Lets hear the political vision vision. Means testing for social care is current. We do not means test for medical care – officially – but more people may now pay for private care. The national number is 10% but it may well increse in the next few years. The lottery that is the 4 health services extensds to hereditary and housing assets. NHSreality sees no reason that these assets should not be used for old age care, or health care. Many countries have rejected inheritance tax, which is another form of lottery as so few people / families trust each other enough to negate what is in effect a choice..
“People need to know what they are paying for, how much funding is needed and how costs will be shared” – Kings Fund report: Social care reform: what is the vision? – Social care has been in the news this week, but what is the vision for it? With the sector having seemingly never been so prominent in public and political discussions, Natasha Curry and Nina Hemmings once more ask the key questions.
Reports in the media this week have been drip-feeding some tantalising glimpses of what might be going on behind the social care reform scenes in central government.
There has been talk of a tax on the over-40s, suggestions of a rise to national insurance, and speculation over a lifetime cap on costs. There have been mentions of individual insurance to cover costs, and even hints of a wholesale shift of social care responsibilities into yet-to-be-formed NHS integrated care systems.
The Secretary of State this week hinted at an ambition for social care that extends beyond previously narrow framings of reform centred on protecting people from selling their homes to pay for care. Instead, his speech pointed to aspirations for a system in which “everyone”, no matter their age, gets “the care they need”. A nod to prevention, oversight and accountability, and to recognising and rewarding carers, were welcome additions.
Looking back at the history of failed social care reform, the debate has all too often started and ended with funding. Inevitably, as the Secretary recognised, any meaningful reform to the care system will require more money to be raised from the electorate. But to gain public support, people need to know what they are paying for, how much funding is needed and how costs will be shared.
Clarity of vision
Our previous work looking at the care systems of Japan and Germany have highlighted there is no perfect system. Instead, each is the product of a set of complex negotiations and compromises that reflect social, cultural and political dynamics. But what underpins both is a vision and clear principles around which public and political support was built.
In Germany, the vision was based on social solidarity – guaranteeing access to a minimum level of care for all, regardless of age, means, postcode or condition – with ambitions to extend and expand benefits as it developed. A standard needs assessment and schedule of benefits across the country ensures consistency and fairness for all.
Japan based its system on Germany’s but started out with a different vision – an ambitious, generous system that would not just care for people but also promote independence, wellbeing and prevention. Like Germany, consistency of benefits and eligibility embedded a sense of fairness but, unlike Germany, Japan restricted access largely to people aged 65 and over.
Two different contexts, two different sets of priorities. Two different visions but each, crucially, designed to build public and political support. And both built upon existing, long-standing and familiar infrastructure.
Fair and sustainable funding
Once the vision is in place, attention can turn to funding. The various options available in England have been well rehearsed. The next step is selecting an option (or combination of options) that will meet the costs of the reformed system, and allow the vision to be realised……