First the Conservatives denounced Gordon Brown’s plans for a “death tax,” putting up posters showing a headstone engraved with the words “RIP Off.” Then Labour eviscerated Theresa May’s proposals for a “dementia tax,” derailing her 2019 general election campaign.
Decades of politicisation of what should have been dealt with as a long-term, non-partisan issue have resulted in a crisis in social care that is piling increasing pressure on the NHS and leaving vulnerable people without the help they desperately need.
The latest Treasury penny-pinching, that would mean many poorer pensioners paying more for their care, is just the most recent example of a long-running failure to prioritise and invest in the Cinderella public service.
It is not surprising that the updated policy, which was slipped out by the government last week and will be debated in the Commons today, has prompted a rebellion on the Tory benches.
The original plan was for there to be an £86,000 cap on care costs funded by the new Health and Social Care levy. This was to protect people from the potentially crippling costs of long-term care which can add up to hundreds of thousands of pounds. But now ministers have introduced an amendment which means that means-tested support does not count towards this total, and so those who get some state funding will end up paying more.
Tory MPs in the so-called “red wall,” who won their seats from Labour at the last election, are furious because they know their constituents will be hardest hit. Some voters will inevitably have to sell their homes to pay for their care in old age, which is precisely what Boris Johnson claimed his social care reform was designed to prevent.
There is also concern among moderate “one Nation” Tories, who fear yet more damage to their party’s reputation. Over the weekend Robert Buckland, the former justice secretary, was among those who urged the government to “look again” at the plan.
Andrew Dilnot, whose own 2011 proposal for a cap ruled out counting state funding towards the limit on the grounds that it would be “unfair to those on low incomes,” told a committee of MPs that he was "very disappointed" by the government’s new idea. He did not beat about the bush when he made clear that there was a “north-south axis” to the scenario, adding: "It will tend to hit people in regions of the country with lower house prices harder than it does those in regions with higher house prices."
The government estimates that by not including the care covered by councils in its calculation of individuals’ costs, it will save £900m on Dilnot’s plan, but as he said: "That needs to be compared to the much more than £10bn a year the health and social care levy is going to raise.”
“Over the last 20 years there have been 12 white papers, green papers and other consultations on social care in England”
Sally Warren, director of policy at the King’s Fund, pointed out that the average house price in a “red wall” seat is £160,000, compared to £270,000 in traditional Conservative seats. The cap as described “no longer protects those with lower assets from catastrophic costs” when they need care, she said.
Almost certainly, the prime minister did not understand the implications of the chancellor’s “tweak” when he was first told about it, but the consequences go against all the government’s rhetoric about “levelling up.” With an embarrassing revolt looming tonight, Downing Street is said to be confident of seeing off the rebels, but there may yet be another U-turn from a Number 10 that is already under growing pressure from disgruntled Tory MPs.
Whatever happens in the Commons this week, the fundamental truth remains that more than two years after Johnson pledged to “fix the crisis in social care once and for all,” it is really not sorted. One senior Tory told me that the “burning platform of Covid-19” had turned a medium-term priority into an urgent one, but the Treasury is still trying to fund elderly provision on the cheap.
The government deserves credit for biting the bullet and announcing an increase in national insurance to pay for improvements in health and social care, but for the next few years much of the cash will be hoovered up by the NHS. The £86,000 cap is itself more than double the £35,000 originally proposed by the Dilnot Commission (which is the equivalent of around £42,000 now). With the latest clarification, that upper limit has been made even less generous.
Meanwhile, care workers are paid so little that there is a crisis of recruitment and retention in social care. MPs say care homes in their constituencies are struggling to find staff because working in a supermarket looks like an increasingly attractive, and less stressful, option in a tight labour market.
While the prime minister talks about wanting to move away from the low-wage economy, the chancellor has not provided councils with enough funding to increase the rates they pay to providers. That means the companies that run residential homes or domiciliary care services cannot afford to give care workers the pay rise they deserve.
A postcode lottery has developed, with disadvantaged areas more likely to be in care “black spots.” Meanwhile, according to Age UK, 1.6m pensioners still do not receive the care and support they need.
There is a danger that this is another missed opportunity. Over the last 20 years there have been 12 white papers, green papers and other consultations on social care in England as well as five independent reviews and commissions. Successive governments have ducked the challenge because it is so expensive to fund a long-term solution. But an ageing population means there needs to be a shift in priorities to cope with rising demand.
This government took the brave decision to act rather than just talk about social care, but it is in danger of derailing its own noble intentions by under-investing in the plan. That is a false economy, as the growing emergency in the NHS, and the scandal of unmet need among the elderly, show.
