Where’s the social care in the health and social care bill?

by Peter Watt

There has been, rightly, an awful lot of attention given to the government’s health and social care bill. It proposes opening up the delivery of NHS services to any willing provider and the introduction, in some instances, of competition on the basis of price rather than outcome. Controversial stuff. Especially as the Conservatives promised no “top down reorganisation” during the election.

But there is one aspect of the bill that hasn’t been much commented on. It is misleadingly named. It is a “health” bill, certainly, but it is not a “social care” bill at all. This is not a pedantic point. The bill does not cover the social care system, which provides care and support to hundreds of thousands of people across the country in their homes and in residential settings. Last year, social care cost the state in the region of £27 billion. And individual families billions more on top. Many people do not realise that social care, unlike health, is not universally free.

Basically, if you have assets of more than £23,500 then you have to pay. If you become old and infirm, and need help staying at home, you will probably pay. If you need to move into a residential home, you will probably pay. With the average cost of a room in a nursing home at £36,000 pa, it won’t come cheap.

As the population ages, older people’s demands for care and support are expected to rise by around two thirds over the next 20 years. A system that is already creaking is in desperate need of reform if this increasing demand is to be met and afforded. The last Labour government established a royal commission into long term care that reported in 1999. It did not implement its recommendations. It wasn’t until March 2010 that the proposals for a national care service were set out. They were too late to be implemented. This set out what the shape of services might be in the future, but put off establishing how this would be paid for until after the election. The coalition agreement committed to establish a further review. The Dilnot commission, on the funding of care and support, was duly established and is due to report in July. The government has said that it intends to produce a white paper in response by Christmas.

There is, of course, a reason why reform has been put off for so long. Any solution is going to be controversial. At its heart, any reform will need to establish how we pay for the vast and increasing costs of care. What is the balance between what the state and the individual should pay? The likely answer is that it will be a partnership. And that partnership will be a hard sell. Any subsequent legislation may well prove to be even more controversial for the government than the current misnamed health and social care bill.

A solution that is fully funded from general taxation is quite frankly a non-starter: the costs are just too high. So any solution is going to require a combination of some funding by the state and individuals and families. Let us assume that the poorest will, as now, be protected by a safety net and that, as now, the richest will be able to take care of themselves. Once again, the squeezed (and numerically large) middle will bear the brunt.

The options available are all pretty unattractive to voters. Just remember, before the general election, when Andy Burnham laudably tried to get a consensus with an offer of inter-party talks. The Tories turned it into a political football. Further evidence, they said, of Labour’s alleged love of taxation. One of the options being considered was a tax levied on someone’s estate: the so called death tax.

But the hard fact is that the number of options is as limited as they are unattractive. Compulsory or voluntary insurance; a death tax or a charge on people’s property; charges on people’s savings – none would be popular. Savings having to be spent or assets built up in property having to be liberated. They all go to the heart of people’s desire to pass wealth to their family after their death. Families, already having to pay more for pensions, will be compelled to face the prospect of having to pay, at some point, for their care when they become frail.

It is an uncomfortable area for governments. And only the brave dare go there. And that, I hope, means that when Dilnot reports and the government brings forward proposals, Labour does all it can to support them. Already nervous back bench Tories may well be agitated; Lib Dems similarly.

It will be tempting to try and score points. After all, they played politics with the issue before the last election. But this issue needs to be dealt with. The status quo cannot continue. Families are already facing crippling costs of care for their loved ones, an incredibly complicated system, and a lottery in terms of outcomes. We know that we need to establish a way of balancing who pays along with simplifying the system. Families now, and in the future, need this to happen.

So in July, however tempting, let’s not turn our backs on people for short term political gain.

Peter Watt is a former general secretary of the Labour party. He is now chief executive of counsel and care.

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