Former New York governor Mario Cuomo once said that politicians campaign in poetry but govern in prose. When it comes to social care issues in the current election campaign, most UK politicians are struggling with even basic literacy.
How we fund and deliver good care for an ageing population in which younger people with care and support needs are also living longer is one of the most pressing public policy challenges of our generation. Thanks to the excellent work of the Care and Support Alliance and others, the care system is emerging from the shadows and attracting a higher media profile. It even made it into the party leaders’ debates. But is the rhetoric of politicians reflected in what the party manifestos are saying about social care?
The Conservatives say they will integrate social care with health through the Better Care Fund and ’guarantee’ that people will not have to sell their home to pay for social care (Tony Blair said something similar in 1997). Social care is one of the functions that will be devolved to cities – ‘DevoManc’ is name checked. Nothing about funding.
Labour’s manifesto reprises its vision of whole person care, bringing together services for physical health, mental health and social care into a single system. They pledge to end 15-minute care visits and zero-hour contracts and to recruit 5,000 home care workers as part of a ‘new arm of the NHS’. Setting aside some big questions about implementation, these are laudable aims; however, their proposed £2.5 billion Time to Care Fund will barely begin to plug the funding gap of a system that Labour acknowledges is ‘close to collapse’.
The Liberal Democrats promise to pool all health and care budgets by 2018 (the Better Care Fund on steroids?). There are some interesting proposals to tackle workforce quality – for example, statutory licensing of care home managers and a statutory code of conduct for care workers. The funding can is kicked down the road – they want a ‘non-partisan fundamental review’ of NHS and social care funding needs (I make that the fourth in the past 15 years).
In this new era of multi-party politics, the smaller parties have some interesting things to say about social care. UKIP and the Greens are the only parties committing to finding more money for social care immediately. UKIP wants to spend £1.2 billion more on social care straight away and proposes to create a new ’Sovereign Wealth Fund’ to fund future care needs. It too supports complete integration but under the control of the NHS. The Greens would introduce free social care with an immediate extra cost of £8 billion a year (citing the Barker Commission), offer more support for carers and disabled people, and retain the Independent Living Fund. These are bold and very expensive pledges, easy to make for parties that will not secure an overall majority. But could any of them become ‘red-line’ issues in coalition negotiations?
It was never likely that social care would outgun the NHS in the election war of words. It looks likely that the next government will repeat the mistake of this one in protecting the NHS but at the expense of non-protected areas, notably local government and social care. Politicians are not coming clean with the electorate about these trade-offs, but for the next government they will be unavoidable, as the independent commission on local government has warned.
Austerity is suffocating a sensible public debate about how we pay for the success story that is our ageing population. Last year the Barker Commission pointed out that a good health and care service is both affordable and sustainable if we take a long-term approach and face up to the hard choices about where the money comes from. All parties support integration and have lined up behind the Dilnot-inspired funding reforms of this government – but neither of these policies address the bigger funding challenges. Might a fresh cross-party consensus emerge from the Liberal Democrats’ idea of an independent commission? If there’s no poetry for social care this side of the election, there could much more prose to come afterwards.
Assistant Director, Policy Kings Fund