NOTAbsolutely everything in last week’s budget was wrong. But one thing that went well was met with an avalanche of anger. The government has walked away from a decade-long promise to safeguard the assets of the wealthiest people who have to pay for their own social care in England. The pledge to set a cap of £86,000 as the maximum anyone should pay has yet again been delayed, nominally until after the election, effectively meaning the policy is dead. Right now, surely, it must be fair not to spend billions protecting the wealth of the wealthiest people when so many of them are being denied care. Again, how to pay for social care turns out to be a political mine.
How to pay for care is the same pernicious issue that contributed to Labor’s defeat in 2010 and exploded during Theresa May’s ill-fated 2017 election campaign. To borrow her notorious phrase when she flip-flopped, ” Nothing has changed,” because the same old, unsolved conundrum in social care is more politically toxic than ever. But with each year that passes without a solution, the crisis worsens.
In the minds of the public, there is a confusion between two quite distinct welfare crises, deliberately confused by Conservative governments who continue to pretend they have a plan for both. A crisis – the lack of care – is a real shock. But the other – wealthier people who spend their savings – not quite as much.
The serious problem is the lack of care in a collapsing system: Shrinking municipal budgets have left 2.6 million people over the age of 50 in need of care but getting none, according to Age UK . (This frightening figure obviously does not include the plight of disabled young adults.) Every day, cash-strapped councils receive a staggering 5,400 requests for care, according to the Association of Directors of Adult Social Services. This has long been predicted as my baby boomer generation grows fragile, but the great Osborne/Cameron austerity has cut consultancy services like never before, instead of preparing for this inevitable demographic need. Healthcare providers – mostly privatized in Thatcher’s time – are going bankrupt, being paid too little by councils for each patient, running out of staff fleeing to pay better, leaving 165,000 vacancies.
Councils struggling to buy enough care are also going bankrupt – even lush Kent, Hampshire and Surrey whose Tory leaders, after 12 years of rest, are finally speaking out – too late. A month ago, the rebel, pre-Budget version of Jeremy Hunt said social care needed £7billion to stand still: but now, as chancellor, he’s ‘giving’ councils just 2 £.8billion next year – and they need to find two-thirds of that from a 5% rise in council tax which most won’t dare to impose as they face local elections in next May.
The public may be paying more attention to the importance of social care since Covid, but local politicians know that despite growing numbers, at any given time a relatively small proportion of their constituents are using care. It’s actually an invisible service, so locals put libraries, swimming pools, emptying trash cans and filling potholes above care hidden behind lace curtains.
Hunt’s budget claims to provide 200,000 more “packages” of care over the next two years, but that barely touches those 2.6 million who are lining up for help. As Care England’s Martin Green puts it, a ‘package’ can mean an expensive care home bed or a half-hour visit once a day. Funding for care is also not ring-fenced, he says, so there is a fear councils could divert it to their visible side.
As for the grotesquely unreformed council tax, a 5% increase would yield far more in wealthy parts of the country than in poorer parts, where few people pay for their own care: it reverses the leveling up. Nationally, most cannot afford to pay, relying on councils that keep reducing eligibility criteria. This makes the queue for care so long that 150,000 people have died waiting in the past five years. It doesn’t take much of the imagination to imagine the lives of those who cannot move, bathe or feed themselves often dying alone.
But that was never the problem the Conservatives chose to solve. Their only welfare commitment, as Boris Johnson has done again, was to protect inheritances: no one would have to sell their house to pay for care. A state subsidy at a cost that the Institute for Fiscal Studies (IFS) estimates at “several billions” would protect them from “catastrophic costs” and guarantee their right to pass on their wealth on their death.
This phrase of “catastrophic costs” keeps coming up, although the real catastrophe is the inability to provide care for so many people. In the current crisis, the government is absolutely right to redirect part of the “costs” of this commitment towards care for those who do not have it. The admirable Sir Andrew Dilnot was only instructed by David Cameron to devise a plan to save the property, not a plan to ensure everyone received the care they needed. Writing passionately for the Guardian last week, he argued for the removal of the injustice that can force those unlucky enough to need years of care for dementia or stroke to pay for everything what they have, while those who are lucky enough to die suddenly leave their property to their heirs. The NHS treats everyone, regardless of wealth, so why not social care too? Completely correct in principle. May that day come soon.
But we live in this miserable country where, says the IFS, “the truth is that we have become much poorer”, thanks not only to Covid and the war in Ukraine, but to the depredations of austerity, Brexit and by Liz Truss. This forces us to ominously rank disasters in a hierarchy of suffering. Should we put protecting the savings and assets of some before spending on the care of others, or even the many other sterile public services? Easing the pain of losing savings is less urgent than, say, the pain of those waiting for NHS surgery. What about all those other urgent needs? For example, the schoolboy’s one chance in life snuffed out by a lack of attention from overworked teachers or the starving child deprived of free school meals. When it’s cold, those who can’t pay their heating bills need insulation and investments in cheap green renewable energy. Add your own public spending priorities here.
Compared to these and other deprivations, talking about the “catastrophic costs” of losing an inheritance seems somewhat hyperbolic. Savings should be used for a rainy day in old age. The real danger is that the collapse of social protection will take the NHS with it, blocking its beds. Labor promises a national care service, although details are still vague. Let’s hope he can get there, but put it wisely in the hierarchy of needs: as Aneurin Bevan said, the language of priorities is the religion of socialism. The instinctive priority of curators is legacy before care. Yet time and time again, when faced with reality, they step back from the cost, so now they have no care policy.