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Social care needs a cheque, not more delay

Lord Forsyth

Lord Forsyth

4 min read

Social care is chronically underfunded and undervalued. It needs an immediate cash injection to bring it to an acceptable standard, and then urgent reform, says Lord Forsyth 

On Thursday the House of Lords Economic Affairs Committee published our report on social care funding in England. Like others, we were shocked by underfunding in the system. The number of people who need care but aren’t receiving it is increasing. Age UK estimate that 1.4m older people have unmet care needs. Many working-age people also have unmet care needs, and care for working-age people constitutes nearly half of all public social care expenditure. Unpaid carers, usually family and friends, are providing more care with less support. Local authorities are struggling, with many overspending their budgets or using their reserves. The market for care is starting to collapse, with local authorities unable to pay care providers enough to cover their costs. And the care workforce continues to be undervalued and underpaid. One care worker told us she was tired of hearing colleagues describe themselves as “just a carer”.

We often hear about how difficult it will be to fix the social care crisis, but the problem of underfunding should not be conflated with other more complex flaws in the funding system. Fixing underfunding is simple: we need to spend more money. The Health Foundation and the King’s Fund estimate £8bn would return the system to 2009/10 standards. This won’t be perfect – 800,000 people had unmet care needs in 2010 – but it will be a marked improvement.

There are other flaws in the system. There is a postcode lottery in social care funding. Local authorities rely primarily on business rates and council tax, which vary according to local economies, to fund social care. Care needs also vary between local authorities. This means different local authorities have very different amounts to spend per head. Social care should be funded by a national grant, distributed to local authorities according to local care needs and their ability to raise other funds.

'If we cannot find money to provide basic support to the most vulnerable in our society, what is the state for?'

There is also a ‘condition lottery’. Someone diagnosed with cancer receives free treatment on the NHS. If they are diagnosed with dementia they have to pay, sometimes hundreds of thousands of pounds. This is clearly unfair. Everybody should be entitled to a level of personal care—help with essential daily activities like washing, eating and dressing—free at the point of use. Individuals would still pay for accommodation costs and other care needs themselves, though the government should explore a cap to protect people from catastrophic accommodation costs. The King’s Fund and the Health Foundation estimate this would cost £7bn. We recommend the Government introduces free personal care over the course of five years.

This may sound like a lot of money. But if we cannot find money to provide basic support to the most vulnerable in our society, what is the state for? The government has recently found an additional £20.5bn to spend on the NHS—more than total adult social care expenditure.

We have been waiting for two years now for the Government to publish a Green Paper consulting on social care funding, but we have already had decades of discussion on social care. The government needs to bring this crisis closer to resolution and produce a White Paper with specific proposals for reform.

Clearly some level of political consensus will be needed to find a sustainable funding arrangement. Our own cross-party committee, which includes two former Chancellors, two Treasury permanent secretaries and a former Cabinet Secretary, agreed its conclusions unanimously. Last year’s joint Commons Committee report also proposed free personal care. Think tanks as varied as the IPPR, Policy Exchange and the Centre for Policy Studies have all proposed some form of free care entitlement in recent months. Free personal care is both the fairest solution and the only solution attracting cross-party consensus. It is not hard to see why – it has long been agreed that the state should provide a safety net to protect the most vulnerable in society.

Lord Forsyth of Drumlean is a Conservative peer and chair of the Lords Economic Affairs Committee

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