This autumn could prove to be a crucial moment for the future of the social care system. Many within the sector are pinning their hopes on the government’s long-awaited green paper to solve the crisis, which becomes more acute with every passing week.
Councils, which deliver social care to older people and younger people with care needs, are in the grip of serious financial problems. Earlier this month, Somerset County Council revealed it was making emergency cuts to stave off bankruptcy, a fate that has already befallen Northamptonshire County Council.
Councils have had their budgets from central government cut by an average of 40 per cent since 2010, which has seen over £7bn drained from social care funding, reducing the amount of care councils can provide. The funding gap, which already stands at around £1.3bn, is set to rise to £2.5bn by 2020.
These funding reductions mean that 400,000 fewer people are now getting publicly-funded care than in 2010. 1.4m older people who need care do not get the support they need to carry out basic tasks like washing, dressing and toileting.
Cuts have led to a growing number of care providers within the predominantly outsourced social care system handing back contracts or closing altogether because they cannot provide safe care on the sums allocated to them.
Access to care is not the only problem. A fifth of all services nationally are rated as requiring improvement or as inadequate, and there are pockets of particularly poor care throughout the country. Many dedicated care workers are overworked, underpaid and struggling to give the care they want to provide.
The current crisis is unsustainable, but it is remarkable how often that has been said over the 20 years since the first review, the Royal Commission on Long-Term Care for the Elderly, reported in 1999.
Who pays for care remains the most vexing question. Under the current rules, anyone with assets or savings of over £23,250 pays for the whole cost of care without any state support. Beneath this figure, support is tapered until the individual reaches £14,250, at which point their care is free.
This is manifestly unfair. It makes an arbitrary distinction between people with certain medical conditions, such as cancer, who get free healthcare on the NHS, while others, with conditions such as dementia, get no care unless they pay for it.
The low asset threshold of the means test often sucks large numbers of people into paying high and even “catastrophic” social care costs, exhausting their savings or selling their home to meet costs accrued over many years. There is no upper limit: one in ten older people pays £100,000 or more for social care, though lower sums can be equally catastrophic for many more.
A recent survey by Which? found that only one in ten over-55s have money set aside to pay for the help they may need in later life, and that 15 per cent of those surveyed said they would ask their GP about social care rather than their local council.
So why is it that the current system, with all its inequities, has persisted? Since 1999, there have been 12 white papers, green papers and other consultations about social care in England as well as five independent reviews and commissions, not to mention a host of other research papers, all full of ideas on how to put in place social care on a sustainable long-term footing. And yet no lasting settlement.
Labour’s plans to offer care free at the point of need, outlined in its 2010 white paper, were shelved by electoral defeat that year after aggressive Tory sloganeering that branded Labour’s plan to impose a levy on estates a “Death Tax”, poisoning the well of debate on social care thereafter.
Since then, the Conservative government has ducked reform while simultaneously cutting care funding. In 2016, it shelved the care cost cap created by the 2014 Care Act. The ill-thought out “Dementia Tax” policy, which included the value of people’s homes in the means test for home care, had an impact so toxic it was effectively dropped within four days.
Fearing the wrath of a distrustful electorate, the government has delayed a green paper it promised to deliver this summer until the autumn – a full year after it was first announced. However, the succession of ideas floated tentatively in the press recently, including a “Care ISA” and an auto-enrolment savings scheme, suggest that the green paper is not likely to produce any firm new proposals, or indeed the funding needed to ease the current crisis.
The government appears to lack both the courage and the ideas to reform social care and it also fails to understand the value of social care to the people who rely on it. Labour recognises that social care enables people to live with independence and dignity, which is why our reforms will address how social care is delivered as well as how it is funded.
Labour has already pledged to invest an additional £8bn to lift both the quality of care and access to care. We would then plan to move to a sustainable system of care which would pool the risk of paying for care through a cap on individual costs.
We would encourage councils to commission care on an ethical basis from providers who sign up to an ethical care charter and agree to certain terms and conditions for care staff as a minimum. Ethical commissioning could also create a more vibrant network of services; social enterprises, mutuals, public and third sector organisations, not just private sector providers. This would help lift quality and enable a focus on the personal needs of people who are cared for.