“Over the last two decades there have been at least 20 commissions, inquiries and reports analysing what is wrong with the system and what might be done to address the problems…”
By Neil Duncan-Jordan MP
There is now widespread acceptance that our current social care system is neither sustainable nor fit for purpose. For far too long, it has been the Cinderella service of the welfare state – overlooked and underfunded – and suffering from a number of inherent problems that started to emerge decades ago, but which have now become critical as a result of severe cuts to funding and increasing demand.
In reality, the wider public has little understanding of how social care operates and even less understanding of how it is funded, unless and until they are directly affected. Many think the current funding system is more generous than it actually is, whilst others assume social care will be free when they need it.
Since the years of austerity, various factors have created a ‘perfect storm’ which now threatens the entire care system. These include severe cuts to funding, growing demand, decline of preventative services, unsustainable economic models of many private care providers and an accumulation of continued failure by successive governments to act.
Part of addressing the crisis in the system requires us to reconsider the meaning of the term “social care” and to abandon the false divisions between medical, nursing, personal and social care and instead regard all these activities as part of a single care service.
There also has to be some guiding principles that shape any future care service and these should include parity of illnesses, equality of funding, how services are delivered and generational fairness.
A new National Care Service should therefore seek to go further than the existing model of provision. As well as providing free domiciliary and residential care to all existing users who are currently self-funding, it would also have to take account of the 2m older people who have needs that are currently excluded from the system, improve terms and conditions for care staff, strengthen regulation and monitoring of services and provide greater support for the country’s 5m unpaid carers.
Other improvements such as care, support and advocacy should also be made available to enable individuals and their carers to stay independent, well, and socially included for as long as possible in their own homes. It is important that we also have a range of care and support services made available that can be tailored to individual personal circumstances and needs.
In this respect, nationally determined assessment criteria should be used to assess care needs and individuals and their carers should be able to easily access straightforward information and advice about their entitlements to services at every stage of their care. It is important to recognise the difference between assessment for eligibility and the assessment of an individual’s care needs which will form the basis of the individual’s care plan. Assessment of an individual’s care needs requires skill and specialist knowledge and is not just a “tick box exercise”.
At the heart of any reform should be a new “Care Contract” based on pooling the risk and sharing the cost across society as a whole, which will fund a free at the point of delivery care system from a number of different forms of general, progressive taxation. Hypothecating taxation in some way will be essential to command the public’s confidence and support in the new National Care Service. That is why there also needs to be an immediate national debate about how a new National Care Service can be both publicly funded and delivered, about what it should include and who should be responsible for its delivery.
The current system is dogged by problems of service rationing, disputes over which budget should pay for what, a draconian means-test, a postcode lottery of charges, inadequate provision through “flying” 15 minute visits, variable quality of care and little support for family carers, alongside very serious concerns surrounding the training, remuneration and employment conditions of the care workforce, the lack of robust and effective monitoring and regulation of care providers and the dubious financial status of many large private care companies.
But none of this is new. We have known about the problems for a long time. Back in June 2018, the Health and Social Care Select Committee summed up the crisis, saying: “Of greatest concern, is the fact that the very people the system is there to support get only the care they need to survive, rather than the care they need to live full and independent lives”.
Over the last two decades there have been at least 20 commissions, inquiries and reports analysing what is wrong with the system and what might be done to address the problems. However, successive governments have all found the issue too difficult to tackle; and instead have favoured short-term answers which have largely left the system untouched. The issue that all politicians have avoided is the false division between health and social care, and the question of how such care is funded.
Labour’s new commission, chaired by Baroness Louise Casey is therefore sadly another unnecessary delay in fixing what we already know (a) doesn’t work and (b) needs addressing. The real debate has to be about how we fund a National Care Service that is free at the point of delivery and accessible to all because millions of older people and their families simply cannot wait.
- Neil Duncan-Jordan is the Labour MP for Poole. You can follow him on Twitter/X, Facebook and Instagram.
- If you support Labour Outlook’s work amplifying the voices of left movements and struggles here and internationally, please consider becoming a supporter on Patreon.
