Report on the talk by Dame Kate Barker – former government adviser on housing and health care and ex-member of the Bank of England Monetary Policy Committee – at the Saffron Walden Constituency Labour Party All-Member Meeting, Thaxted 13 September 2018
Kate Barker began her talk by quoting a recent survey which found that 50% of people in England believe that social care, like most NHS services, is free. In fact it is actually means-tested. Many people therefore only discover the reality of the costs involved when the need for social care impacts on themselves and their families. However, although the demand for social care is growing in our society, with people living longer but developing longer-term health issues including dementia, governments of all parties have failed to create and fund the policies needed to address the issues adequately.
In 2014 Dame Kate produced a report for the King’s Fund think-tank entitled: ‘A new settlement for Health and Social Care.’ It made a number of recommendations, including the need for adequate funding, as well as integrating health care and social care in order to deliver coordinated services and rationalise the funding of the whole offering.
The main recommendations have not so far been taken up by government, and health care continues to be delivered through a centrally-funded NHS, while social care costs are borne by local authorities. This produces startling anomalies, whereby for instance treatment and care for cancer patients is correctly seen as an entitlement, while care for dementia most often has to be paid for by individuals and families when local authority funding falls short. NHS funding is ring-fenced, while social care funding is not. The organisations are separate and generally have different workforces.
When the NHS was established after World War 2, social care was less of an issue as people didn’t live as long as now, and ageing relatives tended to be cared for at home by younger female relatives. The NHS still tends to be regarded as unassailable, and issues around its funding and operation all too often deflect attention from the problems surrounding social care and the resources needed there.
The King’s Fund report panel listened to many ‘experts by experience’ – many of them people who had social care needs which were not being adequately met. Their testimony was often moving and pointed to systemic failings in delivery and its funding. During a discussion session at the meeting, several Labour members described situations within their own families which reflected the same problems of accessing and funding adequate care for their relatives, and the need to raise funds from family assets to cover care.
So the needs and the problems are stark, and this is coming home to people all the time throughout the country. And yet government still fails to grasp the social care nettle, despite pledges made during election campaigns.
Following the 2015 general election, the Government postponed for an uncertain period the implementation of the report commissioned from Sir Andrew Dilnot, which recommended protecting families from catastrophic social care costs (above £72,000). To fund the better care recommended in the King’s Fund report would cost at least £3bn annually now, rising to an estimated £5bn by 2025.
Kate Barker said: “The worrying aspect of the present debate is the focus on helping those who have some financial resources, rather than on extending care to those with limited resources whose needs are not being met – Age UK estimate these number 1.2 million.
“A civilised society should be embarrassed about this and prepared to share the burden of risk in social care as we do in health. In addition, cuts in local authority funding has led to those in more deprived areas being less likely to receive support.”
She went on: “There is a stark divide between those with their own assets, and those with none, which the government is failing to address. In addition, local authorities, faced with the need to fund social care for the elderly in particular, have often been compelled to respond by cutting back on services for younger people, including those with housing, social and mental care needs.”
Over recent years a number of reports have put forward concrete proposals, including making pathways to care clearer, ensuring people can easily access information about entitlement, issuing personal care budgets to fund people’s needs, and free social care for those with the most critical needs.
The possibilities of compensating for social care funding by charging for some NHS services have not been taken up, even though this already applies to areas such as prescriptions, dental care and vision care.
Changes to taxation and National Insurance could also raise funds for social care, but are seen as no-go areas by a Government determined to keep taxation low to appeal to its electorate. In addition we already need to fund the promises to the NHS, which often succeeds in shouting more loudly than social care. But with the numbers over 85 requiring round-the-clock care expected to double by 2035, effective action must not be postponed again and the Green Paper due out this autumn must be a full response to the social care crisis.