So where is the social care plan? The problem is that, although most of us will need some care eventually, it feels a long way off, and all solutions are expensive and risk upsetting a lot of voters.
The solution may be difficult, but the problem is clear. We are all living longer, and most of us will spend more of those extra years in poor health.
So, we need more support, and someone has to pay for it. This could involve 24/7 care for someone with severe dementia, or just occasional help with everyday tasks. Some of us will receive care in our homes, while others will live in residential accommodation.
Many people believe that social care is paid for, like healthcare, by the state, but this is not true. If you have assets above £23,250 (including the value of your home), you will have to pay all the costs of your care. What you get will depend on the policies and budget of your local authority. Since Boris Johnson promised the plan, 1.4 million people have had requests for support turned down.
Care need is an unpredictable risk
There are many unpredictable risks in life. But we don’t treat them all in the same way. I might have a serious illness; I might crash my car; or I might need social care in my last years. If I am lucky, none of these will ever happen to me. However, if I fall ill, the whole community pays for my treatment through the NHS, whatever it costs. If I crash my car, my insurance company pays from the premiums of all their customers. But I can’t insure against my social care needs.
Like these other risks, social care costs are unpredictable. We don’t know what they will be or when they might happen. On average, those who go into residential care live there for about two years, but some stay for decades. One in four of us will need little or no care in our lifetime, but one in ten will need care which costs £100,000 or more.
So, if we all paid a modest sum, everyone could be guaranteed the care they need, when they need it, and without fear of losing all their money. This was the basis of the plan which Sir Andrew Dilnot’s commission gave to the Coalition Government in 2011.
The system is broken
The Dilnot report concluded that the current adult social care funding system in England needs urgent and lasting reform. It is confusing, unfair and unsustainable. People are unable to plan ahead to meet their future care needs. Assessment processes are complex and opaque, and what you get varies depending on where you live. Provision of information and advice is poor, and services often fail to join up. Many people do not get what they need: in 2019, 1.3 million people requested social care in England, but only 840,00 people were receiving it.
The system is not only failing old people, it is also expensive. At any one time there are over 300 people in East Anglia occupying expensive hospital beds which they do not need, because there is no social care available.
Dilnot’s report was shelved, and since then the situation has got worse. Spending on social care has not kept up with inflation and Local Authority budgets have been cut, so it has become more difficult to get care, more expensive for those who can pay, and care workers’ pay has not kept pace with the cost of living. On top of that, Local Authorities have had to cut other services, like libraries, youth services and roads to try to keep up with the spiralling costs of social care.
The Dilnot plan
Dilnot’s report looked in detail at how to pay for a better system. First, there should be a cap on the amount that anyone should be required to pay: he suggested that this should be £35,000 in total. Individuals should be allowed to keep up to £100,000 of their savings: at present it is only £23,250. People in residential care would pay a standard fee for their accommodation and food of between £7000 and £10,000 a year. The rules on who is entitled to what kind and what level of care would be the same across the country.
He costed these changes at £3.6 billion in the third year of operation, or about a quarter of one percent of national income.
Can we afford to put things right?
Although Dilnot’s plan was well received in 2010, and the Coalition government legislated for some of the recommendations in the Care Act (2014), including a cap on care costs to take effect in 2016. However, the incoming Conservative government’s austerity plans led to delays and the abandonment of most of the proposals.
Today Dilnot’s £3.6 billion no longer looks like a huge sum. As an accidental result of the Covid recession, the “triple lock” on the state pension, which guarantees that the state pension will rise by the same percentage as average earnings is set to cost £3 billion in 2022. £3.6 billion also shrinks dramatically by comparison with the £300 billion which the government borrowed in 2020 to deal with Covid.
There is a plan: let’s get on with it
Our care system is broken. However carefully we plan ahead, many of us and our relatives suffer anxiety, distress and poor care in the last years of our lives through no fault of our own.
Dilnot gave us the “oven ready” plan which Boris Johnson promised on the steps of Downing Street. The government is now talking about a new plan. Will it be as carefully planned or generously funded as Dilnot’s?
Is it not time to do the job properly. We will all grow old. We all deserve the security and dignity in our later years.
Meanwhile: getting help
The problems of getting social care are not going to be solved tomorrow. In the meantime, if you, or someone you know, is in need of care, here are some contact details:
Norfolk – Start with social care
Suffolk – Care and support for adults
Essex – Get social care help
Cambridgeshire – Support to stay independent