on the system from the day you are born. Either way, it’s difficult to drum up political momentum around a service that the majority of people rarely use.
Perhaps that’s part of why its unsustainability has been ignored for so long. That, and the huge and mounting scale of the problem.
In England, social care is the responsibility of local authorities. (As a devolved matter, there are different systems elsewhere in the UK.) Councils are mandated to provide these services for vulnerable people. It is one of their statutory duties, so if they don’t deliver it, they are breaking the law.
This means less money going on the services that they aren’t legally obliged to deliver, and more of the pie eaten up by social care. In fact, social care spending on children has actually gone up while other services have faced deep cuts.
Yet overall, real-terms spending on social care has fallen steeply since 2010, shrinking by £7bn over that period, building to a funding gap of £4.3bn by 2020, as predicted by the Local Government Association. The spend for older people has dropped by 17 per cent in real terms since 2010.
This is all while demand is rising. The number of people aged 85 and over has increased since 2009/10 by almost 9 per cent, according to the Kings Fund think tank, and the number of assessments of children at risk of harm or neglect have increased by 77 per cent, according to the Guardian. The number of children in care has increased by 15 per cent.
Resources are so stretched that people are being deprived of care: according to a group of health organisations led by the NHS Confederation, who wrote to the Prime Minister last month, 1.4 million older people in England now receive no help.
These same experts said “social care is on the brink of collapse”, and called it a “national scandal”.
So why is today the first time this topic has brushed the top of the news agenda since 2017? And not as a government policy, but a proposal in a think tank report by a disgraced former cabinet minister?
Today, the BBC’s Today programme on Radio 4 interviewed Damian Green about his idea for wealthier homeowners to pay towards their social care.
The former de facto deputy prime minister, forced to resign from cabinet in 2017 for breaching the ministerial code by lying about pornography found on his computer, laid out this plan in a report published by the conservative Centre for Policy Studies think tank.
Newspapers ran with the story. “Over-50s could be forced to pay £300 extra National Insurance to cover basic social care in old age – as well as give up property wealth if they want ‘perks’ like bigger rooms or days out,” said the Daily Mail (the word “could” is doing some heavy-lifting there). Meanwhile, the Guardian reported: “Damian Green suggests modelling social care provision on state pension”.
Green’s idea for a new social care funding model includes a flat-rate payment by taxpayers, like the state pension system, plus supplementary top-ups by those who can afford it to boost the budget with private contributions. He also proposes taxing the winter fuel allowance, diverting savings from the upcoming spending review, or a 1 per cent National Insurance surcharge for over-50s to fill the immediate funding gap.
Labour and the Kings Fund have criticised it, and the Local Government Association has welcomed this contribution to the debate. But whatever you think of this plan’s merits, why is a report that is very unlikely to become policy the only news we have about the future of social care?
Two years ago, in the March 2017 Budget, the government announced that it would publish a green paper on adult social care, to allow for a public consultation and a new policy for funding it. This was also a promise in the Conservatives’ 2017 election manifesto.
It was originally supposed to be published in summer 2017, but has yet to appear. It has been delayed eight times by my count, the most recent government utterance being that it will be published “at the earliest opportunity” – watered down from its previous line earlier this year of “the first opportunity in 2019”.
This is even vaguer than the Health and Social Care Secretary Matt Hancock saying in January that he “certainly intend[s] for that to happen before April”. And on Wednesday, with apologies for stating the obvious, it will be May. Another month further from even a squeak of policy-making to fill a vacuum currently depriving people of care.
The received Westminster wisdom is that the Tories have been spooked by the unpopularity of their 2017 manifesto plan for social care, dubbed the “dementia tax”, which is thought to have partly costed Theresa May her majority. But England stands to lose far more than a majority government if the issue is ignored any further.