The debate over social care reform has become fixated on the Dilnot Commission’s proposal for a cap of £35,000 on an individual’s contribution. There needs to be a much wider policy discussion
Last week saw debate on social care reform slip further away from the real issues of concern.
First, there was an announcement that wasn’t an announcement: multiple newspapers splashed with headlines that the government had decided to implement the recommendations of last year’s Dilnot Commission for a ‘cap’ on costs. After clarification from ‘Downing St sources’, the most likely scenario appears to be that the legislation required to implement the ‘capped cost’ model will be included in the draft Care and Support Bill when it goes before parliament. A decision on paying for it will, however, be taken at the time of the next Spending Review.
Then there was a spat between the Department of Health and the venerable Conservative MP John Redwood, who published a critique of the ‘capped cost’ model and called on the government to set the proposals aside. The Department of Health responded with some of the most febrile language employed in this debate since the fallout of the collapsed pre-election cross-party talks on social care in early 2010.
What can we conclude from these events? More than anything else, it appears that the Dilnot Commission’s recommendations have now become a kind of political totem, whose real value lies in keeping social care high up the political agenda. The proposals have helped journalists especially in providing a simple, accessible line of interrogation for the government.
This state of affairs is testament to the efforts of social care campaigners, and is fine up to a point. But with the social care reform agenda largely fixated on the ‘will they, won’t they?’ drama surrounding the ‘capped cost’ model, it’s important to examine both the other debates that are being squeezed out and what the eventual pay-off of all this political manoeuvring will be.
In an ideal scenario, what would the social care reform agenda now be focused on? Two issues spring to mind. First, driving forward a revolution in prevention and re-ablement that reduces demand for services (and costs). With the helpful projections of the Office for Budget Responsibility, no one now has an excuse to ignore the fact that even in the absence of any reform, the cost of the current system to the Exchequer is going to grow.
Yet there is also a growing body of evidence around the multiple and varied types of preventative interventions that can bring down levels of disability and need. Much of this is actually about how we can change the behaviour of individuals. Policy and practice in this area has advanced enormously in the last decade, but with a dire fiscal backdrop combining with the effects of population ageing on public spending beginning to bite, we need to go much further and faster.
Getting this right was one of the reasons that the Health Committee proposed structural reform in the shape of joint commissioning of health and social care.
The second issue would be how to rationalise public spending and taxation on older people, so that some of this money can be used to fund social care. For example, it surely cannot be tenable for the older population with housing wealth to think that state support in retirement will grow to meet their needs, without having to make any new contribution from the unprecedented, untaxed, unearned housing wealth they have accumulated.
This debate has completely dropped out of sight, despite the airtime it received when the last government looked at how to fund rising demand for social care. And it is far from being an academic debate: most commentators now believe a funding gap exceeding £1bn has opened up in the English social care system since the last election. There is real and growing suffering in the care system right now.
So the time and attention given over to the Dilnot Commission’s ‘capped cost’ model is coming at the expense of other important debates. But will it be worth it in the end?
The truth is that were the ‘capped cost’ model to be implemented, most people would probably remain oblivious. This is partly because the ‘cap’ only limits the financial value of how much council support individuals are excluded from owing to their wealth, not how much the average self-funder of care pays overall.
This means self-funders wouldn’t really experience a ‘cap’ because of the premium they have to pay for care over and above what councils pay, as the government acknowledged in its recent ‘progress report’. This would be particularly true for those in the south-east.
Any ‘peace of mind’ provided by the cap in the mind of the public will also be limited by its annual uprating with inflation. Indeed, a year on from its final report, it is more accurate to say that the central recommendation of the Dilnot Commission was for a £36,225 ‘cap’ on costs, not £35,000.
In short, if implemented, the ‘capped cost’ model will not be the seismic event that the buzz around it might appear to suggest. Social care, one of the three fiscal challenges posed by population ageing, is not getting the proper policy debate it requires.
Rather than looking at the big strategic challenge we face as a society, the social care reform debate is becoming over-fixated on one relatively insignificant battle, for which victory will result in some improvements, but only some. There remain other big, difficult questions for politicians and stakeholders to face up to.
James Lloyd is director of the Strategic Society Centre
