We need a national social care service, says Peter Beresford
There is a broad consensus, which includes the government, that the present system of social care funding is untenable. Yet with the publication of the green paper expected next week, there is little agreement or clarity about how social care should be funded for the future, with minimal evidence-based discussion about what will actually work. Instead, the preoccupation remains with satisfying short-term political and economic considerations.
The irony is that social care is emerging in importance as the new NHS. What the evidence highlights is that needs are increasingly likely to come its way, rather than that of traditional healthcare. The debate about rising social care need has tended to be framed in narrow and unhelpful terms of the “demographic timebomb”. But many other factors are increasing the numbers of people with support needs particularly associated with improvements in medical and health care as well as changes in attitudes and lifestyles.
Conditions that might once have been acute or terminal are now increasingly requiring longer-term support. This includes the greater life expectancies and greater numbers of disabled people with inherited or acquired impairments. It is reflected in the increased length of survival for people with cancer and other previously life-threatening illnesses and conditions.
There is also growing recognition of the need for social care support after health intervention to prevent people’s deterioration, as well as before to stop a medical crisis such as a stroke resulting in chronic impairment. The problem is that public and political understanding of social care still have to catch up with this if it is to get the funding priority that governments have recognised they must give to health. This is not an argument for taking money from the NHS, but to match social care funding with its expanding 21st-century role. Last year, the government identified a problem of a £6bn “black hole” in future social care funding. Since then, it has bailed out banks for many billions more, yet social security has to be as important as economic security.
There has been little pressure on the government to attempt the radical rethink of funding that is likely to be needed to counter ever-narrowing eligibility criteria and the penalising of people with savings. Charities have been reluctant to call for free care, for fear of being dismissed as financially unrealistic. Instead, they have played up the idea of “co-funding”, institutionalising financial responsibility for service users and their families, with little evidence about the scale of losers as well as winners from such arrangements.
Social care can still only expect to be at the end of any queue for what diminishing public funding is likely to be available. At the same time, it is committed to a three-year programme of transformation to a system of customised support, or “personalisation”, that carries its own costs.
How the government can square this circle remains unclear, but if it is serious about ensuring equal rights and opportunities for disabled and older people, mental health service users and people with learning difficulties, then we will need a social care green paper that acknowledges the scale of the funding issue.
• Peter Beresford is professor of social policy at Brunel University