Social care has been one of the victims of Rachel Reeves’ discovery of a £22 billion “black hole” in public finances. The cap that would have been introduced in October would mean that individuals would be liable for a maximum of £86,000 for social care costs. Melanie Henwood argues that the new Labour Government needs an ambitious vision for social care like the one Beveridge had for the NHS. And instead of using it as an area for spending cuts, social care should be seen as a driver of employment and economic growth.
The post-election honeymoon period for the Labour government has come to a screeching halt with the announcement from Chancellor Rachel Reeves of her surprise discovery of a £22 bn “black hole” in public finances, necessitating radical actions to “fix the mess” allegedly left behind by the departing Conservative government. In setting out a raft of measures to comply with fiscal rules across spending, welfare and tax, Reeves stated that the introduction of the capped cost for social care due to be introduced in October 2025 (after being previously postponed) will not go ahead, in an attempt to save £1.1 bn in 2025/26. The cap would have limited people’s individual liability for social care costs across their lifetime to a maximum of £86,000. The fury that greeted the statement, both inside parliament and among political commentators and campaigners was obvious; but when the dust settles there remain profound questions about the future of this vital area of policy reform that has – yet again – been dumped from the political “to do” list as if it were a mere optional extra.
The capped cost would not have solved all the issues around social care, but it would have provided some level of confidence that people were not being left to fund their own way in a complex and inequitable system that judges health care needs to be a shared risk between citizen and state, but social care needs to be an individual liability and lottery.
Sir Andrew Dilnot – the architect of the capped cost model who has continued to make the case for reform and is a man not noted for hyperbole – could not disguise his irritation and anger on BBC Radio Four’s Today programme. The decision once again to shelve the plan was, he stated, “a tragedy”, and especially so in light of the commitments that had been made during the election campaign. Wes Streeting – now the Secretary of State for Health and Social Care – had previously pledged to honour “the certainty and stability” of the cap, and gave a commitment to the sector and people relying on social care that change was coming. As Dilnot remarked, to see this pledge “ripped up” is:
“unbelievably disappointing for hundreds of thousands of families who need care, for the people that are providing it, for those who are trying to make decisions about it. It is another example of social care – something that affects people at some of the most difficult times of their lives – being given too little attention, being ignored and being tossed aside, and it is very, very disappointing.”
The capped cost would not have solved all the issues around social care, but it would have provided some level of confidence that people were not being left to fund their own way in a complex and inequitable system that judges health care needs to be a shared risk between citizen and state, but social care needs to be an individual liability and lottery. As Dilnot remarked, it seems the government has judged “this is not an important enough thing to carry on with,” and there seems to be no other plan on the table, in short “we have to recognise that we have failed another generation of families.” Abandoning the plan to make emergency (but relatively modest) savings may offer Reeves a short term fix, but it does nothing to resolve the big questions about how to pay for social care, how to share the costs fairly, and – perhaps even more importantly – what we need social care to look like in order to genuinely enable people’s independence, quality of life and social participation. It simply kicks the issue – once more – further down the road, out of sight, into the long grass. There are powerful, indeed surely compelling, reasons for the government to get to grips with this massive challenge, but there are no imminent signs of the political courage to do so.
The Labour manifesto had little to say on the matter beyond a vague aspiration to move towards a “National Care Service”.
The saga of social care reform failure is well documented and lamentable. In the last 25 years there have been 12 green papers and white papers, five independent reviews and commissions, including the Royal Commission on Long Term Care that reported in 1999 and was effectively ignored. Capping costs is part of what is needed, but much more besides including investing in the care sector, raising standards, addressing recruitment and retention through a proper national workforce strategy, and developing a vision for a care system fit for the 21st century.
The Labour manifesto had little to say on the matter beyond a vague aspiration to move towards a “National Care Service”. Since taking office there have been recurrent mutterings about establishing a new Royal Commission to build consensus. This would be the worst of all worlds right now – ditching the capped cost guarantee, but offering nothing in its place that could amount to a model for a National Care Service, and then further procrastination while a Royal Commission deliberates. The lack of support for such a proposal from across the sector has been evident; it is widely recognised by analysts and practitioners that what social care lacks is not further analysis of the problems, but a commitment to solutions. With further years of delay people’s immediate needs for care and support will intensify; worries about money running out and how to pay for care in the last years and months will increase; unpaid carers will be stretched and obliged to pick up the pieces and fill in the gaps with cobbled together packages of privately bought and often poor quality and unreliable support alongside juggling of family and employment responsibilities. The ability of the NHS to recover capacity and operational efficiency will also be further jeopardised without adequate investment in the parallel social care system.
There is an opportunity now for the Labour government with the confidence and security of a majority of 174 to do things differently, and to make seismic changes in how social care is framed, understood and financed.
There are moments in political history that are genuinely legendary and come to define the core values and culture of a government and an era. The post-war Beveridge reforms introducing a model of national insurance and the establishment of the welfare state and NHS were crucial landmarks. There is an opportunity now for the Labour government with the confidence and security of a majority of 174 to do things differently, and to make seismic changes in how social care is framed, understood and financed. It’s also an opportunity with a limited window – for too long social care has been overlooked or repeatedly delayed. If the Labour government is serious about creating a National Care Service, it needs to change the mood music very rapidly and deliberately.
Instead of allowing social care to become a major casualty of flawed fiscal planning with no contingency plan, this is the time for courageous and visionary change, and for the potential of the sector as a major employer to contribute to economic growth to be seen as an opportunity not a dead weight. No doubt, Chancellor Reeves is deeply disappointed to be retreating so soon on spending commitments, but abandoning social care will be short sighted and disastrous for this and future generations. It’s time to change the despairing narrative that social care is unaffordable and to recognise that ignoring it will be far more costly – both socially and politically.
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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