Adult social care should be an urgent priority for the next government – and it is a problem which successive administrations have failed to address. In his first speech as prime minister, Boris Johnson promised to “fix the crisis in social care once and for all […] with a clear plan we have prepared”. There was, however, no plan in his party’s election manifesto.
The Conservatives, like Labour and the Liberal Democrats, recognise the scale of the problem – but the manifestos of all three parties don't agree on a solution. The acute pressures in the publicly-funded system are problems which the next government could fix alone, but more extensive reform – changing the scope of what the state provides – will be controversial, and will only succeed with cross-party consensus.
Simply to meet demand for social care requires significantly more money than is currently planned. Our Performance Tracker, produced in partnership with CIPFA, shows that the next government would have to spend at least £700m above current budgets just to provide social care – rather than improve standards – to the growing number of eligible people.
The Conservatives have promised £1bn more each year to “stabilise” social care and to build “cross-party consensus”. If it is is entirely additional to budgeted social care spending, then the £1bn might be enough to meet demand – but it leaves little headroom. If, as is likely, the cost of care rises as companies and charities implement the national living wage, then spending would have to increase at a faster rate. Nor is the extra money budgeted for in the manifesto, which suggests that it will be found within existing plans – requiring cuts to other government spending.
The Liberal Democrats have promised to ringfence an extra £7bn for the NHS and social care – although the split between the NHS and social care is unclear. They have also promised to set up a “cross-party health and social care convention” to build consensus on how to fund health and social care.
Labour has made the most extensive offer. It has promised to introduce free personal care for the over 65s – making some state-funded care and support universally available, as in Scotland – at a cost of £10.8bn. This figure is credible – based on independent analysis from The King’s Fund. Unlike the Liberal Democrats and the Conservatives, however, Labour has not committed to any cross-party work.
Since 1997, there have been five public consultations, four white papers, two green papers, two commissions (including a royal commission), two major pieces of legislation, and one policy paper on social care. The latest social care green paper has already been delayed five times, with no publication date yet scheduled.
The last two major attempts to reform social care alone ended in failure. Labour’s 2010 attempt to introduce a 'National Care Service' funded by a form of inheritance tax was quickly dismissed by the Conservatives as a death tax. The Conservative’s attempt to increase the floor of assets which an individual could keep in 2017, making the means-tested system more generous, was in turn labelled a ‘dementia tax’. The potential long-term merits of both proposals were immediately dashed by the search for short-term headlines.
This is an abysmal record, but it would still be a mistake to dismiss the value of cross-party consensus. For while there is clear blue water between the parties on many policies, there is enough overlap on social care to suggest they could work together. There is a shared commitment to a cap on care costs, and recent reports from Policy Exchange and the Institute for Public Policy Research – think tanks at the opposite ends of the ideological spectrum – are remarkably similar in both their diagnosis of the problems and their proposals for variants of free personal care.
The numerous ways to build cross-party consensus – from a royal commission to an independent inquiry – have mixed track records. But some, like the Pensions Commission, were able to build consensus for lasting changes. Our research found that the best option for social care would be a cross-party parliamentary commission of MPs and peers, led by a select committee chair, who would then champion its recommendations beyond the life of the inquiry.
To maximise its chance of success, the next government should appoint a high-profile, politically savvy chair to conduct an inquiry at the start of its term. The opposition parties should be given an opportunity to comment on the terms of reference and membership of the inquiry – and both the prime minister and chancellor should give the commission their full support. The inquiry should undertake extensive public engagement to help raise awareness – unlike the NHS, there is little understanding of what is meant by social care.
Paying for social care – how much the state and the individual should contribute – is a problem that has been dismissed for generations. And it is a problem which is now in need of an urgent solution. A parliamentary commission would inevitably take time to set up and then conduct its inquiry, but if the political parties are truly committed to achieve lasting reform then the only realistic way forward is to work together.