Politicians from different parties offer up their ideas at election time, citizens vote for their preferred option, and a government is formed. That is how democracy is supposed to work. Sometimes it feels as if the British political system has never been more distant from this ideal.
From the Conservatives, we’ve had years of populism: the dishonest idea that Brexit was somehow the answer to all the longstanding structural challenges facing the UK. It didn’t deliver and they were punished accordingly. The Labour party, on the other hand, ran an election campaign designed to translate widespread disaffection with the Conservatives into the maximum number of votes by saying very little about what they would do about the pressing problems that would face them in government. It worked, but has left them hamstrung when it comes to the tough choices facing a country that is no longer a global economic powerhouse, and that is confronting the fiscal reality of an ageing population and a declining birthrate.
There is no clearer sign of that than what’s happening with social care, a system that has been in crisis for well over a decade. The case has long been clear: as Britain gets older, the demand for adult care services continues to increase. But, unlike with NHS services, many people must meet the costs themselves of the care they need as a result of diseases such as dementia; the state will support those who need care but only if they are on a low income and have assets of under £23,350. That state help is significantly underfunded, meaning that more and more people are being left to cope alone without the care they need, even if they meet the financial test: Age UK estimates 2.6 million people aged over 50 cannot access the support they need to go to the toilet, eat and wash. Local authorities pay so little for care home placements that private payers end up cross-subsidising state-funded care, and being a good carer demands high skills yet offers low pay. The human costs are dreadful: people are denied basic dignities and end up in hospital because there’s nowhere else they can be supported to live. The implications for a struggling NHS are profound.
We are in this miserable position because politicians have failed to grasp the nettle for three decades: it was back in 1999 that a royal commission recommended that personal care should be provided on the same basis as healthcare in the NHS. Since then, there have been scores of green papers, white papers and independent reviews of social care – including the 2014 Barker commission, which reached a similar conclusion to the royal commission. But reform has never been forthcoming, because while there is a consensus that we’re not spending enough on social care, the question of who should pay is too politically difficult.
Keir Starmer’s approach was to be vague about social care in the Labour manifesto. And last week, health secretary Wes Streeting announced that cross-bench peer Louise Casey would chair yet another independent commission on social care that will report in 2028. She will be tasked with building a cross-party consensus on a new model.
Casey is a wise appointment by Streeting – a fearless operator used to knocking heads together and forcing people to confront hard truths. But she’s been given the wrong brief. The biggest decision that urgently needs to be made on social care – how to fund it – is a political choice. At the moment, the costs of care are highly individualised: if you’re unlucky enough to get dementia, people need to meet the sometimes extremely high costs of that care themselves until they’ve run down their assets.
The choice facing Labour is how far to collectivise it? Should they go for a more universal, NHS-type system in which everyone who needs care in their later years receives state support? Or the in-between solution of the kind of capped-cost model the Conservatives were considering, in which people with assets must meet the costs of care themselves, but until they have about £100,000 rather than £20,000 left, and where the state will eventually step in but only after you have paid for a significant amount of care yourself? How should more state support be funded?
The best time for Starmer to decide his stance was in opposition. Though, to be fair to him, the lesson of the past couple of decades is that any politician going into an election offering a solution gets picked apart by the other side. The second best time is now: when you are leading a new government with a huge majority. Starmer shouldn’t have asked Casey to lead a commission but given her a brief for what he wants the system to look like and put her in charge of delivering it.
Instead, we are to believe some kind of cross-party consensus will be achieved by 2028, presumably with the hope parties will go into the next election lined up behind the same idea despite their differences in the political values. This will not happen in a million years. It is to misunderstand what politics is for and how consensus, where we see it, tends to be achieved: not by cooking it up in advance, but by doing something future governments of other colours find themselves not wanting to unpick.
The Conservatives might have signed up to the vague principle of an NHS after the Second World War but they fought Labour tooth and nail on what it took to create it: bringing hospitals into public ownership to create a unified health service free at the point of delivery. There’s a similar postwar story on social housing: the Conservatives were initially reluctant converts to Clement Attlee’s programme of public housebuilding.
Yes, there are risks. Yes, Starmer faces more difficult circumstances than Tony Blair, the last Labour prime minister to win big. Yes, asking taxpayers to contribute more to a collectivised system may dent Labour’s majority at the next election or even cost them it altogether.
But doing nothing is not risk-free either, as voters increasingly lose faith in politics to deliver. Politicians trying to contract out politics isn’t going to help. And, ultimately, there is a bigger question at stake here: if you’re not going to spend political capital meeting the big challenges facing the country using the social democratic principles you hold dear, what’s the point of winning an election in the first place?
Sonia Sodha is an Observer columnist
