The country’s social care is in crisis, the party manifestos recognise as much. But after decades of failed reform proposals, both Labour and the Conservatives are offering the same old “solutions” of the past. And while Ed Davey and the Liberal Democrats have put social care at the centre of their campaign, their proposal for free personal care in itself would not address the wider failings of the social care system, argues Melanie Henwood. 

The virtual absence to-date of social care from national election debate between the two main Parties has been conspicuous. The ITV leaders debate between Rishi Sunak and Keir Starmer on June 4, for example, spent just 36 seconds on the topic. Social care is the elephant in the room, and with good reason given the inept handling of the matter in previous elections, and the failure to engage with the increasingly urgent need for reform over several decades

The problems with the existing system are well known, and unchanged since they were examined in detail by the Royal Commission on Long Term Care which reported in 1999, identifying that “confusion and uncertainty exist as an intrinsic part of the system.” Anyone needing support from social care in England (that is help at home with personal care to maintain independence and social participation, or permanent residential/nursing care for people with more complex and continuous needs), has to pay the full costs themselves if they have assets greater than £23,250, and for people moving into permanent residential care, this includes the value of their home.  At the heart of the issue of paying for care is the question of fairness when the need for social care is unpredictable and largely a lottery – what the Royal Commission referred to as “the true risk and catastrophic nature of needing long term care.” Their core recommendation was that the costs of personal care should be exempted from means-testing altogether and funded by the state. The Commission’s report was ignored and left in the “too difficult right now” pile of issues.

A recent history of proposed reforms to social care

At the end of March 2010 the outgoing Labour government published a White Paper on Building the National Care Service “in which everyone is protected against the costs of care and in which no one needs to lose their home or their savings to meet these costs.” Instead, there would be a national system based on a principle of shared social insurance (much along the lines of the health service). It was arguably too late to publish these proposals and with a general election on 6 May, the Government was wide open to the attacks made by the Conservatives that Labour would introduce a ‘death tax’ of £20,000 to pay for long term care.

The Labour Party seized the opportunity to label this as a new “dementia tax”, and despite Theresa May’s protestations that “nothing has changed” when she watered down the policy, it proved to be game changing with the Conservatives losing their majority to a hung parliament.

The incoming Coalition government of 2010 opted to establish another inquiry into the issues, and within a year the Dilnot Report on Fairer Care Funding came up with a new model based not on free personal care for all, but on a capped cost approach that would limit people’s lifetime liability to £35,000. Dilnot, like the Royal Commission more than a decade earlier, was clear that “the current system is unfair, confusing and unsustainable.”

The principle of a capped cost model was accepted (although not the amount recommended by Dilnot) and was embedded in the 2014 Care Act, with a vision for national eligibility criteria for social care, and a lifetime contribution ceiling set at £86,000. Despite receiving Royal Assent, this part of the Act has never been implemented, having been repeatedly postponed.

The 2017 general election moved the goalposts yet again and saw the Conservative Party bringing forward two sets of proposals in their manifesto that unleashed further confusion and chaos around social care. First, the capital threshold for support would be raised considerably from £23,250 to £100,000. Second, the value of people’s homes would be taken into account when means-testing for home care as well as for residential support. The Labour Party seized the opportunity to label this as a new “dementia tax”, and despite Theresa May’s protestations that “nothing has changed” when she watered down the policy, it proved to be game changing with the Conservatives losing their majority to a hung parliament.

The Liberal Democrats were the first major party in the current election campaign to bring forward proposals for social care reform.

Fast forward to the 2019 election and Boris Johnson declaiming in his first speech as the new Conservative Prime Minister that he was ready “to fix the social care crisis once and for all with a clear plan we have prepared.” It didn’t happen, the ‘prepared plan’ turned out to be illusory, and the arrival of the Covid-19 pandemic in March 2020 ensured that the fate of a capped cost model or any other approach to social care funding has remained in the doldrums. In theory, for the moment, the capped care model remains on the statute books for introduction in 2025.

Social care in the 2024 election campaign

The Liberal Democrats were the first major party in the current election campaign to bring forward proposals for reform. Sir Ed Davey’s personal experience of being a carer has been profound in shaping his knowledge and understanding of the issues, and his commitment to change. It is easy to dismiss the relevance of his plans given that the Party will not govern, but the Liberal Democrat proposals are important in contributing to national debate and to establishing a basis for political consensus which will be the only way social care can be resolved.

Seeing social care simply as something to be ‘fixed’ in order to save the NHS misses the point that social care is about more than how to relieve pressures on hospitals.

There are considerable similarities across the main manifestos, with references to the “crisis” and “chaos” in social care, but the ways forward are significantly different. While the Liberal Democrats and the Green Party are both committing to “free personal care”, the Conservative and Labour Party plans are largely a reissue of previous policies. The Conservatives are sticking to the capped cost model which they have failed to introduce for the past 10 years, and Labour is once again proposing a model of a National Care Service.

Free personal care in itself would not address the wider failings of the social care system, nor introduce the scale of investment in quality support and workforce development, recruitment and retention required. Moreover, seeing social care simply as something to be “fixed” in order to save the NHS misses the point that social care is about more than how to relieve pressures on hospitals. The capped cost model could have some appeal for people hoping to hold onto more of their assets, but the way in which costs would be defined, counted and recorded would be complex and bureaucratic – with associated administrative costs – and many people would fail to reach the cap in their lifetime and would therefore continue to be liable for their care costs much as now.

The only way through the endless cycle of crisis identification and inaction, that has dogged social care for decades has to be through political consensus and national engagement, but the shape and ambition of a National Care Service needs a vision and clarity that is currently absent.

The Labour Party model of a National Care Service arguably has the virtue of equity and simplicity – with obvious echoes of the ideas and values underpinning the National Health Service – but the devil will be in the detail, and this needs to be much more than a “three words” descriptor. The manifesto gives no indication of how the model would be funded or what it would mean for people using services; much more elaboration is needed on what a “programme of reform” would entail. Labour has presented a restrained and modest manifesto – no rabbits out of hats or big surprises, but a commitment to growth as the engine of change, while holding down income tax, national insurance and VAT. Whether the figures can add up for social care, the NHS and other public services remains to be seen.

Focusing on the principles around supporting independent lives and “home first” models is vital, particularly in understanding that social care is about enabling people to live the lives they want, and not merely about ways of paying for residential care, which has tended to dominate the narrative. Building a consensus offers both a glimmer of hope, and a  sinking sense of déjà vu.  This was the position that Labour was reaching for in 2010, and came close to achieving following lengthy consultation and engagement. The only way through the endless cycle of crisis identification and inaction, that has dogged social care for decades has to be through political consensus and national engagement, but the shape and ambition of a National Care Service needs a vision and clarity that is currently absent.

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.

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