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Andy Burnham’s determination to lift social care up the political agenda is encouraging and correct – even “brave”, as Sir Humphrey would have put it.
But his day-one announcement that a new National Care Service needs to be treated “on an NHS basis”, which everyone has interpreted as being free at the point of use, could be his most expensive pledge yet.
The figure being touted as extra government expenditure under this scenario is £18bn – but that does not take into account the suppressed demand we currently see for care services.
What he inherits is the commission under Louise Casey set up by the previous government in a transparent attempt to avoid making any big decisions on social care for the whole parliament. Burnham has indicated that he wants a final report from Baroness Casey this year, instead of 2028, which is good.
At the same time, Casey is starting what she calls a “Big Conversation” with the public covering four questions: who do we think should receive social care, what should families be asked to do for their loved ones, what should people be able to expect from the state, and what should people contribute in return?
These are all good and essential questions, but I hope the conversation stays balanced, with as much emphasis on what we can all do for ourselves and our families as on what the government can do for us. Experience tells us that an unfiltered Big Conversation is prone to generate the answer: “Give us more free stuff and pay for it by taxing the rich/the banks/big business.” This will not provide a consensus for practical action.
And the new prime minister still has the basic question of what he means by a National Care Service. I suspect that the aspiration of a “free” service will be left to develop gradually, for financial reasons, so here are some immediate improvements.
The Social Care Foundation has sent a number of suggestions to the Casey Commission as detailed in the report, Who Cares?. Here are seven ideas that contribute to the development of a National Care Service without putting any significant extra strain on public finances.
1. The public funding of social care should not rely on council tax receipts with national top-ups to stop the system falling over. This is leaving care services squeezed while quietly bankrupting local councils. We should take funding away from council tax and make it national.
2. To make sure the system is fair in every part of the country, there should be a national assessment to say what amount of state support a person should get, depending on the seriousness of the care need. For example, some people will need regular home visits, others will need full-time care in a residential setting. Once granted this award, the recipient and family can choose a local provider, and I would allow families to top up this award from personal income.
3. To help those facing an often impenetrable bureaucracy for the first time, we should create a national “My Care” online portal. This would guide potential care users and their families through their entitlements and responsibilities and should become a valuable one-stop shop for information and advice.
4. Since most people prefer to stay in their own home for as long as possible even while they need care, and as it is much better value for the taxpayer for this to happen, we should change planning policies to introduce a presumption in favour of later-life housing as part of any new development. Such houses would make it safer and easier for the elderly and frail to lead a normal life at home.
5. We should introduce proper, equal, joint budgeting, commissioning and service design between the care sector and the NHS. Too often greater integration has meant greater emphasis on NHS needs with care left as the poor relation. True integration means the National Care Service being treated as an equal priority with the NHS.
6. After the Fair Pay Agreement has come into force, hopefully making care work a more attractive career option for young British workers, we need a professional registration scheme for care workers. This would both provide greater safety for recipients of care and raise the status of care workers, who will be able to show publicly that they are part of a respected profession.
7. To promote a diverse group of providers with the potential for new entrants, we should allow the sector to access lower-cost capital through the British Business Bank. This would be a practical way of stabilising the sector, and a public sign that care was a priority in economic as well as social terms. The economic effect of the care sector is often under-rated.
There will be many more changes needed to allow the care sector to look forward with confidence to the future. But these initial steps would provide a good basis for what will become a true National Care Service and would more importantly make a measurable improvement to the quality of life of some of our most frail and deserving fellow citizens.
I hope the new prime minister will give them a hearing and will continue his interest in a sector that does vital work, but which too often falls below the political radar.
Damian Green is a former deputy prime minister and chair of the Social Care Foundation
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