There was a brief moment in early March when the Government seemed to have delayed still further its plans for social care reform. In two separate documents it talked about bringing forward plans ‘next year’ rather than ‘this year’, as it had promised. But it was cock-up rather than conspiracy: the documents were drafted in 2020, ‘next year’ meant ‘this year’, and we can still – it seems – expect reform proposals in 2021.
This is small comfort, though, partly because we still do not know when in 2021, but mostly because we are no clearer about what is being planned or how it might be funded.
The Government has gone backwards from its initial claim to have a ‘plan’ to fix social care to the care minister’s less-than-reassuring statement in a Westminster Hall debate in March that work ‘has already begun’ on one.
What might be in it? Those hoping for clues in the health and social care White Paper published in February will be largely disappointed. The few social care measures in it are best seen as the Government’s response to the issues about oversight and data in social care exposed by COVID-19 rather than as the first instalment of any grand plan for the sector. Similarly, measures to develop integrated care systems – the essence of the White Paper – are essentially an evolution of an already planned direction rather than a change of tack. Perhaps the one clear signal on social care in the White Paper is that the Government has abandoned – if it ever, even temporarily, embraced, ideas of the NHS ‘taking over’ social care. One does not propose Care Quality Commission oversight of local authority commissioning practice, as the White Paper does, if you intend to give those powers to someone else.
So, the only clear evidence of the Government’s intent on social care reform remains its manifesto commitment to ensure people do not have to sell their homes to pay for care and the reference to ‘sustainable improvement’ of adult social care in the 2020 one-year Spending Review. These are meagre pickings indeed.
There is certainly no shortage of reform proposals – Conservative backbenchers, peers and former ministers are queuing up to explain what they believe should be done – but relatively few public clues as to the Government’s direction.
One possibility is that it will, in effect, choose to do nothing beyond tinker with the existing system, build on the measures in the White Paper and try to argue that this constitutes real reform. That would satisfy no one and may be politically difficult after the grand claims to properly fix the system, yet the history of social care reform says that doing nothing is always an option for governments.
A more credible if limited reform would most likely involve some variation of Andrew Dilnot’s 2011 proposals for a cap on care costs and an increase in generosity of the means test to bring more people into the system.
This already exists as legislation and would fulfil the manifesto commitment to save people’s homes. It wouldn’t satisfy all demands but could be a base on which to build a better system in the longer-term.
The sticking point remains how to pay for reform (and, indeed, how to cover the growing costs of the current system, which may well concentrate the minds of local authorities even more than further change).
Former chancellor George Osborne put a reductionist, Treasury view of reform in an interview recently when he said that there are only two ways to fund a better social care system – from taxation and from people’s housing assets – and both of these are ‘incredibly unpopular’.
The failure of reform to date shows the political weight of his argument. Yet it is by no means a watertight one. Despite the cost, there is overwhelming evidence to show that people do in fact want a better, fairer social care system. And COVID-19 has brutally exposed the failings of the current one.
Will this tip the balance towards reform? We should be wary of teleological assumptions that real social care reform is inevitable. It has proved elusive and may continue to be so.
In a world turned upside by COVID-19, who knows? Crisis could yet be the catalyst for longer lasting change.
Simon Bottery is a senior fellow, social care, at the King’s Fund
