Social care – rift in the coalition?

Social care, which proved so divisive when Labour sought cross-party consensus in the face of ‘death tax’ hysteria, is back on the table. Andy Burnham teases out the divisions between the cohabiting Lib Dems and Tories on this crucial issue.

In England, the way we care for older and disabled people is a broken system. And things are about to get much worse.

Last week I wrote to every Lib Dem MP asking them to think long and hard about whether their voters support the coalition plans to break up the NHS. I believe that funding of care and support has the potential to be just as divisive.

The stakes are high. Funding of care and support is the most urgent of all social policy issues we face as a society.

The key policy issue under debate is that of voluntary versus compulsory payments. The Conservatives have characterised compulsory payments as a ‘death tax’. They may in time come to regret that language.

Mary Riddell writing in the Telegraph has already told David Cameron to swallow his pride saying, ‘The question is how to spare people indignity, unhappiness and discomfort as they grow old, and the answer is obvious. Mr Cameron should swallow his pride and learn to love the death tax’.

The political row over the ‘death tax’ misses the point. A compulsory tax on vulnerability already exists.

My proposals for a National Care Service would provide a comprehensive system of care and support, free at the point of use.

It would be funded collectively by a 10 per cent levy on estates. Everyone would contribute. Contributions could be capped at £50,000 per couple, but I have recently proposed a major reform of property tax, which changes the context. A new land value tax would replace stamp duty, council tax and inheritance tax. This would clear the way to build public support for an uncapped 10 per cent care levy.

The tax on vulnerability that can wipe out everything that people have worked for would be transformed into a fair, predictable, progressive care levy. It would give all people peace of mind that 90 per cent of what they have worked for will be protected.

The Conservatives put forward an alternative proposal – a voluntary scheme that would cover the costs of residential care in return for a payment of £8,000. The proposal was called ‘unworkable, unfair and unaffordable’ by the Lib Dems and did not survive coalition negotiations.

Although it has since been dramatically ripped up, the coalition agreement did not hold many surprises on health. On social care however, we saw the Tory manifesto commitment to an £8,000 voluntary insurance scheme swapped for the Lib Dem commitment to an independent commission on funding.

People as well as policies must have been discussed. The former Lib Dem health spokesman, Norman Lamb, is notable by his absence.

As the architect of the cross-party talks that ended in acrimony with the Conservatives producing tombstone posters, Lamb was well versed in the political and policy issues surrounding social care funding. I got the impression that Lamb favoured a compulsory system, but was told by the party hierarchy to be lukewarm when the white paper was published.

By the time of the election, the Lib Dems were refusing to be drawn on funding for care and support, but Lamb was clear in his views on the Tory proposals, saying ‘This is basically a ‘poll tax’ and many people on modest means will be wondering how the Tories could think it’s fair that they should pay the same amount for care as multimillionaires’.

The coalition hope that the commission can find a middle-ground solution. But momentum for a National Care Service had built to such a level before the election that the public, media and care sector will demand a truly sustainable, progressive solution. I do not believe that a voluntary approach can offer that.

In a final bid for consensus before publishing the white paper Building a National Care Service, I called an emergency summit in February this year.

The summit was attended by local and national politicians, charities and care providers. It was boycotted by the then shadow health secretary, Andrew Lansley, who refused to attend unless the compulsory option was taken off the table. Lamb wrote to Lansley, urging him to take part in the talks.

In a statement produced by delegates at the end of that day, they backed a comprehensive, compulsory system for the funding of care and support.

Considering the history, it is disappointing but perhaps not so surprising that Lansley is thought to have refused to work with Norman Lamb.

Lamb’s successor as Lib Dem health spokesperson, Paul Burstow, also criticised the Tory insurance scheme for failing to cover the costs of care in the home. It was Paul Burstow who forced Lansley’s hand on the commission.

We learned on 20 July that the care commission, chaired by Andrew Dilnot, would be free to consider all options, including compulsory payments – the very issue on which Lansley boycotted earlier talks.

There was not much Lansley could do about this because Burstow had been telling the media for weeks that the commission would look at all options. He told the Telegraph on 5 June that a compulsory option would be considered.

While Burstow defended the decision, rightly saying that the commission must not be constrained, No 10 were falling over themselves to confirm that the prime minister and Lansley still opposed the ‘death tax’ and that although the commission would ‘make recommendations’, final decisions would rest with ministers.

Burstow was forced to backtrack, telling local government social care leaders, ‘The prime minister has made his views very clear both before the election and in the past 24 hours that his view about the death tax is unchanged.’

It’s a pretty shabby way to launch an independent commission – give it free rein to consider all options but publicly announce the answer you won’t accept.
The commission chair, Andrew Dilnot was forced to speak up against allegations that he is a government stooge, saying, ‘It was made clear to me that we were an independent commission… we don’t feel constrained’, and adding that he would be surprised and disappointed if the government rejected realistic recommendations.

Dilnot was part of the 1997 Joseph Rowntree Foundation group that suggested the establishment of a national care insurance scheme, funded through compulsory contributions, so that social care would be free at the point of use.

I believe that many Lib Dems already recognise the benefits of a comprehensive, compulsory solution. They must use their position in government to make the case for it and reassure the commission that all recommendations will be considered.

I have welcomed the commission and will support it in any way I can. The issue of how to fund care and support is too important to be derailed by party political interests. But we owe it to our older and disabled people to secure a fair, sustainable solution that will give peace of mind to all and allow us to celebrate our ageing society.