Why are we more comfortable with the decline of social care than with the same phenomenon in the NHS?
Consider the endless column inches devoted to consternation at overlong treatment waiting lists and the additional billions poured by this government, like so many others, into its endlessly voracious budgets. Meanwhile, social care overspends are taking many councils to the brink of bankruptcy.
During the pandemic, we were exhorted to “protect the NHS” – while safeguards for care homes often seemed like an afterthought.
We are sleepwalking toward a version of the welfare state that treats bodily illness as a matter of high-priority public concern and frailty, dependency and decline as something halfway between a family burden and an asset test.
That marginalisation ignores how central social care is to other policy questions whose significance is not in doubt.
The state of adult social care has a massive bearing on hospital flow, local government solvency, intergenerational fairness and the scale of women’s unpaid labour.
There is no parity of esteem between these two parts of our public services, and that, more than any single policy idea, is surely what drives the current vogue for a “National Care Service”.
But if that is to be anything more than a rebranding exercise, it will require a radically new approach to funding. This is the area where decline matters most. The collapse of the funding model helps explain the underinvestment, workforce pressures and unmet need that have become normalised across the system.
The current model is what happens when a decades-old settlement collides with contemporary demography, a new demand profile and the diseases of old age that come with it. Working-age adult social care used to be a relatively small part of the spend; now it accounts for around half. And we used to live shorter lives.
The extraordinary advances in medical science, nutrition and living standards have brought with them a simple reality: most of us will one day need some amount of care, some of us a great deal of it, and this is a normal and predictable part of the human life course.
That makes later-life care a classic case for collective risk-pooling. In our new report, Beyond Caring, we argue that England should stop bundling working-age and later-life care together as though they raise the same ethical and fiscal questions.
For later-life care in particular, the case is for a new social insurance settlement: one in which people contribute during working life to a genuinely pre-funded national pot, invested for growth to meet their cohort’s care costs in old age, with clearer entitlements and stronger protection against ruinous expense. No more council tax precept.
No more default reliance on general taxation. And the transition should be supported by asking the wealthiest older people to contribute more.
If we can prise this debate a little further open, we will have done our job. If we fail to fix the system, the disappearance of dignity in later life will be a blot on all our copybooks.
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