Those with one type of illness – cancer, for example – are well looked after by the NHS. Medical care, from GP appointments to the operating theatre and into recovery, is free at the point of use and usually of a high standard, even if there is some room for improvement.
Constituents with more long-term conditions, however, are not so fortunate. An elderly person who suffers from dementia, for instance, and who requires long-term complex social care – either at home or in a residential setting – may have to pay tens of thousands of pounds, even hundreds of thousands, from their own capital and retirement income, until they are down to their last £23,250.
The fruits of a lifetime of hard work and careful saving can be wiped out: there is certainly no reward for prudence here. The powerful bequest motive that guides behaviour among all conservative-minded people is effectively demolished.
Thankfully, the social care received will usually be of a good standard, even if underinvestment in the sector has taken its toll. But the impact on that person and their family, at a difficult time in their lives, can be devastating. It can involve the forced sale of the family home. The effects can be even more severe when a much younger person requires long-term care and finds the welfare state has turned its back on them.
Politically, it is by no means easy to fix this problem. We saw this in the 2017 election when an untested and frankly disastrous policy was launched in the Conservative manifesto – the so-called “dementia tax”. It protected some assets, admittedly, but it highlighted and confirmed the huge sums people might be forced to spend on social care.
There was no sense of pooled risk. The public was not impressed and that was evident in the election result. Worryingly, it seemed as if social care had become a “third rail” in British politics: too dangerous to touch, which perhaps explains why the Government’s Green Paper has yet to surface.
For this reason, I am pleased that Policy Exchange, a centre-right think-tank, has explored such a vital policy area, which affects millions of people – including the children and relatives of those needing care.
In 21st Century Social Care, researchers have put forward recommendations that I find persuasive. This is one area, it is clear, where the state has a significant role to play.
It is far better to pool risk and for the taxpayer, where appropriate, to step in and help those who would face ruinous costs on their own, making social care largely free at the point of use. This is something we can afford as a nation, as Sir Andrew Dilnot and others have pointed out, if we can only get our priorities right.
Nonetheless, as a Conservative, I also applaud the idea of an affordably small co-payment, of the order of £5,000 per year, for those who need social care, so that they are treated more like consumers of a service and less like those who can only take what they are given by some beneficent state provider.
It is also right that it is charged on income, not savings, and is only paid by those who can afford it – not, for instance, those whose retirement income is the state pension alone or not much more.
There are some who have argued for a new tax used solely for the funding of social care – in other words, a hypothecated social care tax. This would be pure sophistry and should be avoided. In cyclical downturns in the economy, the amount raised by such a tax would fall. In that scenario, would it be right to slash social care provision? Of course not.
Likewise, in periods of boom, there might be higher-than-expected revenues and earmarked money, in the absence of a rise in demand for social care, might be wasted.
Partial hypothecation, where the Government can top up the tax revenue or take some of it for other uses, is even more fraudulent: a lie told by those who believe the taxpayer is gullible.
Far better, as Policy Exchange’s paper sets out, to pay for social care out of general taxation like any other normal area of public expenditure.
The Conservative Party has a better record in the area of social care than recent history might suggest. For example, it was the Tories who introduced the Attendance Allowance in 1971, which is not means-tested and helps well over a million people today pay for personal care.
But there is much more to do and for too long the issue has been kicked into the long grass. It is time for Conservative leaders to think differently, and radically. In another age, the original One Nation Tory, Benjamin Disraeli, sought to improve the “condition of the people”; in our own time, we should recognise that social care reform is one of the great challenges where the people need to see new political leadership.
Jacob Rees-Mogg is a Tory MP and has written the foreword to a report, 21st Century Social Care, published by the Policy Exchange.