Not absolutely everything in last week’s budget was wrong. But one thing it got right was met with an avalanche of anger. The government abandoned a decade-long promise to preserve the assets of better-off people who have to pay for their own social care in England. The pledge to set a cap of £86,000 as the maximum anyone should pay has been delayed yet again, notionally until after the election, which effectively means the policy is dead. At this time, it must surely be right not to spend billions on protecting the wealth of better-off people when so many are being denied any care at all. Yet again, how to pay for social care proves to be a political landmine.
How to pay for care is the same wicked issue that contributed to Labour’s 2010 defeat and blew up under Theresa May’s ill-fated 2017 general election campaign. To borrow her notorious phrase as she U-turned on this, “Nothing has changed”, because the same old unresolved social care conundrum is as politically toxic as ever. But with every year that passes without a solution, the crisis deepens.
In the public mind there is confusion between two quite separate social care crises, deliberately conflated by Tory governments who keep pretending they have a plan for both. One crisis – the lack of care – is a real shocker. But the other – better-off people spending their savings – not quite so much.
The serious issue is the lack of any care in a collapsing system: shrinking council budgets have left 2.6 million people over the age of 50 in need of care, but getting none, according to Age UK. (That frightening figure obviously does not include the care plight of younger disabled adults.) Every day cash-strapped councils are receiving a phenomenal 5,400 requests for care, according to the Association of Directors of Adult Social Services. This has been long predicted as my boomer generation grows frail, but the great Osborne/Cameron austerity cut council services as never before, instead of preparing for this inevitable demographic need. Care providers – mostly privatised in the Thatcher era – are going bust, paid too little by councils for each patient, starved of staff who are fleeing to better pay, leaving 165,000 vacancies.
Councils struggling to buy enough care are going bust, too – even the likes of lush Kent, Hampshire and Surrey whose Tory leaders, after 12 supine years, are finally raising their voices – too late. A month ago the rebellious, pre-budget version of Jeremy Hunt said social care needed £7bn to stand still: but now as chancellor he “gives” councils just £2.8bn next year – and they have to find two-thirds of that from a 5% council tax rise that most won’t dare impose, as they face local elections next May.
The public may be more alert to the importance of social care since Covid, but local politicians know that despite growing numbers, at any one time a relatively small proportion of their voters use care. It’s effectively an invisible service, so locals rate libraries, pools, emptying bins and filling pot-holes above care hidden behind lace curtains.
Hunt’s budget claims to provide 200,000 more care “packages” over the next two years, but that barely touches those 2.6 million queueing for help. As Care England’s Martin Green says, a “package” might mean a costly nursing home bed or a once-a-day half-hour visit. Nor is care funding ringfenced, he says, so there is a worry that councils could divert it to their visibles.
As for the grotesquely unreformed council tax, a 5% increase would raise far more in affluent areas of the country than in poorer regions, where few pay for their own care: this reverses levelling up. Nationally, most can’t afford to pay, relying on councils that keep cutting eligibility criteria. That makes the queue for care so long that 150,000 people died waiting in the past five years. It doesn’t take much imagination to visualise the lives of those who can’t move, wash or feed themselves often dying alone.
But that was never the problem the Tories chose to solve. Their only social care pledge, as made again by Boris Johnson, has been to protect inheritances: no one would have to sell their home to pay for care. A state subsidy costing what the Institute for Fiscal Studies (IFS) estimates at “several billion” would protect them from “catastrophic costs” and secure their right to pass on their assets when they died.
That phrase “catastrophic costs” keeps cropping up, though the real catastrophe is the failure to provide any care for so many. In the present crisis the government is quite right to redirect some of the “costs” of that pledge towards care for those with none. The admirable Sir Andrew Dilnot was only commissioned by David Cameron to devise a plan to save property, not a plan to ensure everyone got the care they needed. Writing passionately for the Guardian last week, he made a strong case for removing the injustice that may oblige those unlucky enough to need years of care for dementia or a stroke to pay everything they’ve got, while those lucky enough to drop dead suddenly bequeath their assets to their heirs. The NHS treats all, regardless of their wealth, so why not social care too? Quite right in principle. May that day come soon.
But we live in this miserable country where, the IFS says, “the truth is we just got a lot poorer”, thanks not just to Covid and war in Ukraine, but the depredations of austerity, Brexit and Liz Truss. That forces us to grimly rank catastrophes in a hierarchy of suffering. Should we put protecting some people’s savings and property ahead of spending on care for others, or indeed the many other barren public services? Alleviating the pain of losing savings is less urgent than, say, the pain of those waiting for an NHS operation. What of all those other pressing needs? For example, the schoolchild’s one life-chance dashed by a lack of attention from overstretched teachers or the hungry child denied free school meals. As it turns cold, those who can’t pay heating bills need insulation and investment in cheap green renewables. Add your own public spending priorities here.
Compared to those and other deprivations, talk of the “catastrophic costs” of losing an inheritance looks somewhat hyperbolic. Savings should be used for a rainy day in old age. The real danger is that the social care collapse is pulling the NHS down with it, blocking its beds. Labour promises a national care service, although details are as yet vague. Let’s hope it can make it happen, but rank it wisely in the hierarchy of need: as Aneurin Bevan said, the language of priorities is the religion of socialism. The Tories’ instinctive priority is inheritances before care. Yet time and again, when confronted with the reality they step back from the cost, so now they have no care policy at all.
Polly Toynbee is a Guardian columnist