Today a joint report from the Health & Social Care and Communities & Local Government select committees has called for a radical reform of how we fund and provide social care. Amidst its recommendations – which include making personal care free at the point of use, supported by the introduction of a social care premium – it also recognises that the necessary change cannot happen without widespread political support.
After decades of failing to address the pressures in the service, successive governments have allowed social care to enter a cash, crisis, repeat cycle. The need to confont the changing nature of demand is unavoidable. The Institute for Government thinks the report’s proposed solution – a cross-party parliamentary inquiry – is the best means for the Government to be able to make the tricky policy decisions which are needed.
Ahead of the 70th anniversary of the NHS, the Prime Minister announced that the service would receive a five-year settlement with average annual growth at 3.4% in real terms. Although this was welcomed by the NHS, it wasn’t long before the cracks in this shiny new birthday present became clear.
To fix the funding challenges facing health and social care, there are three questions that government needs to answer: how much money is needed; how should additional funds be raised; and how can funding be provided consistently over time. The Government’s recent announcement has answered the first question for NHS England, but not for other parts of the health budget and not for social care (with the green paper on social care for the elderly being delayed once again). Critically, it didn’t provide a credible answer for where the money will come from. The assertion that a Brexit dividend will fund the additional NHS spending goes against the weight of economic evidence and makes the future task of gaining buy-in for new funding mechanisms even more difficult.
The issues facing social care have not emerged suddenly – rather pressures have developed over years as the population has aged and the reliance on traditional family care has declined. There has been a failure to reform the service, which has become something of a political football in the last decade (from the ‘death tax’ in 2010, to the ‘dementia tax’ in the 2017 General Election).
Acknowledging the wreckage of past social care policy, today’s joint report on social care from the Health & Social Care, and the Communities & Local Government select committees advocates a cross-party parliamentary inquiry as a mechanism to build political consensus around difficult policy issues. The suggestion has already gained the support of over 100 MPs earlier this year.
In our recent report on health and social funding, the IfG concluded that this style of inquiry is the best route to change. Such an inquiry represents the best chance of providing the Government with sufficient political cover to address the most vexed of the three funding questions – how to raise the money. Furthermore, it could be set up quickly, drawing on the existing capacity and expertise of select committee staff. If the inquiry were to be chaired by a select committee chair, there would be a high-profile body that could continue to hold government to account after the inquiry had finished.
By studying tricky past policy-making, we have found that there are a number of factors which such an inquiry could use to maximise its success – from using an interim report to roll the pitch for their final proposals, to using a politically savvy chair. Critically, it would need buy-in from the Prime Minister, and preferably the Chancellor, to have real impact.
A parliamentary inquiry should also engage the public, both to improve the quality of its recommendations and to demonstrate to the Government that the argument can be won. Today’s joint select committee reports provides an example of how this could be done; in a welcome parliamentary first, their report has been informed by a Citizens’ Assembly. This deliberative event saw members of the public come together to learn about the social care system and then collectively agree principles and recommendations for its future.
The groundwork of political momentum has been laid – what is now needed is government leadership to make the most of the opportunity.
The Institute for Government explores the value of a parliamentary commission further in our new report ‘How to fix the funding of health and social care’.