We’ve been here before; the Dilnot Commission of 2011 reported on how to deliver a fair, affordable and sustainable funding system for social care in England. It proposed a cap on costs, and local authorities were gearing themselves up to implement the new system, but progress faltered and was then stopped by the incoming government.
In the past, care homes were run by local authorities, with varying quality. Private sector involvement in long-term care began in the 1980s under the Thatcher government, as one of the first targets for outsourcing public services. By 1990, the National Health Service and Community Care Act restructured councils as ‘enabling authorities’ rather than care providers, requiring them to spend 85% of their funding on purchasing care services from the private sector. Today, 84% of residential care beds are privately provided.
I’m sure much of this care is excellent, and standards have improved over the years. The old-fashioned style of home with residents in ‘God’s waiting room’ sitting round the walls has been replaced with many activities, and there are homes like country houses – if you can afford to pay. We probably all need to think about the future while we can and plan, whether that’s moving to warden-run accommodation or choosing the sort of residential care we want.
Adult social care is now the biggest spend for our authority. It covers social work, personal care and practical support for adults with physical disabilities, learning disabilities, or physical or mental illness, as well as support for their carers. Roughly a third of recipients are aged 18-64, but the great majority of long-term care recipients are older people.
The central issue remains – who should take financial responsibility for how we end our lives? Inequalities in how we end our days persist, and governments have failed to deal with the issue. At present, the costs are largely borne by families and individuals who can afford it, often by selling property. Government promises of “no-one having to sell their home to provide care” ring hollow.
Over the last decade, local authorities have seen funding from Government slashed, while costs continue to rise. With adult social care, authorities have been left ‘holding the can’ too often, as evidenced by the Covid-19 crisis, when local councils had to purchase and provide PPE to private homes over which they have no control. According to the LGA, adult social care services will face a funding gap of almost £4 billion by 2025.
We need genuine integration of health and social care, ensuring adequate funding and dignity for older people, rather than using ‘integration’ as a smokescreen for more cuts. We don’t just need an ‘integrated care plan’ – we need to make our National Health Service truly cradle to grave, with high standards everywhere.
Good end-of-life care shouldn’t depend on how lucky you were when house prices went up. While many people want to remain in their own homes, the choice between several short visits a day or residential care isn’t one people should have to make. Care homes only make a profit by charging more to self-funders, with private investors taking up to £1.5bn in profits while families and local authorities struggle.
The issue of adult social care will ultimately come back to funding. The NHS blames local government when beds are ‘blocked,’ while adult social care blames the NHS for inadequate facilities. The common mantra of adult social workers is that people want to stay in their own homes, but care homes are often preferable to 15-minute calls and being left alone for the rest of the day.
For those of us who own homes in the southeast, many of us can afford to pay for social care. My home has earned more money than I have over several years, through no action of mine beyond being lucky enough to buy initially. While children may wish to inherit, doesn’t this perpetuate inequality, like the ‘bank of mum and dad’ helping with house purchases? We need good quality low-cost housing, but we also need to redistribute wealth.
Solutions could include properly paying family members who want to provide care – the current carers allowance doesn’t make it worthwhile giving up even a low-paid job. An urgent solution can’t wait another three years. We need a national care service, but the issue remains: who pays? As Greens, we believe in universal provision funded by taxation on wealth and higher incomes.
Steve Davis is Green Party Convenor and Leader of the Opposition
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