England & Wales Health and social care

The neglected drama of the social care crisis

This article was first published by Total Politics.

This week a group of parliamentarians from both Houses and all parties met under the auspices of the all-party parliamentary group for local government to continue their inquiry into adult social care.

This may seem inconsequential in the week of double dip and Leveson, but we shouldn’t forget that the importance of these seismic political and financial movements lies not in the copy they provide for political commentators but in the impact they have on the lives of real people. Nowhere is this more acute than in the field of adult social care an area in which the divergence between shrinking state resources and rising demand is moving rapidly towards crisis.

Last year the Dilnot Commission had a stab at plugging some of the emerging holes in an increasingly creaky system.

You can read LGiU’s summary and comment on areas of particular interest to councils here

They recommended that care costs should be capped at £35,000, food and accommodation costs should also be capped and the means test threshold should be raised from £23,500 to £100,000. Dilnot argued that this would mean that no-one going into care should have to spend more than 30% of their assets.

The government’s long awaited response to Dilnot will be seen in the Social Care White Paper. Latest rumours are that the paper will be released on 14 June but that it will hold back from tackling the long-term funding of adult social care and will limit itself to the Law Commission’s recommendations around local government adopting a duty to provide financial advice and to the non-funded elements of Dilnot ie those measures that can be adopted without cost.

This is progress of course, but many will wonder whether tweaking the existing system in this way will really get to heart of the issue in the long term.

We still need to establish political and public consensus around the principles that should underpin a future care system. The vast majority of people remain unaware for example that for most social care, unlike health care, must be paid for by most people. Questions about fairness, self-reliance, service levels, funding mechanisms and quality assurance all have to be addressed.

While many questions remain, we do know that local government will have a crucial role to play, though this role is likely to change radically, hence the APPG’s interest in the issue.

Councils will have to help people lead independent lives: intervening early and working with partners in health to build holistic support for older people and supporting individuals to remain in their own homes for longer.

They are also likely to have a role to play in supporting people to remain financially independent: building on existing good practice to ensure that the resources of self-funders, who make up an increasing proportion of recipients of care, are supported to make the most effective use of their resources.  

Finally, we are seeing an increasing role for local authorities as market shapers, helping stimulate a broader range of public, private and voluntary organisations to provide care services.

The detail underpinning these changes is complex and contested. it will require some decisive shifts in practice: a move towards real outcome based commissioning over block booking and real investment in  preventative measures which in turn will depend on more effective joint working between health, social care, planning and housing services.

These debates are vital for us all if we are to have a secure, happy old age. That’s why the Social Care White Paper and the APPG inquiry are so important. In a week of high political drama, it’s worth remembering that this is where the real action is. The quiet, unheralded political process of addressing real issues and improving real people’s lives