The Conservative Party manifesto plans for funding long-term care took most people by surprise. Melanie Henwood argues that the rapid unravelling of the proposals and the continued confusion raise fundamental questions both about the direction of policy and about the leadership of the Party.
One of the dangers in going for a snap election is that it catches everyone on the back foot, and published manifestos and briefings prove to be lacking detail, or have to be hastily rehashed and elaborated. Such seems to be the case with the Conservatives’ own plans for reforming the funding for adult social care.
The pledge – and what’s wrong with it
The publication of the Conservative Manifesto unexpectedly outlined a change of direction when Theresa May seemed to dismiss the ‘capped cost’ model of funding which was brought into legislation by the Coalition Government in the 2014 Care Act, and implementation was delayed by the incoming Conservative government in July 2015 on the grounds that it would give local government longer to prepare and to have adequate resources. The manifesto made no reference either to the Care Act, or to the capped cost model, but remarked that “where others have failed to lead, we will act”. Further detail will follow in a green paper, but the sketchiness of the proposals has already proved a major flaw.
The manifesto lamented the costs of caring for older generations, “borne by working people through their taxes” and proposed a way forward that would be “more equitable, within and across the generations.” Except, it hasn’t quite played out like that. Some might think that ditching legislation that has not yet been fully implemented is disingenuous; others may see it simply as May’s blatant attempt to stamp her own brand of conservatism all over policy and political doctrine, and distance herself from her predecessors. What this episode reveals more than anything is political naivety, poor judgement, and lack of understanding of the complexity of social care.
This is a story which isn’t over yet, and it is evolving rapidly. On 22 May, the Prime Minister offered ‘clarification’ on the manifesto position on social care. This was less a clarification than a reinvention and post facto justification of a policy that is lacking in detail or subtlety, which caught her own parliamentary candidates off-guard, and on which members of her cabinet are less than united. But May claimed she was having to ‘reiterate’ the position and make things clear in order to counter “fake claims made by Jeremy Corbyn”. If May thinks that borrowing Trump’s clothes and dismissing criticism with the condescending assertion that it is just ‘fake’ will win her favour, she may be in for a surprise. There would, May said, “be an absolute limit on what people need to pay.” The media immediately reported the Prime Minister’s ‘U-turn’, for that is what it is; this is both a policy and a Party that appears in disarray, and where accusations of a shambolic performance are widespread.
The manifesto set out the intention to raise the ‘capital floor’ of assets that people can keep hold of when being means-tested for social care from the current £23,250 to £100,000. But at the same time, the manifesto set out to equalise the means-testing model for both residential and domiciliary care so that people being supported at home would also have the value of their property taken into account, and have a charge placed on the value of their estate if required to meet deferred costs. Where this differs fundamentally from the Dilnot model of care that provided the basis for the 2014 Care Act is the issue of capped costs. Thus, the Care Act sought to ‘cap’ individual lifetime liability for social care costs at £72,000 – this is the maximum that anyone would pay. The Conservative manifesto plans, by contrast made no mention of a ceiling on costs, only of a floor to the assets that people would be left with.
Responding to the backlash
Reaction to the manifesto was largely critical, and from a surprisingly wide range of commentators including the King’s Fund, the Institute for Fiscal Studies, and – perhaps most surprisingly – from the Conservative think-tank the Bow Group that described the plans as “the biggest stealth tax in history.”
In the light of such negative press, and weekend polls suggesting that the Tory heartland is less than enamoured by the proposals, it is not surprising that Theresa May should seek to exercise some damage limitation. The cap, it seems, is back in the picture and although there was no mention of it whatsoever in the manifesto, Theresa May states that nothing has changed, and the “basic principles” set out in the manifesto remain. Call it a clarification, but it looks remarkably like a skidding doughnut of a U-turn, with the lingering aroma of burning rubber. From the gritted teeth and steely expression adopted by May in making her announcement it appears this is also a construction of reality that she is determined to adhere to.
Social care funding is widely reported to be ‘in crisis’; the last two decades have been punctuated by repeated efforts to find solutions to the challenge of long-term care. The Care Act was the closest we had got to a working solution; it wasn’t perfect but it did offer a way forward that seemed to avoid the catastrophic costs that fall on individuals having to fund their own care, and recognised the need for these costs to be shared in part with the state. In place of this the Conservative manifesto has once again created uncertainty about the way forward, and spread divisive and doom-laden reaction to the costs of an ageing population.
There is no mention in the manifesto of anyone else that may require long-term care; this is presented exclusively as an ‘elderly care’ issue. There is also no recognition that care is complex and often characterised by interdependency; the main carers of older people are in fact other old people – usually a spouse or partner. Indeed, the implications for informal care of the Conservative proposals are absent from their consideration, while it is highly likely that radically increasing the liability of individuals will serve to increase the pressure on carers as people resist and delay using care.
The manifesto states that “those who can should rightly contribute to their care from savings and accumulated wealth”, but this fails to address the fundamental inequity of what Polly Toynbee described as “the lottery of life and death”. If you have an accident, get an acute illness or need surgery – the NHS will be there. But have the misfortune to have a chronic and degenerative disease, or disability, or frailty due to extreme old age, or dementia, and you become the focus of social care where the costs of care lie where they fall. No wonder this is being seen as a ‘dementia tax’. Attempts to share the costs and risks need to be much more radical and to share them properly across the entire population, not just those people left in the hinterland of care.
It is not only the Conservatives that have something to say about social care; the manifestos of the other main parties also acknowledge the need for a new model, whether through a hypothecated health and care tax, or a national care service. Something has to happen, and what the past few days have demonstrated beyond doubt is that this is difficult territory that demands detailed attention. The back of an envelope content of the Conservative plans rapidly unravelled under scrutiny, and Theresa May will need to show considerably more grasp of these complex matters if she is to have credibility as a leader, and confidence from the electorate. Re-writing and redefining a manifesto only days after its publication looks awfully like panic, whatever the window dressing.
Melanie Henwood is an independent health and social care research consultant.