Two proposals in the course of a week present opposing approaches to England’s care crisis. A government scheme will recruit volunteers to run errands, in a desperate attempt to lessen the problem of people stuck in hospital because they can’t be safely discharged. Tasks, including collecting prescriptions, will be allocated via an app. A far more substantial plan from the Fabian Society sets out a roadmap for what it hopes will be a Starmer-led government. It also shows up the present government’s scheme for the panicked quick fix that it is.
But there is no easy solution for a social policy challenge that only gets more challenging the longer it is deferred. The population is ageing, more people with disabilities are living for longer, and the need for care continues to rise. Currently there are 165,000 vacancies in the sector, and data suggests that the workforce shrank last year. But still the party that has governed the country for the past 13 years shies away from implementing the reforms it commissioned from Andrew Dilnot in 2011, or even from more modest steps such as improved training (a £500m boost to workforce spending was recently halved).
Any future administration will, as a result of this damaging delay, have its work cut out. One of the points emphasised in the Fabian report, which was requested by the shadow health secretary, Wes Streeting, and funded by Unison, is that the question is not whether to spend more money on social care, but when and how. On the vexed question of how the cost of care is to be shared between the public purse and private savings, the authors do not commit themselves. This is a political move designed to spare Mr Streeting’s blushes. Big spending promises, Labour fears, might trap the party with an election expected next year.
This is a serious shortcoming. Improvements to adult social care provision depend on increased cash. Current problems include low wages and excessive dependence on heavily indebted, private equity-owned businesses. Thinktanks should not be afraid to advocate changes to the tax system or other funding mechanisms.
But there is much that is useful in this latest attempt to grapple with the issue. The idea of resurrecting the national care service brand first proposed by Labour in 2010 is sound. More important than the name is what it means, and the proposal for nationally agreed pay and conditions combined with a new funding formula, via ringfenced central government grants to local authorities, is a good one. With regional inequalities as stark as they are, it is hard to envisage a more local solution to funding shortfalls, and some redistribution of resources to poorer areas is desirable. New regulation of private providers is also essential, though it is questionable whether they can be induced to deliver tightly drawn service specifications on the model of bus companies, as the report proposes.
In the short term, volunteers may slightly ease the burden on public services, as they did during the pandemic. Unpaid carers make a vital contribution to society, and willingness from members of the public to help their neighbours should be appreciated. But such assistance is no substitute for a properly resourced and skilled workforce. Conservative ministers promised much but will have delivered nothing unless they keep their promise to introduce the Dilnot commission’s plan in 2025. This constructive report offers Labour the chance to show how much better it can be.
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