Another general election, and another missed opportunity to tackle the glaringly obvious crisis in social care. The Conservative manifesto due to be published this weekend will tread water, even though everyone knows the system is drowning – and compounding the problems in the NHS.
Boris Johnson will promise an extra £1bn a year for social care and to seek a long-term, cross-party consensus so that the issue is no longer a political football. He will pledge real reform after the election, based on the principle that no-one should have to sell their home to fund their care bills.
By trailing this three-point plan before the manifesto launch, the Tories hope to avoid questions about why they are doing so little about a crisis that Johnson promised to “fix” on his first day as prime minister in July.
I'm told there was a debate at the highest level of government about going much further in the manifesto. A radical policy did feature in an early draft, similar to Labour’s plan for a national care service working in partnership with the NHS. That would have been a genuinely big, and welcome, idea.
But the Tory manifesto has been stripped of anything that could unravel and distract from Johnson’s “get Brexit done” message. Across the board, it will be at the cautious end of the spectrum. Team Boris is desperate to avoid a repeat of Theresa May’s 2017 campaign, derailed by a manifesto proposing social care reforms dubbed a “dementia tax”. May backed down, making it worse by denying a U-turn. The disaster is still fresh in Tory minds. Another reason for caution was Sajid Javid’s drive to limit Johnson’s ambitions to splash the cash on public services. The chancellor argued that the Tories must preserve a dividing line on fiscal responsibility with Labour.
For now at least, Johnson is prolonging the paralysis that since 1998 has seen 12 green papers, white papers, other consultation exercises and five independent reviews on social care, but no real reform. The 2017 Tory manifesto promised yet another green paper. Various drafts gather dust on Whitehall shelves, to the frustration of civil servants. “Everyone knows what the issues are,” one Whitehall source told me. “Calling for consensus will just mean another delay. Somebody just has to get on with it.”
At Labour’s manifesto launch today, Jeremy Corbyn side-stepped a question about a cross-party consensus. Labour, too, has had its fingers burnt: at the 2010 election, Andy Burnham, the then health secretary, saw his sensible proposals for a levy on people’s estates when they die denounced as a “death tax” by the Tories. Labour’s revenge was sweet in 2017, but it meant the inertia continued.
Professionals working in accident and emergency departments warned that last week’s worrying statistics on missed targets were due in part to the pressures caused by the creaking social care system. One in five emergency admissions to hospital is for an existing condition that primary, community or social care could manage.
Since 2010, the government has cut funding for English councils by 49 per cent. Local authority spending on adult social care rose to £16.1bn a year – 2 per cent when inflation is taken into account.
Although demographic change increased the pressures, the number of adults receiving state-funded care fell by 28 per cent to 1.3 million in the five years to 2012-13. Age UK estimates that between the 2017 and this year’s elections, 74,000 older people have died or will die while waiting for care. The number needing publicly funded care could increase by 300,000 – or 69 per cent – by 2035.
Labour’s manifesto promises free personal care for the over-65s at a cost of about £6bn. This is less comprehensive than it sounds as it would not cover accommodation costs in residential care. The Lib Dems would pump £7bn into health and social care from a 1p rise in income tax rates and create a “joined-up system.”
Crucially, when the Tories discussed including a national care service in their manifesto, it would have been funded through general taxation. Previously, the government was moving towards an insurance-based system under which people over 40 could have contributed to their future care costs.
Matt Hancock, the health and social care secretary, insisted the value of people’s homes should no longer count towards the assets threshold (currently £23,250), below which they get financial help, so they would pass on more to their families when they die. But Philip Hammond, the then chancellor, argued that property should still be included, to keep down the cost. Now that the Tories are relaxing the purse strings, there is no excuse to keep social care in the "too difficult" box.
While the outcome of the cabinet debate over the Tory manifesto was disappointing, its extent does offer a ray of hope that Johnson would finally grasp the social care nettle if he remains in power. The next government cannot afford not to.