Clear thinking on care funding
In the rarified atmosphere of political debate engendered by the general election, social care is only just about hanging on. General elections do not spread attention fairly and, sadly, the best that we can expect – and by and large are getting – is the occasional mention, usually coupled with the more widespread worries associated with the NHS.
When the dust of election settles, those of us who care about social care funding need to be prepared to renew the struggle for political attention. At that point, it will be important to separate two distinct strands of the problem, both of which must feature in the promised Green Paper.
The first is that explored – six years ago! – by the Dilnot Commission. This would lessen the unpredictable financial impact of needing extensive care late in life by capping any individual’s spending, with the state taking over when a certain level was reached. But after the 2015 election, the implementation date was, without warning, put back by George Osborne to 2020; that cruel and unjustifiable delay should certainly be reversed.
This, however, will do no more than selectively transfer the responsibility for funding care, helping only the relatively well-off, since the seriously poor already have their fees paid for from the public purse. It will do nothing at all about the overall cost, and thus the quality, of care. Realistic action on that front would have to address the gap between what care costs to provide and what the commissioners who foot the bill for the majority of customers are prepared to pay.
That divide is widening. Everyone agrees that the Living Wage is sensible in principle, but a rising staffing bill presents an enormous headache to providers unless the local authorities who purchase places pay up proportionately. Providing an enhanced quality of care for ever more demanding clients – people in the late stages of dementia, people with multiple disabilities, people approaching death – is staff intensive. Meeting rising expectations for clients’ wellbeing through better community contacts, more comfortable physical environments, access to cultural stimulation, and so on also costs money.
Yes we certainly want Dilnot, and we want it soon, not some years hence. But the system also needs major, new, and ring-fenced resources channeled to providers via responsible commissioning. This must not take the form of mere transfers from already overstretched health services, small-scale additions to local authority fund-raising powers, or one-off gap-plugging cash injections, which are the tactics tried over recent years. Something much more radical is required.
As soon as the general election is over, we need to get back to this debate, both strands of it.
- The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.