Why social care won’t be fixed by money alone – David Hinchliffe

If he expects this week’s announcement to be viewed as delivering on that commitment, I think he may be in for a disappointment.

During many years in the House of Commons alongside former Conservative leader Iain Duncan Smith, I cannot recall one single occasion where I agreed with him in any policy area.

But, listening to a BBC news interview with him before Tuesday’s announcement, I found myself in total accord with every single point he made in anticipating what the Government might propose on social care.

Mr Duncan Smith’s key point was that if Boris Johnson’s plan to fix things focused merely on increasing funding to the system, rather than reforming it, he would be unable to support the Government on its proposals.

His apprehension was well founded.

The “crisis” in social care is about a good deal more than just its funding, but we will differ profoundly on what’s at the heart of its problems and how they should be sorted.

Our care system is unco-ordinated, expensive and inefficient directly as a result of its almost complete privatisation by the Thatcher and Major governments, underpinned by huge public subsidies, during the 1980s and 1990s.

They regarded care as a commodity to be purchased in the market by shopping around for the best deal.

Those who have had the experience of trying to find a decent care home for a relative with, say, dementia will probably testify that the process is markedly different from buying a new settee.

It was a bitter disappointment to me, having been Shadow Care Minister, that “New” Labour in Government didn’t follow the policy directions we had developed in opposition pre-Blair.

Mr Duncan Smith made the key point this week that social care and the NHS are inter-related, with problems in one impacting upon the other.

Our proposal, subsequently endorsed in a number of Health Select Committee reports, was that only by moving towards formal integration of the two systems would it be possible to resolve the long-standing difficulties which have impacted upon far too many people at a difficult time in their lives.

This week’s announcement should have had at its core an acceptance that it is nonsensical to have free provision of NHS care alongside means-tested social care when it is, frankly, a lottery establishing which side of the great divide an individual’s particular needs fall.

The attempted cost-shifting between the two sectors, with so-called “bed blocking” a key symptom, should have been ended once and for all.

It should have set out a clear pathway towards, in the short term at least, the joint commissioning of both health and care by NHS primary care and local councils.

The logic of such a move in the longer term would be that a return to direct care provision by local authorities – both community and residential care – would pave the way for the development of a much wider range of care options at a local level.

It’s such a depressingly familiar story to learn of elderly people giving up their own homes and entering permanent care as a consequence of the lack of any clear alternatives within the community.

Placing care in the hands of the market has led directly to an emphasis on permanent care at the expense of a whole range of other options which could – and should – be explored.

This week’s announcement should have trumpeted a 
massive expansion of the likes of extra-care housing, where 
people with care needs can retain their independence while receiving round the clock support to do so.

It should have incentivised the use of the huge range of new technologies which exist nowadays and can offer reassurance to the vulnerable and isolated through the ability to monitor their wellbeing remotely.

Sadly, Prime Minister Johnson’s “fix” is rooted in giving the private providers of residential homes more cash to sustain an outdated care system which needs to be radically changed to meet the needs of the 21st century.

As Mr Duncan Smith feared, the Government has merely thrown more cash at a system which is crying out for wholesale reform.

And, if my agreeing with him was a shock to the system, being of the same mind as the right-wing Adam Smith Institute 
about how the Government is sourcing the increased funding of social care was even more disquieting.

But its comment that the 1.25 per cent National Insurance increase was “morally bankrupt” was so right.

Making younger working people, who are often on low wages and struggling to obtain mortgages, fund the care of the frequently far better off older generation, doesn’t seem like the much-vaunted “levelling up” to me.

David Hinchliffe is a former Labour MP for Wakefield. He is also a former chair of Parliament’s Health Committee.

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