What isn’t being said in the social care white paper?

There are vital aspects missing from the white paper, including a discussion on social care funding. The conversation won’t be easy but it does need to happen, argues Melanie Henwood.

The white paper on care and support holds few surprises and no assurances of a solution to the funding dilemma in paying for long term care. The most controversial aspect is not what the document contains, but rather what is missing.

As was widely reported in recent days, attempts to establish cross-party consensus on funding long term care have broken down, and while accepting in principle the recommendations of the Dilnot report to cap the amount people have to pay for care over a lifetime and raise the means-testing threshold, the white paper fails to set out plans for funding reform. Rather, this is to be looked at in the context of the comprehensive spending review in 2013. Supporting the principle, but declining to address how this might be delivered in practice feels like something straight out of Yes Minister; it would be funny if it wasn’t so tragic.

The argument that the money involved is significant, and therefore any commitment must be considered carefully, is both obvious but also disingenuous. There has been plenty of time for detailed consideration of these proposals, which have been on the table for more than a year.

The estimated cost of meeting the Dilnot proposals (of capping individual liability at £35,000) would be £1.7 bn, rising to £3.6 bn by 2025-26 as the population continues to age. As the Guardian’s Jackie Ashley has pointed out, the issue of affordability is not of absolutes but of political priorities. We’ve been here before – several times.

This government is not unique in failing to deal effectively with long term care. In 1999, the Labour government similarly choked when confronted with the recommendations of a royal commission. In the years since, there have been repeated investigation and analysis of the issues, and all have reached the same broad conclusion: the current situation is unfair and unsustainable. Indeed, Dilnot summed it up succinctly: the funding system “is not fit for purpose and needs urgent and lasting reform”.

The failure, once again, to grasp this nettle and establish a new funding model that protects individuals from catastrophic costs and spreads risks more evenly across the population, is indefensible, and as the Guardian’s David Brindle has observed it is “an indictment of the short-termism of our system of government.”

The procrastination on the part of government is even more significant because it adds to the continuing uncertainty and worry hanging over people’s heads as they wonder if and how they will afford to pay for care. Perhaps most damaging of all, it has added to the widespread perception of older and disabled people simply as a financial burden dragging on the economy.

It is increasingly commonplace to hear politicians openly blaming the now ageing baby boomers for everything from student fees to property prices, and arguing for removing universal benefits (such as free TV licences and winter fuel payments) from these feather-bedded pensioners. The fact that older people have contributed through a lifetime of work and paying taxes, and that they continue to contribute to society as carers, volunteers and active citizens is somehow lost from this one-sided equation. At a time when solidarity is vital in securing a new social contract, there are increasingly deep divisions being driven between generations.

The proposal to introduce a national deferred payment scheme will offer some comfort – it will avoid the necessity of people selling their homes to pay for care during their lifetimes. But it doesn’t remove the need to pay, and a charge on the estate (with interest) will still be a significant blow. How local authorities are to finance such loans is also far from clear, and balancing the demands of social care against all other claims on local government is increasingly fraught.

The white paper does address other important matters, and in responding to some of the other recommendations both of Dilnot and of the Law Commission review of the legal framework for adult social care, the government – as expected – proposes the introduction of a national eligibility threshold and portability of entitlement. This attempt to deal with the much criticised postcode lottery of care will be welcomed, but of itself it will not make much difference to whether people are eligible for support. Most councils already operate a threshold of “substantial” needs as the entry point for support, and making this a national minimum threshold is a change that may be more apparent than real.

However care is funded, there are other urgent questions about what that care is trying to deliver and whether it succeeds. Debate of these essential matters is likely to be overshadowed by the wider financial issues, but the continuing emphasis on delivering personalisation, choice and control to people needing care and support is vital. So, too, is the emphasis on supporting independence through providing better information and advice, developing social capital, and by investing in prevention and wellbeing, recognising that too often people get no help until they reach crisis point.

These are not new objectives but they have been challenging to progress when the major concern of many councils has been with rationing scarce public resources. The transfer of £300m from the NHS to local councils to improve integration of support should go some way to prioritising interventions that can “prevent, postpone and minimise people’s need for formal care and support”.

The BBC series When I’m 65 has offered salutary and often depressing viewing of the limited options and poor quality of care on offer to many older people today; if this is to change, bold and visionary approaches are needed in government policy. Without resolution of the big questions of how to fund care equitably and sustainably, and how to bring additional resources into the system, the debate will continue to be overshadowed by crisis, fear and misery. The fear remains that what is being offered instead amounts to little more than rearranging the deckchairs.

Melanie Henwood is an independent social care consultant