The Observer view on the urgent need for extra social care funding
The social care system for older people and disabled adults in England is in severe crisis. People are going without the professional care they need to maintain basic dignity and live fulfilled and flourishing lives, leaving relatives and friends trying to fill the gaps as they juggle jobs and children. The blame lies squarely with the government.
Over the last decade, conditions have grown worse as an increasing number of people have been left in the most inhumane of circumstances, while ministers have cut care funding further. Currently, 1.5 million people aged over 65 do not get the help they need with basic tasks such as washing, dressing and eating. And – astonishingly, in light of our ageing population – the number of older people in receipt of government-funded care has shrunk significantly over the last decade; as it has cut care funding, people are having to demonstrate everhigher levels of need before they qualify for means-tested support with their care. The gap between the number of disabled adults requesting support with their care and receiving it has widened.
The funding crisis has maintained a downwards pressure on care work wages. Caring is low paid and wrongly perceived as low-skill work, despite the fact that providing a high standard of professional care to someone with a condition such as advanced dementia requires great skill. Some carers are forced to work under terrible conditions by the nature of contracts with local councils, in which providers are paid the minimum and carers are sometimes allocated such short slots they cannot properly care for their clients. The result is a huge shortage of carers that Covid- and Brexit-related shortages have made even worse.
The human costs are dire. Older people end up in hospital with broken hips after trying to get out of bed unassisted when their agency fails to send a carer round. People with disabilities are effectively excluded from the labour market when they can’t get to work reliably because no care provider has the capacity to support them. People are left stranded in hospital wards for weeks or even months because there are no carers to look after them once they have been discharged.
The government urgently needs to set out a proper funding plan as part of the forthcoming spending review. There is no good reason why, while people who get cancer have their care funded through the NHS, the vast majority of those who develop dementia in older age are expected to fund their own care: it is ageism. The principled case for free personal care is stronger in older age than for universal healthcare; very few people in their 30s and 40s feel inclined to imagine, plan and save for a future with dementia and the costs of care can be far more crippling than many other conditions whose associated costs are absorbed by the NHS.
Commission after commission – from the royal commission on social care in 1999 to the Barker commission in 2014 – has recommended that the NHS principle should be extended to personal care in older age and shown that it is eminently affordable for a society as rich as ours. It can be funded through an increase in taxation on wealthier individuals, as the TUC is calling for today.
Instead, the government is proposing to reheat the 2014 capped cost model of social care that was shelved before its introduction. It is not only a bureaucratic nightmare for councils to implement, but it imposes only a theoretical, rather than actual, cap on costs. The government is reportedly considering a cap so high that relatively few people would benefit, and increasing national insurance contributions to expand funding, which would disproportionately load the burden on to younger households when wealthier baby boomers should undoubtedly be contributing to a national system of universal free personal care.
The shocking number of people who died from Covid in care homes last year exposed in the most tragic way the overall disdain for older and disabled people demonstrated by this government. It is time to finally end the decades of political neglect of social care.