The combining of Social Care and Medical Care budgets may backfire on all of us unless the problem of chronic long term care is addressed. Ignoring the problem is a result of the perverse incentive for all governments’ to address the short term: the next election, and ignore the longer term bigger issues..
Gathering dust on a shelf in the Department of Health’s London headquarters is a plan for reform of the care system for the over-65s in England. It is the much heralded cap on care costs, which was a key part of the 2015 Tory manifesto .
It was meant to have launched in April. But last summer ministers announced it was to be postponed until 2020 amid concerns it would not work given the pressures in the system.
Officially it still remains policy, but many doubt it will ever see the light of day – even former Care Minister Norman Lamb, one of the architects of the plan, is in this camp. Instead, they believe it is destined to go down on the long list of failed changes to the system.
The care system has remained more or less unchanged since it was created, along with the NHS, after World War Two, when life expectancy was nearly 10 years shorter than it is now.
But people are not only living longer, they are surviving with more complex conditions that require care and support. So just at the time when you would expect the amount of support provided by the government to be rising, it is falling.
Councils complain they do not have enough money – the Local Government Association estimates the gap between what they need and what they get will be about £4bn by the end of the decade. That would leave them about a third short of what they need
So what can be done? Over the years a variety of suggestions have been put forward.
Increases in tax or national insurance contributions could be used to put more money in – and in a way this has already been done, as councils have been given the power to raise council tax to fund care. But already it looks like that will not be enough.
Other options include diverting existing spending on pensioner benefits (the winter fuel allowance for example) to go on care. But ministers seem reluctant to tackle that.
In the dying days of the Labour government, a plan was drawn up to create a universal care system – giving everyone a minimum entitlement to care.
But the Tories leapt on that, suggesting it would be paid for by a “death tax”. And it was soon consigned to the bin.
There has also been talk of merging the system with the NHS – the budget for which is 10 times more than what councils spend on care.
But following Andrew Lansley’s changes to the health service, there is little appetite in the corridors of power for more structural upheaval.
Instead, the NHS is being encouraged to, in the words of one social care director I spoke to, tinker around the edges by setting up shared budgets under a scheme called the Better Care Fund, currently worth £5bn a year.
The result is that councils are left to limp on. Each year, they cut the amount of care they can provide.
It leaves people to pay for themselves, rely on family and friends or, increasingly, go without care.
Elsewhere in the UK, the devolved governments have tried to offer more generous access to help in the home – it is capped in Wales and provided largely free in Scotland and Northern Ireland.
The hope is that it will keep people well – and their costs down. But people still complain they are struggling to get the help they really need.
It means those with money are increasingly having to subsidise the government-funded system – people who pay for their own places in care homes pay nearly 50% more on average than the fees councils pay homes.
Meanwhile, those without have to rely on family and friends or simply go without. As always, there will be calls for reform. The problem is no-one seems to have a plan.