We must reform social care – we can’t afford not to

The definition of ‘social care’ and rules for eligibility vary across the country, but poor understanding is nationwide, says Melanie Henwood

An open letter to the Telegraph urges the government to grasp the nettle and introduce fundamental and lasting reform to the social care system. This reopens a vital debate. The issues are depressingly familiar and have been identified with similar urgency on multiple occasions over the last two decades. The debate has been way-marked by significant reviews and inquiries and the Dilnot commission into funding of care and support is the latest in a long line.

While the specific recommendations of the royal commission into long term care, the Wanless inquiry, the Joseph Rowntree Foundation and the Dilnot commission have varied in detail, all have agreed that the current system is failing and will only get worse; that it is unfair and confusing, and that the risk of facing potentially catastrophic costs of care should be shared between individuals and the state.

Since publication of the Dilnot report in July 2011, further detailed work has been taking place through half a dozen groups set up by the Department of Health, which have been concerned with priorities for improving care and support. Such work is vital and underlines the fact that the challenge with social care reform is not simply about the funding model, but there are equally pressing matters about the nature, quality and delivery of care and support services.

Nonetheless, without first addressing funding reform, it is almost impossible to make significant headway with these other matters. Lord Warner, one of the three commissioners on the Dilnot inquiry remarked that quality of care will not be raised “without increasing the size of the social care pot”.

How to inject additional resources – both public and private – is the central challenge. It is also one that polarises opinion and is rife with misinformation and poor understanding. It is little wonder therefore that the quest to achieve cross-party consensus has proved so elusive. Many people have little understanding or awareness of what exactly is meant by “social care”; typically people mistakenly believe the care system is all part of the NHS and that their needs will be met if they should need care. It comes as a huge shock to realise this is far from the case and that social care is means-tested and people can face hugely variable charges across the country.

The distinction between health and social care is by no means black and white; there is a significant grey area in between where the decision that support should be deemed social care rather than the responsibility of the health service can appear arbitrary or irrational. Many people with long-term conditions find themselves in this hinterland, so too do people with dementia – they may have substantial care needs, but these are not classed as matters for the health service.

Even more confusingly, people can become eligible for NHS-funded “continuing health care” when their primary need is judged to be a health need while others with apparently similar needs will be judged to require social care. Furthermore, the definition is one that has shifted over time and many people now judged to have social care needs would – in previous years – have been cared for by the NHS. Such care may not have been the most appropriate, and certainly a hospital is rarely the right environment for people needing long term care, but it would have been free of charge.

John Redwood MP commented that all political parties “agree that healthcare should be completely free”, but “when it comes to their board and lodging, and if they need different arrangements” people should make a contribution. Unfortunately, this further confused the debate – the question of paying for accommodation is a separate issue from that of paying for care and it is not helpful to conflate the two.

As the signatories to the Telegraph letter argue, there is now both a real need and an opportunity to establish a new consensus on the way forward for social care through cross-party talks in advance of the development of a white paper expected in the spring.

However, the debate needs to be much wider than merely across Westminster and Whitehall; it is something that needs to engage the entire population; to take place in a way that does not cause further confusion or social divisions; that avoids negative and ageist language about the “burden” of care; and which produces a genuine new and lasting social contract across the population and between generations. It must share the risks and costs of needing care, and remove the fear of loss of independence and consequent impoverishment. At a time of continued financial constraint, it would be easy to argue that we cannot afford to reform the social care system; in fact, we cannot afford not to – doing nothing and continuing to muddle along until yet another commission or independent review is tasked with examining these issues can no longer be an option.

Melanie Henwood is an independent social care consultant.