There is one pressing issue affecting millions of people that has been conspicuous in its absence from the general election campaign so far. The parlous state of social care in England – a system that has been described as being in crisis for well over a decade – is leaving too many older people and those with disabilities without the personal care they need to lead a full and dignified life, with their relatives struggling to fill in as much as they can.
Yet neither of the main political parties seems willing to have an honest conversation with voters about the cost of a care system that caters for an ageing society, and on whose shoulders it should fall.
Age UK estimates that 2.6 million people in England aged over 50 cannot access the help they need with tasks such as going to the toilet, eating and washing, a number that has grown considerably over the last decade. That is a product of two factors: first, anyone with assets worth more than £23,250 has to meet the costs of their care themselves, a threshold that has been frozen in cash terms since 2010; second, government funding for councils, which are responsible for providing means-tested support with care costs, has fallen since 2010.
This has particularly affected council budgets in the most deprived areas. While real-terms council spending on social care increased by 9% from 2010 to 2022 – taking up a bigger proportion of council budgets – the population of people aged over 85 has increased by 16%. That means the needs threshold for state-funded care has effectively risen over time, leaving people who need care without it.
There are many other problems. The government does not pay providers enough for state-funded care, and the Competition and Markets Authority found a few years ago that private residents typically paid 40% more than local authority residents for the same care, suggesting there is a cross subsidy. Private equity firms own a significant chunk of the care home market; almost half of for-profit care home beds are operated by private equity-owned providers, which effectively loads the extra cost of the returns its investors expect on their investment on to residents. Caring for people with complex needs is highly skilled work, yet wages are too low and significantly less than equivalent roles in the NHS.
The impacts of a failing system are terrible for the older people who cannot access the care they need, with implications too for unpaid family carers – often women with poor pension provision themselves – who struggle to combine filling in with their own paid work. More widely, insufficiently funded care affects the NHS, as patients remain on hospital wards long after they should be discharged, and older people end up in hospital dehydrated or after a fall, because of a lack of care.
Over the last 30 years there have been eight green papers, four white papers, two government-commissioned inquiries and many more independent reviews of social care, yet no government has been brave enough to deliver reform on the scale that is needed. The first-principle case for funding personal care on the same basis as the NHS – free at the point of need, paid for out of general taxation – is even stronger than in healthcare.
It is not right that the costs associated with getting cancer are overwhelmingly met by the state but the costs of dementia for so many are not. But funding such a system would require new sources of revenue, and neither party is willing to be honest about the costs of even incremental reform. It can be ignored no longer.
