Ahead of the election on June 8, the UK’s main political parties have all proposed different solutions for the social care crisis. After the Conservatives’ proposals were labelled a “dementia tax”, and the party made a policy U-turn on the issue of whether there will be a “cap” on care costs, the issue of adult social care has become a key issue in the election, particularly for older voters.
Unlike health care, social care is not covered by the NHS in England – and, in Scotland, Wales and Northern Ireland, health and social care is a devolved issue. Instead, local authorities have a legal duty to meet the needs of people who require care and their family carers.
Since 2010, local authorities have seen significant reductions in their budgets, which has had a major impact on their ability to provide care and support to those who require it.
An estimated 1.2m older people now have unmet care and support needs. This social care gap has been created by a combination of underfunding, an ageing population, and a confusing care system. Part of the challenge is also related to changes in patterns of employment for men and women over the past half a century, which mean that women are less likely to be able to provide full-time care for family members.
Promise of more money
Additional funding for social care would help to partially address this problem, and most of the main political parties have focused on this in their manifestos.
The Labour Party offer an additional £8 billion for social care. The Liberal Democrats offer £6 billion more for health and social care combined, while the Green Party promises a “major investment”. UKIP suggests that it will reverse recent cuts to social care by up to £2 billion per year.
The Conservatives offer no additional funding for social care in their manifesto. The party would, however, offer a year of unpaid leave to family carers, which would re-privatise responsibility for providing care onto family members (usually women).
The current system is considered unfair for three key reasons: first, those who have modest assets (around £100,000) are hit hardest by the predominantly privatised nature of social care provision. They can have up to 80% of their assets depleted by long-term care needs. Second, there is no way that people can protect themselves against care costs by pooling their risk. Third, those who pay for their own care often end up cross-subsidising the care received by those who are funded by their local authority.
Increasing public funding for social care may help to address the cross-subsidy issue, but only if there is additional investment – not simply a modest increase which seeks to fill the current gap. If local authorities were able to cover the full cost of care for those eligible for support, this could mean care providers no longer have to charge those who fund their own care more than they do local authorities. But any extra money promised for social care might not do this, as none of the parties are explicitly proposing to address this systemic unfairness.
Assets and caps
Labour, the Liberal Democrats and the Conservatives have all committed in their manifestos to raising the maximum value of capital that people can keep before local authorities contribute to the their care costs. In England, all those with capital of more than £23,250 pay the full cost of their care, with local authorities funding the full costs of care for those with less than £14,500. This asset threshold currently only includes the value of a person’s home if they are moving permanently into residential care and they do not have a spouse or other dependent living in the home. Labour and the Liberal Democrats have not made clear what level they would set the threshold at.
The Conservatives have suggested they would implement a recommendation made by the Dilnot Commission to increase the asset threshold for help with care costs from £23,500 to £100,000. The Conservatives would include the value of a person’s home as part of their assets for the purposes of calculating eligibility for help with the costs of care in their own home. This would mean that far fewer people are eligible for help at home funded by their local authority.
Labour and the Liberal Democrats both promise to introduce a lifetime cap on total care costs in their manifestos. The Conservatives made a much-publicised U-turn on this issue by saying there would be an “absolute limit” on how much people would pay for their care – though they have not said what the limit would be.
Looking for long-term solutions
The undervaluing of the care workforce is is an even more complex issue to solve and one not mentioned in most of the manifestos. At present, many of those working in frontline social care services are on insecure contracts and low pay. As the minimum wage increases, these care workers will see their pay increase, but the profit margins for many of the private business that own and run care services are squeezed. This can result in care failure, with the Care Quality Commission warning in 2016 that the care sector as a whole is already at risk. Labour has promised to ban zero-hours contracts and UKIP would prevent publicly-funded home care workers from being employed on zero-hours contracts.
My research has stressed that solving the care crisis will require long-term changes and innovative solutions. Three national parties have made commitments to finding a long-term solution: Labour propose introducing a National Care Service, the Liberal Democrats would integrate social care with the NHS and the Greens would re-nationalise care. Whether these parties can put their plans into action will depend on how voters respond to the choice before them about whether care should be privately or collectively funded.