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The Guardian view on social care: a crisis of politics as well as finance The Guardian view on social care: a crisis of politics as well as finance
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No one who has experienced adult social care – whether as patient or provider – will have been surprised by the Care Quality Commission’s verdict this week that cuts to local authority services had reached a “tipping point”, with grave consequences for the NHS. Council-run care services were not included in the Treasury “ringfence” around health spending. Since local authorities face cumulative budget cuts of up to 40%, much of the burden of looking after elderly people is transferred to hospitals. Elderly inpatients, many of whom should be discharged for treatment at home, then “block” beds on wards. There is nothing sustainable or conscionable about a system that treats the elderly as a liability to be shunted around an unfathomably complex system.No one who has experienced adult social care – whether as patient or provider – will have been surprised by the Care Quality Commission’s verdict this week that cuts to local authority services had reached a “tipping point”, with grave consequences for the NHS. Council-run care services were not included in the Treasury “ringfence” around health spending. Since local authorities face cumulative budget cuts of up to 40%, much of the burden of looking after elderly people is transferred to hospitals. Elderly inpatients, many of whom should be discharged for treatment at home, then “block” beds on wards. There is nothing sustainable or conscionable about a system that treats the elderly as a liability to be shunted around an unfathomably complex system.
For that reason a consensus in policy circles has emerged around the idea that NHS and social care services should be merged. But there is no agreed method for delivering this in practice. One ambitious attempt last year in east England failed in the ninth month of a five-year contract worth £800m. The National Audit Office blamed failure to anticipate demand on services, underestimated costs and complicated structures that meant patient accountability slipped through gaps between commissioners and outsourced providers of care. Many people do not realise that social care is a labyrinth of NHS, local government and private-sector provision until they are lost in the maze. And ministers have shied away from confronting voters with painful truths about cost. A cap on the amount any individual should expect to pay, originally due this year, has been deferred to 2020. Even then, the cap will not include bed and board, so residential care will quickly consume the savings of those who do not pass a stringent means test. For that reason a consensus in policy circles has emerged around the idea that NHS and social care services should be merged. But there is no agreed method. One attempt to integrate a range of national services in eastern England failed last year in the ninth month of a five-year contract worth £800m. The National Audit Office blamed failure to anticipate demand on services, underestimated costs, and structures that meant patient accountability slipped through gaps between commissioners and outsourced providers of care. Many people do not realise that social care is a labyrinth of NHS, local government and private-sector provision until they are lost in the maze. And ministers have shied away from confronting voters with painful truths about cost. A cap on the amount any individual should expect to pay, originally due this year, has been deferred to 2020. Even then, the cap will not include bed and board, so residential care will quickly consume the savings of those who do not pass a stringent means test.
The government has tried to divert a few extra resources towards this cinderella service, but there has been nothing to match the scale of the challenge, which grows as society ages. The number of citizens over 85 will double within a generation. A first step towards grappling with the crisis involves setting aside tribal party hostilities. When the last Labour government considered a levy on inheritance to fund social care, the Tories cynically denounced the measure as a gruesome “death tax”. Labour’s preference in opposition for impugning the motives of Conservatives – as if they are incapable of compassion – hasn’t raised the tone of debate.The government has tried to divert a few extra resources towards this cinderella service, but there has been nothing to match the scale of the challenge, which grows as society ages. The number of citizens over 85 will double within a generation. A first step towards grappling with the crisis involves setting aside tribal party hostilities. When the last Labour government considered a levy on inheritance to fund social care, the Tories cynically denounced the measure as a gruesome “death tax”. Labour’s preference in opposition for impugning the motives of Conservatives – as if they are incapable of compassion – hasn’t raised the tone of debate.
Politicians will have to decommission these old rhetorical weapons. The left will have to accept that Conservatives who see a role for the private sector in reforms are not driven by evil intent to denude the public realm of assets. The right must concede that Labour looks at taxes not because it relishes confiscation from the middle classes, but because taxation might be the best way for a society to pool resources in the collective interest. As Theresa May told the party faithful, tax is “the price we pay for living in a civilised society”. A crisis of this order transcends party allegiance. Social care and the NHS will have to be better integrated. Any feasible solution will involve a mix of public and private provision, coupled with public funding through higher taxes. Traditional divisions at Westminster make it difficult to build the kind of consensus required to design a solution along those lines. But without such a consensus, the prospects for a solution – and an ageing society – are bleak.Politicians will have to decommission these old rhetorical weapons. The left will have to accept that Conservatives who see a role for the private sector in reforms are not driven by evil intent to denude the public realm of assets. The right must concede that Labour looks at taxes not because it relishes confiscation from the middle classes, but because taxation might be the best way for a society to pool resources in the collective interest. As Theresa May told the party faithful, tax is “the price we pay for living in a civilised society”. A crisis of this order transcends party allegiance. Social care and the NHS will have to be better integrated. Any feasible solution will involve a mix of public and private provision, coupled with public funding through higher taxes. Traditional divisions at Westminster make it difficult to build the kind of consensus required to design a solution along those lines. But without such a consensus, the prospects for a solution – and an ageing society – are bleak.