Even a means-tested care system will require significant investment

The failure to invest in our care services constitutes death by a thousand cuts to a vital public service and in the quality of care as private care homes are forced to cut their overheads and provide a punitive ‘no-frills’ budget.


By Reema Patel

The failure to invest in our care services constitutes death by a thousand cuts to a vital public service and in the quality of care as private care homes are forced to cut their overheads and provide a punitive ‘no-frills’ budget.

The main worry is that of an unsustainable care economy, which in turn poses the risk of endemic abuse and neglect within the care provision system.

Meanwhile, the effects of Lansley’s reforms so far have been to remove an estimated £1 billion from the social care economy at a time when the baby boomers are approaching retirement, and a higher proportion of British society are ageing and in need of good care provision than ever before and where 10 million people in the UK are over 65 years old.

By 2030, this figure is projected to increase to 15.5 million.

The Dilnot report’s recommendations include investing an additional investment of £1.7bn-£2.2bn as part of wider-scale reform to address this additional pressure on the care economy, and while talks are underway on the basis of this report no financial commitments have been made.

Shadow social care minister Liz Kendall recently clarified the Labour opposition’s policy line on adult social care; a desire to work with the coalition government during currently the cross-party talks which are examining ways of implementing the Dilnot reforms to fairer care funding, combined with criticism of the impact that Lansley’s NHS reforms, and the impact that David Cameron’s instructions to integrate the health and social care systems would have upon such measures.

Social care is rapidly moving to the top of both the government’s and the opposition’s agenda. Labour is now also backing the lobbying and campaigning actions of the Care and Support Alliance for social care reform, and is itself calling for legislation during this government to address the problem of care funding and reform.

Yesterday, hundreds of older people, carers and their supporters were led by the Care and Support Alliance,a consortium which includes over 50 leading groups, including Age UK, Care UK, The Disability Alliance and the Princess Royal Trust, travelled to Westminster to petition the government to take urgent action on social care reform.

This external lobbying activity was preceded by some criticism of Lansley’s reforms within the Health and Social Care Bill, and the extent to which the social care issue is ignored within the provisions of that Bill, from within Westminster itself.

The health committee, chaired by former Conservative health secretary Stephen Dorrell, condemned Andrew Lansley’s NHS reform programme for failing to address the need to reform the country’s social care system.

Paul Burstow, Liberal Democrat Minister for Social Care had notoriously claimed that reform was not required at all, despite all significant research evidence to the contrary which highlighted the escalating cost of the system.

Andrew Lansley has now also been forced into a ‘u-turn’ upon a key government social care target by April 2013. He had aimed to provide every adult social care recipient with a personal budget – a direct-payment system that enabled the person to procure their own care.

The last Labour government introduced the personal budget system, as well as the programme of personalisation of care services. But that administration had never enforced the personal budget system; preferring instead to offer personal budgets as a flexible option to those who opted for them, and managed services – arrangements for the direct provision of social care – to those who did not.

Whilst some elderly people may have the capacity and external family support to make decisions on their own behalf, and therefore to source their own care; an entirely different group of people will be adversely affected by these changes.

Indeed, the vast majority from personal experience in social care preferred governments to source care on their behalf, perhaps because they were too frail, were classified as mentally incapable, or simply did not want to take on the additional stress, liability and responsibility of managing their finances and negotiating with private sector providers  in their later years.

The proposal to introduce a personal budget for all individuals was pernicious to say the least. It allows local authorities to shirk responsibility for the actual business of providing care – and turneds the social care system into a specialised social security benefits programme for vulnerable elderly people unprotected from financial exploitation.

That this change to the social care system has been suspended is to be lauded – but the present government has a remarkable habit of ‘temporarily’ suspending programmes, or introducing ‘listening periods’ without engaging with the substance of the objections to their reforms.

The way forward for a sustainable care system requires more than simply structural or legislative change. The government must recognise that providing an adequate means-tested social care service for the 21st century will require significant financial investment.

It also requires taking brave decisions about the spiraling cost of residential and non-residential care – and looking at ways to keep cost down without compromising quality. Both are highly political decisions; the first because it reflects what the government’s true attitudes towards protecting the vulnerable are, the second because it sets the tone for how the government looks to navigate relationships with the private sector.

See also:

Caring for the elderly: Why cross-party reform is overdue – Reema Patel, January 28th 2012

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

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