No help is guaranteed at all, near-term. The claims that these reforms demonstrate the courage to tackle the difficult issues that other governments have ducked simply do not stand up to scrutiny.
I wish they did, and I wish I could support a bold initiative to get to grips with a situation that is, frankly, a monumental national and social failure that has already, and will continue to, cost the lives of many vulnerable British citizens.
The challenges of social care are significant. The Health and Social Care Levy Bill simply fails to address them. It merely repeats the Dilnot-style measures already legislated for by the Care Act 2014, with a cap that still does not cover all the care costs and still leaves vital funding elements to cash-poor local authorities, which will keep having to ration, reduce or deny care for those in need.
Even the funding promised in this Bill is not ring-fenced to pay for care. It will first prop up the NHS, which already receives the lion’s share of taxpayer money and has itself worsened pressures on social care through the pandemic and proved, yet again, the second-class treatment — for example, by discharging Covid-positive patients, refusing to admit elderly people to hospital and cutting the previous regular visits by GPs to care homes.
This Bill does little or nothing to address so many of the basic fundamental social care sector failings and will still leave ordinary families facing massive costs to subsidise local authorities, which underpay for council-funded residents. There is nothing to address the artificial distinction between free at the point of need NHS care for, for example, cancer, and the hugely expensive social care for, for example, dementia patients.
This Bill will not reduce unmet needs or the financial fragility of care home operators.
It will not end the current rationing of care, nor the ongoing reduction of preventive measures. The national economic model of social care relies on councils’ public funding paying below costs of delivery.
I am afraid this is simply not a meaningful commitment to social care.
It encourages short-term use of this money, supposedly designed to improve social care for the NHS.
This obviously needs to be facilitated—reducing the backlog in the NHS is important—but social care underfunding is equally serious for the health and lives of our nation.
I cannot agree that National Insurance is an appropriate mechanism for care funding. There will be no contribution from pensioners’ pensions, buy-to-let landlords or capital gains. This hardly spreads the burden widely or fairly across society.
This National Insurance change is a regressive tax, which breaks a manifesto commitment and penalises the lowest earners and businesses already struggling to recover from the pandemic.
Of course, as we emerge from Covid-19 disruptions, additional funding for both NHS and social care is needed, but the care crisis predates this period. Why should businesses pay for this?
This is a social policy issue of the utmost importance, which has been neglected by successive governments for decades.
Worthy words, reviews, royal commissions and more have made recommendations for urgent change, but action on the ground was ducked.
Even legislation has lain unimplemented, despite rising need and the financial collapse of major operators. Funding the NHS is still being prioritised over funding social care.
This is a national policy issue. It is not about politics. I hope that Ministers respond to cross-party offers of co-operation on this important issue.
Ros Altmann is a Tory peer and former Pensions Minister who spoke in a House of Lords debate on the Health and Social Care Levy – this is an edited version.