A white paper now might consign social care to the ‘too difficult box’

1 Aug 19

The King’s Fund’s Sally Warren explains why she is not as delighted as she might be by Boris Johnson’s pledge to fix social care.

Elderly person on living room


As a former senior civil servant, I’ve had a ringside seat for every effort to reform social care funding in the past decade.

I’ve drafted green papers and white papers and even got legislation passed, but not one reform has ever been implemented.

So you might think that I would be delighted to see the new prime minister commit to “fixing the social care crisis”, and at breakneck speed, with a white paper ‘within weeks’.

But quite the opposite, I fear that racing out of the starting blocks will mean the policy is destined to fail.

Aside from the very real worries about the rumoured proposal of a move to a system of voluntary insurance (which my colleague Simon Bottery has written about), the process by which we get to real change is also critically important.

Announcing a policy proposition with no consultation and engagement will be a mistake; a more open and consultative process is needed.

If you want a proposed reform to survive its first exposure to the public, you will need to work hard to present it as an improvement on the existing system.

One of the barriers to social care reform is how poorly the current model is understood, as our own A fork in the road report demonstrated.

Most of the public think that social care is free and therefore think that any proposal involving caps, floors, levies or insurance are worse than the existing system rather than a way of limiting the very large bills many may incur.

'If you want a proposed reform to survive its first exposure to the public, you will need to work hard to present it as an improvement on the existing system.'

Real engagement also allows you to explore what the problem really is.

The new prime minister is now joining a long line of politicians, going back to Tony Blair in 1997, who define the problem as “removing the fear of selling your house to pay for care” in older age.

This is an extremely narrow frame of reference. Where is the positive vision for the quality of life we would want for ourselves or for our family? Where is the vision for how we can support independence and wellbeing as we grow older? What about improving the quality of life for working-age adults, who account for half of all public spending on social care?

We need a collective consideration of the issues from this angle – and for this you must talk to the experts in the system and to families who have experience of social care.

The final challenge is to deliver reform that can stand the test of time. Reform which involves any amount of personal financial responsibility (a cap, floor, co-payment) requires individuals to make some long-term financial plans – making decisions today about something they may not need for many decades.

To do that, citizens need long-term certainty and that requires political consensus. This was understood for pensions; political parties worked together on the back of an independent commission to implement change that generations could have confidence in.

Various attempts at cross-party consensus for social care have died when the chance of short-term political gain won out. But why would the parties compromise when parliament and politics are so divided? To be blunt, both parties have now been seriously burnt by social care reform. Now they are even, could they decide to call a truce and seek agreement? I hope so.

You might be thinking – I can see why a white paper now might not have a great chance of success, but what’s the harm in it anyhow? Won’t it move the debate forward? No. It will move it back to the ‘too difficult’ box where it will stay for the rest of this government.

History tells us that governments engage once with social care funding reform in their administration – and that often it’s such a bruising experience they leave it alone.

Blair and the Royal Commission. Brown and the National Care Service ‘death tax’. May with the floors and cap model, dubbed the ‘dementia tax’. Are we about to add Johnson and voluntary insurance to this crash and burn list? I hope not.

We need a process whereby government can consult, engage and collaborate on our collective vision for social care and how we can best get from where we are today to that future vision.

This isn’t about calling for a long, slow kicking of the can down the road, but it is saying learn from what we know already, talk to experts and to those with lived experience of the social care system about what the range of problems are and the potential for change and together we can quickly map a future.

I’m delighted the prime minister wants to fix social care and I hope he works with us to fix it.

This blog was first published by The King’s Fund.

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