After years in the political backwaters, social care has been propelled to the policy front line. But commentators are divided on whether this can result in real reform so near an election
By Lucy Phillips
12 January 2010
The New Year has seen the major parties step up their pre-election campaigning. Political battle lines are being sketched out as Labour and Conservatives clash over spending cuts and the best way to pay down the country’s deficit.
One area that has hitherto sat on the fringes of party politics now looks set to form a major strand in manifestos – social care. But while there might be consensus on the need for reform of this neglected service, are ministers at risk of turning a major social issue into a political football?
Health Secretary Andy Burnham told the Commons health select committee on January 7 that he intended to publish a white paper before the general election, probably in March (see Socialcare white paper “before general election”). He foresaw that overly politicising the issue could stall reform. ‘There has to be a consensus that whatever option is chosen is the right one. This has to be a priority for any incoming government,’ he said.
The government had published its green paper, Shaping the future of care together, in the summer, after a long wait. Now a Bill to give free home care to the most needy elderly and disabled people, hailed as the gateway to reform, is being rushed through Parliament. All the latest thinking favours a shift from a patchwork of local provision to a national care entitlement, although issues such as a funding model and whether care should be provided locally or nationally have yet to be decided.
Andrew Cozens, strategic lead for adult social care at the Local Government Association, says it is ‘disappointing’ that the government took so long to outline its proposals for the reform of a sector that has been chronically underfunded. The green paper, which was criticised by commentators for lack of detail, came ten years after the Royal Commission on Long Term Care for the Elderly reported its findings. That body, part of Labour’s 1997 election manifesto, was established soon after the party came into power. But ministers largely ignored its recommendations, including one for universal free personal care, after high-profile disputes among commissioners about how much it would cost.
Cozens welcomes the public debate that would arise out of making social care reform an election issue. But he says the timing of the forthcoming white paper is ‘absolutely appalling’.
‘To have a white paper which has no prospect of becoming legislation before a general election means all the momentum that has been generated could be lost and we would have to start all over again.... It’s much more of a political document than it would have been at a different stage of the life of a Parliament,’ he says.
But Andrew Harrop, head of public policy for Age Concern and Help the Aged, says the white paper was well timed. ‘It’s great in that it’s keeping up momentum for reform and showing that the Labour Party is really serious about this. We want to see all parties coming forward with their own proposals so care is a real battleground and no-one is allowed to forget about this issue through the election year,’ he says, adding that social care had been ‘the unglamorous Cinderella service for far too long’.
Harrop calls for future funding for social care to be ring-fenced alongside the NHS budget. ‘The system is cut to the bone already and people will die if there are further cuts. More people will be forced into NHS care and costs will go up, so it’s a zero sum gain by cutting care,’ he warns.
So far, despite the £178bn deficit in the public finances, Labour has committed to protecting funds for health and education, and the Tories have pledged to safeguard spending on the health service. Both parties have remained silent about the social care budget, although Burnham said details would be included in the white paper.
According to Jenny Owen, president of the Association of Directors of Adult Social Services, social care budgets have not previously been protected because the financial impact of long-term conditions on the health service has not been well understood. She welcomes the attention that bringing out a white paper this close to the general election brings to social care reform. ‘We all agree that social care does not have a sustainable funding base and demand outstrips the system. Unless it’s an election issue then we are not going to be able to move [forward],’ she says.
Whatever the arguments for and against the timing of the white paper, many people were surprised by the prime minister’s announcement – at Labour’s autumn conference – of free personal care at home for those with the highest needs. The resulting Personal Care at Home Bill received its third reading in the Commons on January 12 and could come into force as soon as October. While the government has hailed the Bill as the ‘first step towards setting up a new national care service’, critics say the plans cut across the system and were irresponsibly thrown into the mix by Gordon Brown.
Burnham has vehemently denied such accusations. He said the characterisation of the Bill by Labour peer David Lipsey, a dissenting member of the Royal Commission, as ‘an admiral firing an Exocet into his own warship’ was ‘100% wrong’. Burnham told MPs earlier in the month: ‘We are not cutting across the grain here of what is going on in local government. Lots of local authorities are looking at how they can make savings by reducing dependency on residential care situations. It’s not a bad thing at all to have a system geared towards prevention.’
The LGA has considerable reservations about the Bill. ‘It is difficult to see how it fits into the wider debate around the white paper. We’re not convinced about the extent of demand and are worried about the financial projections,’ Cozens tells PF.
According to government estimates, the Bill’s provisions would support 400,000 elderly and disabled people to stay in their own homes at a cost of £670m per year. The NHS will have to find £420m of efficiency savings to fund the scheme, while local authorities are being asked to contribute £250m through more efficient commissioning of care provision – leading to fears that essential services will be cut.
The LGA has called for a cap on the amount councils will have to pay. ‘The risk at the moment is that it could end up costing local government more. We already have big financial pressures in adult social care...The problem is that savings will have to be made even in councils that are already very efficient so it becomes a general efficiency target,’ says Cozens.
Owen is also worried about the costs. She expects ‘huge demand’ from people who don’t currently qualify for state help as well as increased bureaucracy and administration costs from having to assess people against qualifying criteria.
But for Harrop, the Bill is a ‘welcome step forward’, although he admits that no-one knows how many people will be eligible for the service. ‘We worry that councils may apply the criteria very tightly and, rather than being swamped by new demand, they turn people away and spend very little on this new entitlement. It needs to be policed so councils don’t break the spirit of this commitment,’ he says.
It remains to be seen if moving care into people’s homes will raise the curtain on social care reform, but it is unlikely that there will be political agreement at a time when parties are trying to accentuate their policy differences. What could be one of the final white papers of a Labour government looks set to cause a stir.
