Social care kicked into the long grass again – a betrayal of older and disabled people
- Social care kicked into the long grass yet again as older and disabled people remain a low political priority.
- The broken UK care system has had umpteen reviews and Commissions, but now we are back to square one.
- Telling Baroness Casey that she cannot assume any extra funding will be available, makes meaningful long-lasting reforms almost impossible.
The announcement that we are to have yet another Commission to review social care is deeply depressing. A huge sense of déjà vu. Of course, Baroness Casey is eminently qualified to lead this work, but her instruction that there will be no new funding, and the long-term timetable for introducing any changes, are a clear indication that Government has no intention of meaningful reform. https://www.gov.uk/government/publications/independent-commission-into-adult-social-care-terms-of-reference
The UK care system is the biggest social policy failure of modern times. With the aging population and rising care costs, reforms were long overdue years ago. Yet, as the baby boomers are already in retirement, the system still retains all the old injustices – and some new ones – that were highlighted by past reviews and Commission inquiries.
After years of promises, we are back to square one: After years of promising radical reform, waiting, hoping and even legislating for significant changes, we are back to square one. The system is broken and does not need yet another review. It needs action.
Baroness Casey is told there will be no extra funding for care: Any meaningful reform will undoubtedly need more funding in the short-term, to help save money in future as more older people need care. Yet, Baroness Casey has been told she cannot recommend anything that will entail additional spending. This undermines the chances of any successful outcome. She has been asked to consider what model of care is needed to address demographic change, how services must be organised to deliver this and how to deliver a fair and affordable adult care system. For nearly 20 years, it has been well-documented that the present system is unfair, but is only unaffordable because councils have been charged with paying for care, but not been given the resources with which to do so. Without new funding, either from redirected NHS money, or extra local authority spending, the Commission’s task seems impossible.
The current system drives local authorities away from offering care: Policy change such as a national care service, that dovetails with the NHS, is likely to cost money initially. For example, at present, there are no incentives for councils to take people out of hospital quickly – indeed councils, patients and their families have a clear financial reason to avoid hospital discharge and try to reject applications for care. Paying councils or care providers to spend money on preventive measures, or accelerate taking patients into less expensive, non-hospital settings, would reduce NHS bed-blocking and backlogs, but it could also cost extra in the short-term, although saving money in the longer term.
Social care is considered a political minefield: Perhaps today’s politicians, mindful that social care proved a political minefield in general elections both for Labour (under Gordon Brown 2010) and the Conservatives (under Theresa May 2017), prefer to just pass the baton to a future Government. Perhaps they also calculate that elderly and disabled people are unlikely to take to the streets to protest, and their families are too busy trying to look after their loved ones to fight.
The system is unjust and ineffective for too many people: For example, in the lottery of later life illnesses, those who become ill in the ‘wrong way’ receive no help from the state and not only have to pay for their own care, but also have to pay for those who have no savings or assets. If their health problem, like dementia, is classed by our strange system as ‘social care’, they do not come under the NHS. Unlike other taxpayers, who are either lucky enough never to need care, or who become ill in the ‘right way’ such as with cancer and can have their care costs covered by the state, they are left out and have to go cap in hand to their council. The burden falls disproportionately on those who are struck by one of the illnesses that don’t count for the NHS. Surely, it would be fairer for everyone to contribute something, along the lines of a national care insurance scheme, so that the costs are spread more evenly.
It is in the long-term national interest to introduce proper reforms. Unfortunately, as the Government grapples with the failing health service, perhaps it does not properly recognise that the NHS and social care are two sides of the same coin. Cuts to social care over the years have left people without early interventions that could prevent future falls, or hospital admissions. Such short-sighted thinking has seen more patients in NHS hospitals unnecessarily, unable to leave because they are awaiting the social care they require, but which local authorities cannot deliver, due to budget constraints.
Social care has long been the Cinderella part of our national healthcare system: Social care was privatised many decades ago, giving responsibility to local authorities, while the NHS is more directly under national government. Delivery of care has been outsourced to charities and private companies, but local authorities still have funding duties. However, budget cuts saw cash-strapped councils having to make major cutbacks to their social care services. They have been refusing to pay for prevention measures and also failing to pay providers enough to cover the costs of delivering care, leaving more people at risk. Indeed, even for the most unwell, councils normally offer no help until their needs become substantial, so those with moderate needs are left languishing and more likely to end up in hospital at greater long-term cost.
Elderly and disabled people seem a low political priority: The announcement of this new Commission, with a very long-term time horizon for change, highlights once more that elderly and disabled people really seem to be at the bottom of political priority lists. Despite warm words of imminent reforms that will transform our broken system, despite millions of people being denied basic care they need, the issue has been kicked into the long grass once more.