Anna Killick, researcher on the PSA Commission on Care project, argues that the Lords’ report on social care is an intervention that needs to be taken seriously by the government.
In the midst of the Tory leadership contest, with not much detail from the candidates themselves, other politicians have produced plans for dealing with the crisis in social care.
On 29th April 2019, Conservative MP Damian Green, previously Theresa May’s Deputy Prime Minister, published a paper – Fixing the Care Crisis – for the free market thinktank the Centre for Policy Studies, advocating a ‘two tier’ system of social care for the elderly, with a big element of private insurance. A cross party committee in the Lords, however, chaired by former Conservative Minister Lord Forsyth, is calling for a care system that is free for all, like the national health service, funded out of general taxation.
Despite an estimated 1.4 million older people now denied care due to cuts, many fear that the government will delay publishing its long awaited green paper on social care until after the next general election. However, the pressure is mounting as the social care crisis deepens. What do these two latest sets of proposals say and are they likely to be taken up by the government?
First, let us examine Damian Green’s paper. His proposals will cost the exchequer less and are not as far reaching as those recommended in the 2016 PSA Commission on Care Report: Towards a New deal for Care and Carers. Under Green’s ‘two tier’ system every older person in need of care would be entitled to a ‘decent’ standard of what he calls ‘universal care’. Whether people were cared for in their own homes or in care homes, the care would be free.
However, it would be ‘basic’. Those who could afford it would be encouraged to buy a care supplement similar to an insurance policy or private pension to ensure they can pay ‘for more expensive care’. This raises concerns about how ‘basic’ the free care might be.
Under Green’s proposals for funding basic care, local councils would still manage the care but Whitehall would dispense the funds. He suggests this would prevent many of the problems local councils have at present where they are expected to raise a large proportion of the money themselves. Poorer councils or those with a heavy care burden currently find this onerous and most commentators recognise there is now an element of ‘post code lottery’ regarding quality of care.
Green accepts the sums of public money needed to fund care are higher than what is presently available. His scheme would cost £2.75 billion per annum extra. He expects some of the extra cost would come from efficiencies and taxing the winter fuel allowance but, as a ‘last resort’, he believes it would be fair for all over 50s to pay an extra 1% national insurance contribution.
Green’s report is welcome in the sense that it moves the Conservative party closer to the principle of free care at the point of need. However, we need to be concerned because in practice the increased funds of £2.75 billion a year will not be adequate and the ‘basic care’ not of a high enough quality. In addition, his scheme does not address the support unpaid carers need and relies too heavily on market solutions, like the private insurance element for those wanting to top up care, when the report of the PSA Commission on Care suggested marketised approaches may not be the most efficient. It therefore builds into the system inequalities in accessing good quality care – limiting access to for those who can pay.
Many politicians and NGOs are calling for a cross party approach, so that whatever reforms are adopted are sustained over time. So how does the cross party Lords’ Economic Affairs Committee report, ‘Social care funding: how to end a national scandal’, published 4th July 2019, compare with Green’s? This report demands an immediate injection of money now. To address the chronic underfunding of the last decade, the Lords’ committee calls for Whitehall to give local councils an extra one off £8 billion to get quality back up to a decent standard. They then propose additional money, £7 billion each year, to make the system fairer. By 2025, they aim for England to have a social care system that is, like the NHS, free for all at the point of need.
They argue the extra money should come from increased general taxation. Committee chair Lord Forsyth, a former Conservative government minister, told the Guardian the fairest and most efficient way to meet the £15bn cost was via taxation: ‘I’m a Thatcherite Tory: I support reducing tax and controlling public expenditure. But this is the minimum requirement to provide a decent standard of care in our country.’ Like Green, they also argue additional funding should be dispensed by Whitehall to local authorities according to a funding formula to help avoid the postcode lottery.
The Lords’ Committee’s report, proposing social care for all free at the point of need, comes close to what was recommended in the PSA Commission on Care Report. It would, moreover, be far less expensive than people might expect. At present, many elderly people who do not qualify for free care under the current rules find their condition worsens. Not only is this a terrible human cost, it means they often end up needing expensive emergency hospital or nursing home care instead of being able to stay in their own homes.
By free care the Lords’ committee means free personal care such as help with washing and cooking. People would receive that free whether in their own homes or a residential home. However, those that need to go into a residential home, would face a means test in order to work out whether they should contribute towards the accommodation costs. The committee recommends that these accommodation costs should be capped, but do not recommend a figure.
The PSA Commision on Care was also concerned about the bigger picture, not just the funding regime these two reports focus on, but broader points about
- the need to consult elderly people and their carers more about the quality of care
- the need to address the lack of access and lower quality of care available to elderly BAME people,
- the need to support unpaid carers better
- and to consider whether the current ‘marketising’ approach is efficient and delivers high quality care.
With these points in mind, and building on the work of the PSA Commission on Care, University of Warwick researchers will be moving into a new phase of evidence gathering later in 2019. They will be asking people locally, in Coventry, to advise the government about what to include in the Green Paper (or, if it actually is released by then, what they make of the reccommnendations of the Green Paper). We last took evidence in 2016 and we want to hear about what has changed since then and, in particular, how we can make sure the green paper addresses the needs of the growing number of BAME elderly and their carers.
Care cannot continue to be a political football, constantly shelved until such time as we have a government with the confidence of a strong parliamentary majority behind it. On current form such a government could be years away.
Distracted by Brexit as it may be, the government needs to draw on all the existing recommendations, listen to the updated concerns expressed by people at the sharp end locally, and adopt a radical well-funded proposal, such as high quality care free for all. They should look closely at the Lords economic affairs committee’s proposals.
Image credit Neil Moralee via Creative Commons License