Liberal Democrat leader Sir Ed Davey has called on the government to seek “a cross-party solution” to the crisis in social care, declaring he is “ready to sit down with ministers and start those talks wherever, whenever.”
His clarion call follows a general election campaign in which social care was barely mentioned, despite the millions of people affected by England’s increasingly threadbare provision for the elderly and disabled.
The Liberal Democrats alone made social care central to their electoral pitch. The lack of a detailed plan from Labour and the Conservatives has highlighted England’s long-standing struggle to solve a problem successfully addressed by a host of comparable nations.
Japan, Germany, the Netherlands and Scandinavian countries have all found solutions that have weathered changes of political administration and found broad public support, underlining the shrewdness of a cross-party approach.
Wes Streeting, the new health and social care secretary, last month endorsed this principle, telling the BBC he was “absolutely committed to . . . building a national care service over the course of a decade, bringing people together across the political divide”. The Times reported at the weekend that Labour was planning to set up a Royal Commission in an effort to find a consensus, although insiders suggested no final decisions had been taken about the best way to proceed.
But over the past quarter century, UK governments have failed to find a durable way forward for a care system facing a chronic funding shortfall and a recruitment and retention crisis writ large in a one in 10 vacancy rate.
Streeting has committed to introducing a cap on the lifetime costs any individual must contribute towards their personal care in England, a policy backed by successive Tory administrations but repeatedly postponed.
Social care is a devolved matter and Scotland operates a different model to England, with over-65s and younger disabled people receiving free personal care.
Natasha Curry, deputy director of policy at the Nuffield Trust think-tank and an authority on social care, acknowledged that limiting the sums that an individual must pay towards care costs should be part of any reform package. However, she argued that English politicians’ focus on protecting older people’s assets, and particularly their ability to bequeath their home to their children rather than selling it to meet mounting care costs, had made it harder to frame a convincing case for change, both to the Treasury and the public at large.
“It’s always about the individual. Whereas when you look at where Germany and Japan started, [it was] from the point of view of ‘we need social care as a vital piece of national infrastructure’,” she added.
The debate over social care — which many people still believe is provided free, like healthcare — needed to evolve as the debate over childcare provision had done, she argued. It was now accepted by all parties that “if you don’t have a childcare system, people can’t work and you don’t have a functioning society. We need to get social care into that same sort of framing, to be able to really shift it out of the toxic place it’s in,” she added.
The UK’s adversarial political culture has made it hard for fresh ideas to get a hearing. It is 14 years since the last attempt at behind-the-scenes cross-party talks, led by then-Labour health secretary Andy Burnham, collapsed. Shortly afterwards, hostilities resumed in earnest when Labour’s proposal for a national care service, to be funded through an estates tax, was branded a “death tax” by the Conservatives.
In 2017, Theresa May’s proposals to reform means testing and make it more generous, but to include the value of an individual’s property in calculating entitlement to support for home care, was demonised as a “dementia tax” by Labour and other opponents.
“In a system like Germany, for example, which is more or less used to coalitions, I think there’s a more fruitful political environment to say ‘OK, so let’s look at this proposal, what are the pros and the cons’ and then to get some sort of agreement,” said Curry.
Martin Schölkopf, a senior director in Germany’s ministry of health, said politicians had recognised as far back as the 1970s that a stable and fair system of revenue-raising must be devised to pay for long term care. It had taken until the 1990s, and only then after four years of discussion, for politicians to agree a system of long term care insurance, with premiums linked to income. Although concerns had been growing in recent years about the spiralling costs of an ageing population, this consensus had “held through the years” he said.
Years of debate also preceded a decision to change the structure of long-term care provision in the Netherlands, according to Nick Zonneveld, a senior researcher at Vilans, the country’s centre of excellence in long term and social care. From 2006, a mixture of public and private insurance had been introduced to pay for care, he said. Since 2015, the emphasis had been on moving people out of big institutions to be cared for in the community or their own homes.
The country’s consensus-driven civic and political culture had been crucial to embedding the changes, he suggested. Even King Willem-Alexander had become involved, Zonneveld said, twice using an annual speech to the country to underline “that we cannot afford this old model [of institutional care] any more”.
As well as consensus that can withstand changes of government, international experience suggests that key to creating a successful long term care system is a clear link between the sums being paid by citizens and improvements to provision.
In Japan, a system of long term care insurance was introduced in 2000, covering people aged 65 or over and others needing care for conditions such as Alzheimer’s, stroke or diabetes. Half of the money comes from taxation and half from premiums paid on a sliding scale according to income.
Naoki Ikegami, professor emeritus at Keio University, Tokyo, who has served on government committees on care for older people, said the premiums were much more popular with the public than regular taxation, perhaps because they could see the tangible difference the spending made to services that benefited their own parents or grandparents.
For the Nuffield Trust’s Curry, France offers a glimmer of hope for the UK. She said that the country had striven for many years to achieve a lasting settlement for social care, but the French government had recently named it as the “fifth pillar” of the country’s welfare state.
“They’re still struggling with the actual reform of the system, but . . . I think just that kind of framing and signal to the population — ‘this is an issue of national significance and as important as health and your pension’ — is really interesting,” she added.
