Hardly a week goes by without a grim warning about the increasing problems with the Britain’s social-care system. Words like ‘crisis’ and time-bomb’ are freely used and the sums of money quoted are so vast that to most people they are almost meaningless.
On 21 November, the BBC website published an article based on the claim from former Pensions Minister Ros Altmann that Britain was ‘sleepwalking into a a social-care crisis’ and that the rising cost of funding the required support was placing an ‘intolerable burden’ on the NHS. The Department of Health retorted by saying that it was ‘significantly’ raising the funds available to local councils (which provide most social-care services in England). This was merely the latest in a series of concerns on this subject voiced by a wide range of politicians, local councils, care professionals and charities.
To the dismay of many, the Autumn Statement contained no direct reference to this problem. However, on 12 December came the announcement that ministers were looking at various ways to inject extra money into the care system. One is to allow local councils to raise council tax without going to referendum.
The matter has been firmly on the political radar ever since. The following day the Prime Minister promised a ‘long-term, sustainable solution’, leading to the accusation by Labour leader Jeremy Corbyn this was ‘a crisis made in Downing Street.’ Unsurprisingly, all leading websites and newspapers have covered the story. The Guardian claimed that Corbyn had scored a ‘direct hit’ over the government’s £4.6bn budget cut; while The Daily Telegraph’s coverage, despite recognising there was a problem, was more concerned with reassuring council tax payers that the proposed 5% increase was ‘unlikely.’ The Daily Mail took a similar line, claiming also that Downing Street blamed councils for ‘failing the worst hit areas’ The Independent, meanwhile, wrote that care providers in 48 separate council areas have recently ceased trading as a result of the higher compliance and salary costs which are outstripping the revenues councils are able to provide. All commentators seem to agree that there is a funding gap and therefore that there is a problem.
A lot of political and media ferment, then: will it lead to any positive change? One of the main problems is understanding the vast figures involved. How much money is actually spent on social care, how much has been cut from the budget in recent years and how much extra will be provided in the future? Governments have long been adept at offering money with one hand while clawing it back with the other and at announcing existing funding arrangements as if they were new ones. The situation here is even more opaque than usual. The BBC website claims that social care should receive an extra £3.5bn by 2020 but that ‘a similar amount’ has already been cur from social-care budgets since 2010. It goes on to add a point with which few would disagree that the budgets need to increase in line with the increasing needs of an aging population.
Whether or not more money has been or will be being allocated is one issue. Beneath this lies a far more fundamental problem. Social care is partly funded by Council Tax, the level of which varies depending on the value of properties in the council area. As Heather Smith, the (Conservative) leader of Northamptonshire Council explained to Radio 4’s PM programme on 14 December, an additional 1% rise in Council Tax (which is what the government is considering) will raise an estimated three times more money in rich areas than in poor ones. In fact, there is probably an inverse relationship between property prices and social-care needs in any council area. The problem is likely to be made worse still by the proposed reforms in 2020 under which councils will be able to retain all their business rates. For some councils, this might provide more than what they need but for others not enough. On the face of it the system seems as irrational as if access to, say, free dental care were assessed on the basis of a person’s height, eye colour or star sign.
I asked John Prendergast, one of the directors of Bluebird Care in Newbury, for his reaction. Was the situation as painted the above-mentioned BBC article an overstatement? “No, it isn’t,” he told me. “The social care system is bursting at the seams, hardly surprising as councils have faced six years of cumulative budget cuts of 40%.” The system is “under extreme and growing pressure” and is also a threat to the increasingly pressurised NHS as patients who are medically fit cannot be discharged if there is no social care available for them.
The councils are, John explains, forced to manage increasing demand and diminishing resources by rationing care. West Berkshire spends around half its budget on adult social care but even this doesn’t seem to be enough. He points out that some care providers are no longer accepting council-funded packages because these cannot be provided safely and at a suitable level of quality for the amount of money the councils are able to pay. “The shortfall can be about 25%,” John says. “For care providers the choice can be between cutting corners and going bust. People who work for these companies are, like the staff employed by councils and other agencies, dedicated and hard-working. They are currently being forced to make increasingly unpalatable and often dangerous choices that go against all their professional instincts.”
This is a problem that will, without attention, get progressively worse. According to the Office for National Statistics, Britain’s population will increase by nearly 10 million in the next 25 years and that 70% of this growth will be people who will then be over 60, who will form 25% of the population. Age UK suggests that the number of people aged over 75 will double in the next 30 years.
What can we do to ensure that there is suitable care provision? Aside from lobbying your MP to demand that a more equitable and sustainable system is introduced, we need to set aside money to enable us to enjoy a decent standard of care in our old age. Back in the 1980s, the Thatcher government begun a series of tax cuts which, in order to be electable, future politicians were obliged to follow or at least not reverse. One by one, centrally-funded aspects of life that had seemed as imperishable as the Cliffs of Dover began to disappear. First were the unloved state monopolies like British Leyland, British Telecom and British Gas. Then there was unemployment benefit; then free prescriptions; then most NHS dentists; then free university education; then a retirement age of 60 or 65. Now the final piece of this legacy is upon us.
With hindsight, we are all perhaps partly to blame. Savings from lower taxes were not always used to provide against the more frequent rainy days that have ensued. Successive governments must, however, also hold up their hands, for they have failed to confront the massive problem caused by the continued operation of a social security system the costs and complex demands of which are increasingly disconnected from the amount they dare raise in taxes.
The real tragedy is that the elderly people now suffering the consequences of this had an unspoken contract with the state that they would be provided for and paid their taxes accordingly. Power for successive governments since 1979 has to a large extent been bought by mortgaging these people’s side of the deal. Either our attitude to the level of social care we can expect, or our reluctance to pay the necessary level of taxation, or our willingness to save and pay for it ourselves, need to change if the disconnect between supply and demand is not to reach catastrophic proportions.
This isn’t just a problem for those for whom care is a current or fairly imminent reality. The resulting strain placed on the NHS is threatening the service it can provide to everyone – right now, here, today. ‘We’re all in it together’ was George Osborne’s much-derided battle cry in 2010, a statement which for a number of reasons I found impossible to accept. Were he to have said it this week about the social-care crisis, though, I would have believed him. Perhaps it needs to be said by a senior politician again but this time with a bit more feeling and followed with a bit more action.
Brian Quinn
