BRITAIN’S welfare state, developed in the 1940s, was said by its architect William Beveridge to be a “British revolution”. We need another revolution to fit with 21st Century lives as the population ages.
National Insurance was supposed to break away from Poor Laws, but social care was never included: Our National Insurance system of benefits and support was designed to break away from the legacy of the Poor Laws, which were a harsh safety net, for those in dire need. The 1940s welfare state aimed to establish a new, universal system on completely different principles, giving support for everyone, as of right. However, social care did not feature in this new system.
The NHS offered healthcare to all, free at the point of need, funded by taxpayers: However it did not factor in social care, which was left untouched and still the responsibility of local councils. In the 1940s, the concept of millions of chronically ill older people needing a little help with their daily lives on a long-term basis was unthinkable. Either their families or local communities would look after them, or they would not live very long. 21st century life is totally different, but our social care system is stuck in the past.
Government must wake up to the reality that social care cannot be left unfunded: Failing to fund social care means millions of people do not get decent, or any, care. If Beveridge had realised the forthcoming population dynamics, he would have included provision for long-term care needs in the welfare state. In the 70 years since our system started, no Government has taken this issue seriously enough – it’s time for a rethink.
Ultimately, taxpayers or National Insurance will need to fund social care: There is little doubt that a 21st century Beveridge would have included social care funding in the National Insurance system. This is a clear risk now, which was not on the horizon in the 1940s. Ultimately, Government will need to tackle the costs of social care provision at a national level, whether via the tax system or National Insurance.
The current cohort needing care is relatively small – it will grow significantly soon: Demographic trends clearly signal a dramatic rise in the numbers of older people needing long-term care. However, millions of ‘baby boomers’ are now reaching their 60s and will need care in the coming 20 years or so. The Government has not planned for this huge looming cost. Estimates suggest that around half the population over age 65 will need to spend at least £20,000 on later life care, and one in 10 will spend over £100,000.
Cutting social care provision is short-sighted and leads to long-term cost increases: Social care provision by councils has been cut and cut in recent years. Even as the numbers needing care have risen sharply, local authorities have reduced availability. A few years ago, people with moderate needs could receive moderate amounts of help – now only those with substantial needs get any council care. There is no help with prevention or early intervention. That is a short-sighted saving causing extra long-term pressure. And the amount of care being provided has also been cut – 15 minute visits are common, with no pay to care workers for travel time between clients – which means quality and dignity of care has also been reduced.
As increasing numbers of elderly people do not have their care needs met, they end up in the NHS after avoidable accidents, blocking the NHS system: The NHS is the backstop with last-resort funding from taxpayers. This will put intolerable burdens on the NHS, on younger generations and on older people. Urgent action is needed to head off a disaster that is clearly on the horizon.
Healthcare and social care must be integrated: The current distinction seems arbitrary and manifestly unfair. Until the Government properly integrates social care with healthcare and insists on higher standards, the current crisis will only worsen. This should be a major political issue, but it is not receiving sufficient attention. The public is not being adequately informed of the problems and possible solutions, leaving families struggling to cope and elderly people at risk in a system that is failing on all fronts.
We’ve left it so late, there is no single solution but encouraging saving for care could help: New products and approaches, together with new Government incentives, are urgently needed to help people prepare in advance for care spending. A savings solution should be part of the mix. This could include new tax breaks to encourage long-term care saving.
This cannot wait, it must be tackled now. So, the message to the Government is that our care system is in crisis, and the time to address this crisis is now. There is no single silver bullet solution. Social care in this country is failing, radical action is long overdue.
Baroness Ros Altmann is the former pensions minister.