That the new government has included reform of social care funding in its priorities will be greeted with relief. The political acrimony that preceded the campaign, and its absence as a key issue during the campaign itself, fuelled fears that the issue would be relegated to that infamous political equivalent of the Bermuda triangle – the long grass.
So the inclusion in the coalition’s programme for government of a pledge to establish an independent commission will be positively received. It will consider a range of ideas including both a voluntary insurance scheme to protect the assets of those who go into residential care, and a partnership between the state and individuals, as recommended by Sir Derek Wanless in his original review of social care for The King’s Fund in 2006. And it will report within a year – a tight timescale by the standards of most commissions and confounding the cynical view that this is merely a device for delay or distraction. This offers a real opportunity to re-energise the debate about how we pay for long-term care and create a fresh platform for change. But the tasks faced by the commission are formidable.
It will conduct its work in the most inauspicious financial climate facing public services since the 1970s. If its predecessor, the Royal Commission that reported in the sunnier economic climate of 1999, could not command political support for its proposals, what are the chances this time round? Caught between a fiscal rock and a demographic hard place, the commission’s biggest challenge is making the case for the affordability of a reformed system. The abandonment of the free personal care at home legislation will offer some temporary respite for councils, but from 2011 the pressures will intensify. There is no sign that the budget protection afforded to the NHS will be extended to social care, with consequences for other services that the government’s programme candidly acknowledges. Council tax – the source of around 39% of social care spend – is to be frozen for one year at least. The immediate prospects for services seem grim.
But there are two other proposals in the government’s programme that might offer a break in the clouds. The first is to break down barriers between health and social care funding (to encourage preventive spending that benefits the NHS but at a cost to councils); and the second, a review of local government finance. Considered together, they could help to ensure that long-term reform of social care is underpinned by a sensible and sustainable framework for funding local government.
Richard Humphries is a senior fellow at the King's Fund
