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Theresa May gestures while defending her social care policy during the 2017 election campaign in Wales.
Theresa May defending her social care policy during the 2017 election campaign in Wales. Photograph: Paul Ellis/AFP/Getty Images
Theresa May defending her social care policy during the 2017 election campaign in Wales. Photograph: Paul Ellis/AFP/Getty Images

Three reasons why politicians can’t solve our social care crisis

This article is more than 1 year old

Political disagreement about the role of the state, the expense of reform and our unwillingness to confront ageing are at the root of the problem

A confidential No 10 memo on (not) reforming social care reads: “The prime minister agreed that this seemed the right course, but noted that careful thought needed to be given to the presentation in order to avoid charges that the government had pulled back from its original commitments on long-term care.”

That’s not a recent leak: it was from 1996, and shows how far back political failure on social care stretches. Politicians have not incurred any penalties for shirking this responsibility. In fact, the only leader who has really been burned by it is Theresa May – and that’s because she tried to do the right thing and be honest with the public about the cost in the 2017 election.

The past three decades have seen many attempts to reform social care. They all had different solutions and all collapsed in slightly different ways. But there are three things that the failures have had in common.

1. The parties can’t agree

Social care reform is so long-term and expensive that it initially makes sense to get politicians of all persuasions locked into its design. That was the reasoning behind the 2009 reforms proposed by the then health secretary, Andy Burnham. His national care service funded by a compulsory levy on someone’s assets once they died really did look like it might happen. Then along came an election, and the Tories pulled their support, calling it a “death tax”. Labour got its revenge with the May “dementia tax” in 2017.

All’s fair in love and elections, but there is also a deeper problem. The two main parties have fundamentally different ideas about the size of the state and the role of private wealth. They will never really agree. Labour and the Tories had both committed to some kind of national health service by the end of the second world war, but disagreed strongly over how that service would work, with the Conservatives voting against the legislation creating the NHS. The same has happened with social care, but in slow motion.

2. The cap on care costs

In 2011, the Dilnot commission proposed a cap of about £35,000 on the amount people should have to pay for long-term social care over their lifetime. The coalition government set that cap much higher at £72,000, and it has been repeatedly delayed ever since, in part because local authorities simply could not afford it.

Boris Johnson claimed he had an “oven-ready” plan for social care when he became prime minister, but left it in the deep freeze for months while he argued with Treasury ministers who felt the money could be better spent on existing provision. Eventually Rishi Sunak said he would only agree to the cap if Johnson also backed an increase in national insurance. It was, those close to the discussions at the time told me, only supposed to be a way of forcing the prime minister to back down, but he called his chancellor’s bluff.

Few senior Conservatives now think the cap will ever be implemented. Councils currently do not even know the level of need for social care packages – and there is little incentive for them to start recording this, because it would then show clearly how regularly they breach their legal obligations to provide packages. The scale of the current problem is hard to quantify – and therefore easier to ignore.

3. We still don’t value elderly people

Where do politicians go when they visit a hospital? It’s rare they bother with the geriatric wards: photocalls are much better in the special care baby unit. The reason social care reform is so difficult is we don’t really like to think about what happens when we get old.

This wilful ignorance means many people think care is free – so any proposals from politicians infuriate them, as they sound so expensive. Some on the right think we should copy southern European countries, where it is perfectly normal for elderly people to move back in with their children: but no politician is going to make that their big pitch, as it will just sound like a moral lecture. Much easier to make meaningful sounds about the importance of reform – and hope someone else does the dirty work.

Isabel Hardman is the author of a history of the NHS called Fighting For Life, published in June

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