This article was originally featured in the Telegraph.
It is quite a challenge to attempt radical reform of social care in a period of public spending entrenchment. Yet to do so now is also a good time. It is painfully plain that state-provided social care is in crisis. Age UK estimates that currently there are 800,000 older people who need care but do not receive it from the state, and that this will increase to one million people by 2014.
No-one involved in social care wants the status quo to continue. Inadequate funding and a chaotic legal framework have created the perfect storm in which those in the last years of their life are routinely failed by the system.
The most vulnerable members of our society often receive inadequate support or no support at all. Others find that the only way to pay for the residential care they need is to sell the family home, a decision that only compounds an already difficult time.
This situation is only going to get worse as social care services are under growing pressure: first, as a result of stand-still budgets which have seen investment in social care increase by only 0.1% per year in real terms since 2004; second because of large cuts in central Government support to local Councils this year and planned for the next three years as well; and thirdly, because there is greater demand than ever – since 2004 the number of people over 85 has risen by two-thirds. Demand outstrips supply.There is also a general recognition that the diversity of our older population calls for a more flexible response in the provision of care. Personalisation is the new leitmotif. Reforms in public services and new models of service delivery are welcome. It is also broadly accepted that we need to forge a new partnership between the state and the citizen – a partnership which acknowledges that both parties will need to contribute more to the eventual financial settlement.
After years of applying sticking plasters to the tottering system, the last government came to the realisation that radical change is needed if we are to look after our old with dignity and care. It initiated a Law Commission review to address the tangled skein of care legislation, and the rights and entitlements of citizens in respect of care. Armed with this, the Dilnot Commission on funding of care and support, led by economist Andrew Dilnot has been tasked with how to pay for a new system. The Commission is due to report its findings to government on Monday, but the key test for the Government will be whether it accepts the hard truth that funding a proper social care system will require a funding solution over and above the present, clearly inadequate, levels. The Coalition Government has promised a White Paper based on the input from these two substantial Commissions, and legislation in the next session of Parliament, but we need this assurance now rather than later.
The first task will be to stem the decline in current care services. That is why the present raft of cuts needs to be reversed and new money found. On the whole, we need fairer ways to pay for care, a more attractive service offer and a vast improvement to the quality of care older people receive – we cannot allow any more neglect to the most vulnerable in our society.
Allied to that, we need to minimise the catastrophic costs which some people face, and the incredible meanness of the means-tested public provision. Those with only modest incomes, savings and capital face punitive charges. Fairness requires a greater public contribution and involvement – something we all need to take responsibility for.
Then there is the issue of preventative interventions – the measures and services which can reduce the total need for care. Over recent years, these have largely been sacrificed as the resources available have increasingly been committed to those with the greatest needs, but it is a wrong-headed approach which makes no economic sense in the long run to ignore the problems upstream.
Andrew Dilnot has a daunting task, and his report comes in the wake of substantial reports over the last two decades which have largely gone unheeded. But his deliberations have been thorough, and his analysis and observations will be weighty.
Successive Governments have been in denial that social care needs more money. So too have individual citizens, who have been reluctant to think about future care needs and how to plan and prepare for them adequately. The Dilnot Report is likely to be a hard wake-up call to both parties, but then both parties surely recognise that the present framework is well past its sell-by date and is delivering almost nothing of any satisfaction to anybody.
This is not a time for silo thinking – it affects the whole Government. Social care is about housing, communities, and the services which support people living independently – it is not just a Department of Health issue in order to manage people whose condition makes them frail and vulnerable. We will, however, be looking for a firm commitment from the Health Department that there will be a White Paper shortly
The Government stands at a crossroads. This is one of the biggest decisions both it and the country will face. Prime Ministers and Governments are judged on how they handle the big issues. This choice is about courage over negligence. David Cameron should be bold.