The launch of the three main party manifestos reveals scant understanding of social care issues, poorly developed proposals, a limited focus that is almost exclusively about older people, and reliance on building consensus for a long-term solution, writes Melanie Henwood. She discusses whether any of the proposals have anything substantive to offer.
At the last General Election in 2017, social care emerged as Theresa May’s Achilles heel when manifesto proposals for funding long-term care were quickly dubbed as the ‘dementia tax’ and rapidly unravelled. In the two years since, a Green Paper has been anticipated – and repeatedly delayed – and has still failed to appear. The publication of the Conservative Manifesto might have been expected to provide some insight to the plans that have been described as imminent for many months. Nevertheless, the manifesto has failed to indicate any sense of a strategy when it comes to social care.
The manifesto describes the complex challenges of meeting the needs of an ageing population and the necessity of establishing a long-term solution rather than a short-term fix. It states that the way forward must be to establish a cross-party consensus: ‘to bring forward an answer that solves the problem, commands the widest possible support, and stands the test of time’.
Yet if the failure to find a solution to funding long-term care over the last 20-30 years tells us anything, it is that building a consensus is highly unlikely. The Conservative pledge has two other commitments: an extra £1 billion funding every year for more social care staff, better infrastructure, technology and facilities; and a guarantee that no one needing care has to sell their home to pay for it. Together with building a cross-party consensus, this is presented as ‘an ambitious three-point plan’, but the response to the manifesto has not endorsed the approach as either ambitious, or indeed a plan.
There are many criticisms that can be made to the lack of progress and priority that the Conservatives have attached to resolving this issue. First is the apparent failure to understand the nature of social care, which is framed almost entirely around the care of older people, despite the fact that half the people using social care are younger adults. In addition, the fixation on people not having to sell their homes confuses the debate; this promise has been made repeatedly and across the political spectrum (including by Tony Blair back in 1997), and has failed to offer a credible alternative. The issue must be not ‘how we do protect people’s property?’, but ‘how do we fund adult social care in a way that is equitable, transparent, and sustainable?’
Solutions to enduring and complex policy dilemmas are arguably easier for opposition parties to offer, so what do the other manifestos have to say on these issues? The Labour Party commits to establishing ‘a National Care Service’: ‘we will provide community-based, person-centred support underpinned by the principles of ethical care and independent living’.
Certainly, the document uses the jargon that will resonate with commentators and critics of the current system, but it is thin on detail. There is a commitment to ‘provide free personal care’, and a lifetime cap on personal contributions to care costs, while also increasing the investment in social care to more than double the numbers of people getting publicly funded care packages, improving standards, and removing ‘the distinction between health and care needs’. But this are mere bullet points, with no indication of how the system will work, what it will cost, or how it will be funded. The separation of older people’s needs from those of working-age adults is also a surprising position that drives a wedge between generations and risks increasing division and inequity.
The Liberal Democrats manifesto refers to introducing a ‘cap on the cost of care’ as provided for in the Care Act but never enacted, as ‘a key starting point’ in seeking a cross-party convention ‘to reach agreement on the long-term sustainable funding of a joined-up system of Health and Social Care’. The lack of detail, and the appeal – as with the Conservative manifesto – to seeking cross-party consensus for a way forward, fails to provide a clear strategy or sense of direction beyond the most general of objectives.
All the main parties agree that something must be done and that the social care system needs a solution, but no-one reading the three manifesto offers would have much idea of what an alternative might look like. For people for whom this is of the most urgency, there is no vision of things becoming better, or even different, in the immediate future. For people who are paying their own way and struggling to navigate the system, the issues are not just about finding the money and spending down assets, but about how being labelled as ‘self-funding’ effectively closes the door to many of them getting any support or advice on their journey.
The failure to grasp the nettle of social care and find a lasting solution that has public support is well known, as are the repeated efforts of commissions, inquiries and investigations to offer analyses of the issues and realistic ways forward. All of these have been rejected in whole or part, from the report of the Royal Commission on Long Term Care in 1999, to the Dilnot report of 2011. The need is not for further investigation or debate about what is to be done, but rather to do it. There is broad agreement about the need for increased overall funding for adult social care; a fair balance between individual and collective responsibility; and limits to the lifetime liability of individuals. If those are the requirements, what is the solution? We seem to be as far away from that as ever.
The Conservative Party is understandably cautious about repeating the debacle of 2017, but the whistling in the wind over the past two years, and the abandonment of any real plan for reform that was supposed to be ready to go over the past several months, is lamentable. Response from key commentators such as the Health Foundation (‘shameful omission’) and the King’s Fund (‘put back in the too difficult box’) has been critical and unequivocal.
A long-term strategy for social care has been a failure of successive governments and the debate continues to be circular and repetitive. It is also a debate that has become stuck in a previous mindset; while the funding challenges are urgent and must be resolved, this is only part of the wider discourse that needs to be reflected. Increasingly, commentators are pointing to the importance of ‘re-framing’ the conversation and looking at ‘social care future’ from a more positive stance that is about quality of life, social inclusion, and participation, and achieving personalised outcomes that are more than time and task service delivery. The narrative around social care is often about crisis, under-funding, and lack of care because that is the reality of people’s experience, but that has to change. The prospects of this being achieved by any of the main political parties following the General Election on 12 December are poor indeed. Reforming social care demands a model for long-term funding and a positive vision for what care and support looks like; both are currently largely absent.
Melanie Henwood is an independent health and social care research consultant.
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. Featured image credit: Pixabay/Public Domain.