The Guardian view on social care: a big deal with holes in it
In 2019, in his first speech as prime minister, Boris Johnson promised to fix the crisis in social care “once and for all”. Two years later, a plan has arrived as part of a mishmash announcement that also tries to address the enormous problem of demand facing the NHS, and rising anger about intergenerational unfairness. The best part of Tuesday’s news is the money: around £12bn a year to be shared between health and social care for each of the next three years. This is likely to be a broadly popular measure; polls show that the public is willing to stump up taxes to pay for a better service. And the NHS desperately needs it, with waiting lists at their highest ever levels in England.
To achieve this, the prime minister has calculated that his MPs, and voters, will swallow the pill of broken manifesto promises. This includes the announcement that the pensions triple lock will be removed next year, as well as the 1.25% rise in national insurance contributions plus 1.25% from employers that (along with a tax on dividends) is the mechanism chosen to deliver new funding. With the proposed cut to universal credit, 2.5 million working families will shell out £1,300 a year. From 2023-24 when government systems have been updated, payslips will show a “health and care levy”, including those of workers over the state pension age (who until now have been exempt from NI). By branding the portion of the new money that will be channelled to the devolved administrations a “union dividend”, the government hopes to bind them to the UK.
But if these are the politics of the plan, what about the policy? Does the announcement bring the UK, above all England (since health and care are largely devolved) any closer to having its social care problem solved? Not much, is the short answer, although that is not to say there is nothing of value in the new schemes. The commitment to raise standards is welcome, even if the £500m allocated for workforce improvements won’t be enough.
But analysis from the Institute for Fiscal Studies says that the new social care funding, of around £1.8bn a year, is insufficient to reverse the last decade’s cuts. And after waiting 10 years to take up Sir Andrew Dilnot’s suggestion of a social care cap (the amount that individuals pay for care costs before the state steps in), the government has delayed implementation of a cap of £86,000 until 2023 – probably after a general election. Ideas about the integration of health and social care have not gone much beyond keywords such as “choice” and “flexibility”, though a white paper should reveal more in due course.
One solution would be a national health and care system funded via general taxation, including new wealth taxes. This would be more progressive than NI, which hits younger working adults disproportionately. The service could be organised regionally, with an enhanced role for local government to avoid over-centralisation. The problem, for Conservatives, is that they don’t want to extend the principle of universal, taxpayer-funded services any further. But attaching an insurance system with elements of means testing – their preferred option for social care – to a taxpayer-funded health service presents complications. Not least, that while there are many good care homes, the sector has a poor record, with extensive private equity involvement and opaque ownership structures.
The social care crisis is partly about funding – the lack of it, due to the longstanding Conservative policy of stripping local government budgets, and the issue of how costs should be shared between individuals and councils. But there are other questions, including ones about ownership and dysfunctional markets, which have not yet been asked by this government – let alone answered.