This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
When the Prime Minister called a snap election to secure a mandate for her vision of Brexit, few people expected the funding of adult social care to become the defining issue that would ultimately turn the tide of the campaign. There is no doubt that the Conservatives’ ‘Dementia Tax’ proposals were fundamentally flawed. While it was right to recognise that people should – and already do – contribute to care costs out of their wealth, the absence of a lifetime cap or the pooling of risk between the individual and the state would have left thousands of people vulnerable to catastrophic costs in old age.
Yet the ‘Dementia Tax’ row also laid bare the hyper-politicisation of the NHS and social care crisis. Above all, it underlined the dangers of putting forward novel solutions in such a tribal political climate – especially in the heat of a general election campaign.
Meeting the care needs of an ageing population is one of the greatest social challenges we face. If we want elderly and disabled people to receive high-quality and compassionate care, we have to be honest with the public about how much this will cost and how we will pay for it. In May, a new report from the Institute for Fiscal Studies and the Health Foundation set out the scale of this challenge. It predicted that public spending on adult social care is likely to have to rise by 3.9% a year over the next 15 years, having fallen by 1.5% a year on average since 2009-10. The authors concluded, unsurprisingly, that tax rises will almost certainly be needed to cover this extra cost to the public purse.
However, there is a real danger that no political party will be prepared to make the tough choices needed to meet this challenge and put health and care services on a stable long-term footing. We need look no further than the Prime Minister’s recent £20bn funding pledge for the NHS. Not only does this completely ignore social care and fall well short of what experts say is necessary for the NHS, but there is no clarity on where the money will come from. Theresa May has admitted that some of it will come from higher taxes, yet the imaginary ‘Brexit dividend’ offers convenient political cover to avoid difficult decisions on which taxes will rise, by how much, and for whom.
As short-term thinking prevails, discussions about the future funding of the NHS and social care end up being dominated yet again by partisan point-scoring and a total lack of bold, effective solutions that meet the scale of the challenge ahead. Meanwhile, the most vulnerable people in our society continue to suffer.
Social care is too important to be left at the mercy of tribal politics. That is why it is absolutely crucial that we find a cross-party consensus on the way forward.
For the last three years, I have been making the case for political parties to work together to explore how we can deliver a sustainable, long-term settlement for the NHS and social care. Together with MPs such as Sarah Wollaston and Liz Kendall, I have called for a cross-party NHS and Care Convention that would engage with health and care staff, patients, and the wider public. This would be the best way to take the heat out of political debate and facilitate a mature, rational discussion in the interests of the country.
Some critics scoff at the idea that a cross-party consensus is achievable, but our proposal is gathering momentum. In March, almost 100 MPs from across the political divide signed a letter urging the Prime Minister to establish a parliamentary commission on health and care funding. Outside the Westminster bubble, the principle of a cross-party approach has been backed by organisations including the highly-respected King’s Fund think-tank. Meanwhile, the public are increasingly looking for fresh thinking as the effects of the deepening crisis are felt.
Nevertheless, there are hurdles to overcome before we will see real progress on this initiative. The Government is loath to lose control over major spending decisions. The opposition frontbench insists that the silver bullet lies in the election of a Labour government. Both need to be reminded that a lasting settlement will extend beyond the lifespan of any single government – some measure of cross-party support will therefore be vital for any party that wants to secure a legacy as the saviour of the NHS and social care. For the first governing party that recognises this, the political prize will be great.
We must also confront the fears of sceptics who believe that a cross-party process will be a cloak for sweeping privatisation, charges and co-payments in the NHS. This could not be further from the truth. We are united by a deeply-held belief in a universal, tax-funded NHS free at the point of need, and a compassionate care system where nobody is denied support because they cannot afford to pay. The burning question is how we achieve this as a society.
Rather predictably, the announcement of a funding boost for the NHS was accompanied by yet another delay to the long-awaited Social Care Green Paper. However, there is little optimism that this will offer the solutions the country is crying out for when this is finally published in the autumn. Indeed, the Green Paper only addresses the needs of elderly people, leaving out of consideration all those younger adults with disabilities who also require care and support.
So to those who favour a cross-party approach, my plea is to keep up the pressure on the Government and Members of Parliament to do the responsible thing. Most of us will rely on social care at some point in our lives. We have a collective responsibility to ensure that safe, effective and compassionate care is available to all. It would be a scandal if we abdicated that responsibility in the name of party politics.