The most strking aspect of the Coalition’s adult social care package is that it is riddled with internal conflicts. The Minister in last night’s Commons debate stressed the importance of preventive action, but how is that possible when intervention is confined only to when the elderly person’s condition reaches the critical category? The whole thrust of the government is to shrink the State, but the support for Dilnot which they affected will certainly expand it.
Osborne torpedoed Labour’s social care proposal just before the last election by claiming they represented a ‘death tax’, but is now bringing forward his own ‘death tax’, only this time it will be £35-50,000 rather thyan Labour’s £20,000. He has now broken off the inter-party talks in order to introduce a vacuous White Paper without the costs – or as Sir Alec Douglas-Home neatly put it in 1964: a menu without the prices.
Osborne still hankers after a voluntary care scheme, but the sums only add up if there;s compulsory risk-pooling. Yet he still won’t face up to the ineluctable logic of a mandatory adult social care system. He’s kicking it into the long grass by postponing it to the uncertainties of the next Spending Review in 2014 when everywhere gross neglect is now endemic and reform is needed urgently. And he’s ignoring any need for upgraded standards: the Treasury’s £1.7bn cost of Dilnot is purely about protecting family inheritances, not at all about dealing with escalating care costs or lifting care standards.
At present many local authorities pay only for 15 minute or 30 minute visits, and many too don’t pay for journey time even though that’s part of the contract, or for the petrol costs of a car which care providers have to make available themselves. Frankly it’s impossible within 15-30 minutes to get an elderly, often infirm, person out of bed, clean the sheets which may well be soiled, get him or her washed, dressed and fed, clean and tidy up, and of course engage in some conversation to establish at least some kind of human relationship. Equally it’s impossible with the minimum wage rates paid by local authorities because of their squeezed budgets – a funding shortfall of some £1.4bn this year – for care providers to offer the higher quality standards of care they want to provide and which their service users deserve.
So how is this big black hole in the care budget to be dealt with? The government does have choices. The long-term cost of Dilnot is estimated at £3bn a year – exactly the sum that Osborne gave to the top 1% earning over £3,000 a week, and which he could have devoted to elderly social care. When G4S goes belly-up, money is found immediately for 3,500 military and police to save the Home Secretary’s face, but not improving care standards for the elderly.
All three parties have failed over this issue and the question of priorities. The only long-term way to contain the costs whilst also guaranteeing high-quality standards of care is by a new social insurance scheme. Labour, which may be in power and in a position to implement it sooner rather than later, should make this one of the highlights of its manifesto.
