Alan Johnson: We must find a way to tackle adult care crisis

In the past week alone, Age UK has said that the system is moving from crisis to collapse. A report by Oxford University and the London School of Hygiene and Tropical Medicine concluded that problems in adult social care are behind an unprecedented increase in mortality.

I was Health Secretary 10 years ago, and I was heavily engaged in the internal debate within the Brown government about the need to devise a completely new and substantial stream of funding for adult social care.

The Dilnot inquiry subsequently made a number of suggestions, including the eminently reasonable one that people like me who are working beyond state pension age should pay National Insurance. That was quickly dubbed the “granny tax”. Between the death tax and the granny tax, the national debate on how we find the means to tackle this crisis has rarely managed to rise above the glib and the facile.​

I applaud the recent cross-party attempt to convince the Prime Minister of the need to find a new cross-party consensus.

It is traditional in debates of this kind for somebody to say that the problems are not all about money. But I am afraid that in respect of adult social care, it actually is all about money. According to the Institute for Fiscal Studies, direct funding to local authorities will have fallen by 80 per cent by 2020. I repeat: 80 per cent.

Adult social care is not ring-fenced. Some £4.6bn was slashed from those budgets in the last Parliament, with the result that we spend less on social care now than we did in 2010. Those are House of Commons Library figures obtained yesterday. It is less in cash terms, which is even less in real terms, and all parties agree that the problem is mainly caused by underfunding.

Pending the Budget, the solution that this Government has pursued with the most vigour is simply to pass the buck to local authorities. Let us for the sake of this debate accept the premise that local authorities are best placed to deal with the issue and that the adult social care precept may be the new funding stream that has proved so elusive.

Even if we accept all that, the first point that the Government must surely acknowledge is that the amount raised does not begin to match the scale of the problem. The precept in 2016-17 raised £382m, which is less than three per cent of council spending on adult social care.

However, it would have been a very welcome three per cent increase, were it not for the fact that implementation of the National Living Wage cost those same councils an estimated £612m, wiping out the additional money and leaving councils with a deficit on this issue alone of £230m.

Hull City Council will struggle to produce any meaningful resources from the social care precept because 80 per cent of our housing stock is in the two lowest bands. The net result – this is a neat little comparison – is that in Kingston upon Hull the increase in the precept to three per cent will bring in £8.01 per person, but in Kingston upon Thames it will raise £15.27 per person. There are even starker anomalies, incidentally, but that is a neat comparison.

Kingston upon Hull, which has higher levels of deprivation, a greater need for social care and a lower council tax base, finds itself getting almost half as much as Kingston upon Thames. Because of the Government’s failure to properly account for deprivation over the next three years, Kingston upon Thames will have £2.3m more to spend on adult social care while Hull will have £2.2m less.

This is not a battle among local authorities; it is a battle by local authorities to achieve a proper understanding by the Government of the crisis they face. The Government must take levels of deprivation and the ability to raise finance from local tax receipts fully into account when considering the future fair funding model for local government.

Local authority funding of adult social care on the current basis is unsustainable, but, in the absence of fresh thinking, it is all we have, and the people who rely on adult social care cannot wait any longer for the urgent help they need. The debate can get lost in dry statistics, but in reality it is about the elderly woman who is stuck in a hospital bed because there is no satisfactory provision in her community. It is about the disabled man unable to receive the help he needs to have a bath, the care home that closes and the dementia care that vanishes. It is about many of the things that make our society civilised – things that are diminishing
daily on this Government’s watch.

Alan Johnson is a former Health Secretary and MP for Hull West and Hessle. He led a Parliamentary debate on adult social care – this is an edited version.