Louise Casey is asking the right question about social care – now we need a clear answer
Baroness Casey in July (PA Images/Alamy)
4 min read
Louise Casey has started the Big Conversation on Care with a deceptively simple question: when we are old or disabled, or have a serious illness, who should support us and how? She is right to start there.
I say that from experience. As care minister, I established the Dilnot Commission and began work that led to the 2014 Care Act. I remain proud of what the legislation achieved: putting wellbeing at the centre, strengthening carers’ rights and giving people a stronger say over their care.
But, looking back, implementation was not the only thing that fell short. We never fully settled the bargain underneath it.
The Care Act gave social care a stronger legal framework. What England still lacks is a settlement people can understand and rely on: what help they can count on, what they may reasonably be expected to contribute, and which risks they will not be left to carry alone.
Other ageing societies have made those choices more explicitly. Germany and Japan took different routes, but both began by defining entitlement and how care risk should be shared. Their systems have had to adapt since, as any care system will. The lesson is not to copy them. It is to settle the bargain before designing the machinery.
My answer is simple. If illness, disability or frailty means you need care and support, you should be able to count on getting enough help to live your life, wherever you live. If you have the means, you may reasonably be asked to contribute. But that should not mean the system steps away and leaves you and your family to make care work on your own.
That bargain also has to be clearer about risk. Needing care can mean much more than an unexpected bill. It can mean support not being available, a family reaching breaking point, someone giving up work, or needs continuing for years.
Care is a common human risk, but it falls very unevenly. Some of us will need relatively little support. Others will face high costs over many years. Catastrophic care costs should be firmly on the shared side of the line. No one should face potentially unlimited lifetime care costs simply because they need care for a long time. How ordinary costs are shared remains a political choice.
Families need a clearer deal too. Most of us want to care for those we love. But when formal support is inadequate, the care does not disappear. It is picked up by husbands, wives, daughters, sons and friends – through lost earnings, poorer health or simply reaching the point where they cannot carry on.
A budget is little use if nobody is available to provide the care
Families should be partners in care, not the hidden capacity that makes an under-resourced system appear to balance.
Rights are only as real as the system’s ability to deliver them. A budget is of little use if nobody is available to provide the care. An entitlement that cannot be delivered is not much of an entitlement.
Nor can the answer simply be a better-funded version of today’s system. The scale of the workforce challenge means we also have to rethink how support is organised around people’s lives. Entitlement, funding and capacity have to move together.
That is the opportunity the Big Conversation creates. Louise Casey is right to ask what care is for, who should get help and who should pay for what. The next step is to turn those questions into a promise people can understand.
What can I count on? What might I reasonably have to contribute? Which risks will I not be left to carry alone?
Settle that bargain – and funding and institutional design become ways of keeping the promise. Leave it unresolved, and we risk another reform that never quite becomes a settlement.
Paul Burstow is former Liberal Democrat MP for Sutton and Cheam (1997-2015) and care minister (2010-2012)
