What is the problem with how we help elderly and disabled people?
The quality of life of social care recipients in England is a lottery based on their council area, wealth and the availability of family to offer unpaid care. Social care is means tested and councils do not pay enough to care operators to cover the cost of state-funded recipients, so private funders in effect subsidise them. Standards and availability of care are patchy, families end up bearing a huge burden and people occupy NHS hospital beds when they could be helped in the community. Funding for people who need social care stands at around £20bn a year compared with £135bn for the NHS, and the population is ageing.
How might Welby’s ‘covenant’ change things?
Underwriting social care more fully and setting it alongside education and the NHS as a public good requires, in the archbishop’s words, making it “a national obligation, expressed by the state”. That would need wider public acceptance of the merit of improving the quality of life for people nearing the end of their lives, or who are disabled, perhaps by emphasising basic values such as kindness, empathy and justice. Far from everyone will need social care, so a broader state commitment to providing better care is likely to need to be sold by politicians as an insurance policy for all.
What approach is the government taking?
Its policy announcements have focused more on personal finances than quality of life. The reason for capping care costs at £86,000 was explained as preventing people having to sell their homes, or in most cases, their children losing a valuable part of their inheritance. Chronic shortages of care staff, which mean about 400,000 people are awaiting care packages or assessments in England, can only be addressed with resources of an additional £7-£10bn a year, experts say. Nowhere near that amount is being offered.
Does the government have a longer-term vision?
The social care white paper, which sets out a 10-year vision, includes elements that could overlap with Welby’s hopes.
It talks about increasing housing options and spreading innovative community models of care so there is no longer a binary choice between struggling on at home or going into a care home. More intermediate assisted-living options are to be encouraged.
This approach could help those who advocate building elderly care into new housing estates and linking care homes with schools to keep the old and young together. A gentler slope between healthy adulthood and death is hoped for.