Caring for the elderly: Why cross-party reform is overdue

Reema Patel details why Britain needs to reform how we care for the elderly in the UK - but explains why it won’t be easy.


By Reema Patel

Cross-party talks began in social care last week – an area that has long been a political hot potato passed about from minister to minister. The last time such talks were held, they broke down acrimoniously. But it is right that they have recommenced.

Social care is a matter that demands urgent reform for the interests of the people in the United Kingdom, and it is a matter that will require the attention of more than one government.

There are two reasons for this. The first is that any substantive reform to the system will cost money. If Andrew Dilnot, who recently released his commission report on the way forward in the funding of social care, is correct, it will cost us between  ₤1.7 and ₤2.2 billion in additional expenditure.

The second is that substantive reform is direly needed; but before reform is found some clarity on the challenges facing social care is required.

The first, most obvious challenge is that social care costs a lot (at least ₤25,000 a year for a no-frills state funded care home and up to ₤57,600 a year). Most people spend around three to five years in residential social care which will cost them at least ₤75,000 – ₤180,000.

The second challenge is that the current system is disproportionately unfair on those with middle incomes. The government only pays for those who have below ₤23,250 in assets (including property). So suppose you have ₤150,000 – ₤200,000 in assets or thereabouts (your average middle-income family) and need care. Your finances will deplete very rapidly should you enter a care home.

The third (and oft neglected, it is argued) challenge is that the cost of care will increase in the future unless there is a strategic approach to place some checks on the rise of its cost, particularly as the baby boomers hit retirement and beyond.

There are clearly a few traps that ministers and shadow ministers ought not to fall into during the course of their conversations if they are to achieve a consensus on the way forward for dealing with these challenges.

Firstly, they must avoid the politicization of social care. A YouGov survey recently said 81 per cent of the public thought that more needed to be done by government on supporting elderly people’s care needs, and three quarters said they wanted to see a cap on the costs they could end up paying.

It is easy to see how social care could descend into a debate about the extent to which the welfare state should support the ‘’deserving’’ and ‘’undeserving’’ and to be seen as an opportunity for point scoring as it grows ever higher on the public agenda.

But it is precisely the point that the current system cripples, not those on low incomes or the very well-off, but those with middle incomes which should remain the area of focus for all political parties.

Secondly, cross party talks must take care not to focus exclusively on how people can fund their social care without considering wider social care market and legal reform. There is a very real risk that even as the well-received Dilnot recommendations (on fairer care funding) are adopted, a range of other important issues are disregarded.

The Dilnot report itself is the starting point for discussion and not the end. It suggests a cap on the cost of social care (of ₤35,000 in total).

Where the report needs greater scrutiny is the proposal to differentiate the cost of residential social care itself from the ‘hotel’ cost of living in a care home (which Dilnot recommends should invite an additional annual individual contribution of between ₤7,000 – ₤10,000 a year).

The Dilnot report also deals with demand (how can people better fund their care?). But we also need to realistically look at the supply of care.

We can expect demand for social care services to increase in light of an ageing population who are living longer (a point for celebration). However, if we do not have a strategy for the longer term issue of increasing scarcity of care home provision, then we can expect a rise in the cost of each individual care home place.

We have often taken a ‘hands-off’ approach to the provision of private sector social care (and this has led to the continuous increase in the cost per individual care home place). But we need to recognize that making sure that the state can make the most of its money to look after older people requires managing the social care and housing economies.

The Law Commission has also indicated the need for significant legal reform in this area (where local authorities set the care needs criteria at quite different levels and at their own discretion, for example), and where there is no clear consolidating statute that makes it clear to managers and workers what the rules are – which in turn must cost a huge amount.

This is certainly an area for greater efficiency and freeing up resources without impacting on front-line provision, and is arguably a ‘quick win’ for reformists in social care.

Thirdly, it is essential that the issue of regulating social care provision and safeguarding older vulnerable people in a rapidly changing healthcare context is not overlooked. Ministers must examine the ‘light touch’ regulation and oversight which consistently lets down older, vulnerable people in residential care homes.

This is likely to be exacerbated by the very real risk that social care is hijacked by the changes that are being rolled out in the NHS through a recently announced ‘integration’ between social care and the NHS (where private commissioners or GPs will manage the provision of health services).

What is meant by the government when it is proposed that social care and the NHS are to be integrated? That it will not be local authorities, but instead, GPs or private commissioners who will be managing the provision of social care services?

This is a proposal to be extremely wary of – not least because of the problems highlighted by the Panorama episode last year which cast light on the ineffectiveness of a hugely underresourced Care Quality Commission (the present regulator of social care services) in identifying the risk of badly treated residents in Bristol’s Winterbourne Park care home. They were secretly filmed being slapped, having cold water being poured upon them, and being pushed into cold showers.

It goes without saying that where the lives and the protection of vulnerable people is concerned, however we choose to provide care services (through the state, private or a mix of state and private providers), we cannot simply afford to just let the market determine its own course but must ensure that there are proper checks in place to safeguard against abuse.

This includes making sure regulatory bodies are well resourced and properly protecting whistleblowers.

The key message that our political leaders should now be looking to communicate is that old age is not a defining characteristic of a person but a phase in life we all go through.

People are living longer – and this is a cause for celebration. But we have to remember that the mark of a civilized society is how well it affords protection to its most vulnerable – and that includes the elderly, whose needs have too long been pushed into invisibility.

Political point scoring must take a back seat on this occasion.

See also:

We can’t dodge the needed change to social care any longer – Jessica Studdert, January 4th 2012

Though cost is important, we need to focus on the quality of social care – Laura Bradley, July 5th 2011

Social care in crisis – Laura Bradley, June 10th 2011

The social care system is at breaking point and needs reform – Hilary Evans, June 1st 2011

Age UK outline vision for the future of social care – Hilary Evans, November 17th 2010

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