Why social care needs 10-year plan – Damian Green

THE Covid crisis over the past 12 months has shone a fierce light on residential social care and has drawn public attention to it in a way that has never happened before.

How should social care be reformed?

It could scarcely have happened in more tragic circumstances, and the only sliver of consolation from the awful death toll has been the developing consensus that we simply cannot go on putting sticking plasters on to an increasingly fragile system.

It is getting on for a quarter of a century since the first in a list of Prime Ministers said that social care was an urgent issue that needed addressing. I have done some research and I think Tony Blair said that at a Labour party conference in 1997.

Sign up to our daily newsletter

The i newsletter cut through the noise

All his successors have agreed with him, but the problem is that none of them has yet met words with action. That is not for the want of trying.

Damian Green (left) was a key member of Theresa May's government at the time of the 2017 election.

Under Gordon Brown, Labour produced proposals for a national care service that foundered when it was dubbed a “death tax”. David Cameron put through the Care Act 2014 and a version of the Dilnot proposals. Shaky Government finances meant that was never implemented.

In 2017, a new version was proposed by Theresa May. It was dubbed a “dementia tax” with not great political results. Here we are in 2021 without a solution on the table and the problem is still with us. Later this year, we are promised a sustainable solution in the Comprehensive Spending Review. Let us hope that we see it.

There are many problems to be solved. At the root of them all is funding. The Health and Social Care Select Committee estimates that £7bn extra is needed to put the system on a sustainable footing.

The most intractable problem, as it has been over the past quarter of a century, is how it is raised. If it is all raised from taxation or national insurance, working-age people will, by and large, end up paying for their own care, perhaps later in life, and that of their parents’ generation. That will rightly seem unfair to them.

More promising models offer a mixture of extra public spending and more contributions from individuals – through an insurance system, through a Dilnot-style system or through variations of those models.

I argued in a paper for the Centre for Policy Studies that we should look to the pension system for an example of universal state provision being successfully supplemented with private savings. As we have seen with pensions, we have established cross-party consensus under Governments of different parties.

Even when the Government come to a conclusion on how to find the extra money needed – let us hope that it is not from council tax, which is not suitable for funding care – there will be other intractable problems, including workforce planning.

The demographics will dictate that we need more workers, so we must make it a more attractive sector to work in. Pay levels have already been mentioned, but the development of a proper career structure for care workers – it can be seen in the NHS, but it is much less easy to see in the care sector – is hugely important.

So much technology of all kinds is available that would improve the daily lives of those receiving care, but I fear that there is no discernible strategy for introducing and experimenting with it.

Housing is a key issue. If we built differently we could keep far more people in their own homes longer, which would make them happier in themselves, most importantly, and be less expensive for the system.

Finally, and perhaps most importantly, there is the whole issue of what integration we want of the care system and the NHS. I am delighted that the Government produced their recent paper on integrated care systems. It will not be easy to make a reality of that, but it will be absolutely vital.

I make a plea for two things, the first of which is that the voice of the care sector is heard. Secondly, I completely welcome the long-term plan for the NHS but equally it is important to have a 10-year plan for social care that fits with it so that it is seen as a system on its own.

I am aware that that is a formidable set of challenges, but 25 years is too long for reaching a decision about how to tackle them. I hope and profoundly expect that this is the year when we will finally see determined and sustainable action on this front.

Damian Green is a Tory MP and former Cabinet Minister who spoke in a Parliamentary debate on social care – this is an edited version.