When the general election was announced, we promised to compare the policy commitments of the major parties on topics relating to the everyday decisions project. Now that the three main parties in England and Wales have announced their manifestos, it has become clear that (for the first time), social care is a big issue. There is general agreement that something needs to be done. In this post, I explore the promises made by the Conservative, Labour and Liberal Democrat parties on funding social care in England and Wales. First, though, a little background on social care:
What is social care?
Social care is funded and provided separately from health care (which is provided through the NHS, free at the point of use). Social care includes help with the activities of daily living, like dressing, eating, washing, and personal grooming. Also included in social care are more complex skills, sometimes called ‘instrumental activities of daily living’ like managing money, shopping, transportation (using public transport, driving, etc), using communication devices, managing medications and work around the home and garden. Very many people with a wide range of physical and intellectual disabilities require varying levels of help with these tasks in their everyday lives. Whilst public and media debate about funding adult social care tends to focus on the care needs of older people, many disabled people of all ages need help with the activities of daily living.
Who receives help with care costs now?
According to the Office of National Statistics, over 10 million people were limited in daily activities because of a health problem or disability in England and Wales in 2011. The vast majority of people with care needs live in the community and do not receive help from local authorities. A very small number of people who need care live in residential or nursing care. The residential care home population has remained relatively stable over recent years at around 300,000.
Only a very small proportion of those who have care needs received services from a local authority in 2015/16: 873,000 people received long term support; 245,000 received short term support to maximise independence; and 57% of the 1,811,000 new requests for support from local authorities received no support. Social care needs are primarily met by the 5.8 million people who provide care and support on an informal, unpaid basis to family members or friends. The value of informal care to the UK is immense, and estimated by Carers UK to be worth £132 billion per year.
Why is there a problem?
Social care funding has been cut substantially in recent years. This has been as a consequence of year on year cuts to local authority budgets since the Conservative party came to power in 2010. There is a significant shortfall in funding for the small proportion of people who do get support from their local authorities. Even after the ‘extra’ £2 billion announced in the spring budget, there is a funding gap of some £600 million this year alone . It is widely known that those who fund their own care (self-funders) significantly cross-subsidise the care costs of those whose care is paid for by local authorities.
The current approach to social care relies heavily on a decentralised social care marketplace. Paid for social care is provided by a complex mix of service providers. Many of these providers are run ‘for profit’ by private companies. Frontline social care staff are often paid low wages, on insecure ‘zero hours’ contracts. As the national minimum wage increases, privately funded care providers are leaving the marketplace as the shrinking profit margins in care provision make it increasingly difficult for these businesses to make a profit. If a care provider fails, local authorities have a legal responsibility to step in and provide care. The current approach to funding social care is unsustainable. Keeping the system funded at the current level, using the current approach, requires increasing investment year on year to keep pace with rising prices and wage costs.
The current system also means that those with the least resources are forced to bear the greatest burden of care costs. Where people cannot afford to purchase care privately, but also miss out on eligibility thresholds for social services support (those with assets over £23,500 are currently denied any help), they have to find other ways to get the care and support they need. This usually means relying on unpaid care from family members. Women are more likely to provide unpaid care to a family member or friend than men, which means that more women than men find themselves giving up paid work to provide care, increasing their own financial vulnerability in later life, and perpetuating the gender pay gap.
What are the main political parties proposing to do about the social care crisis?
The 2017 General Election provides, for the first time in many years, a real choice about what we want for our social care system.
This at-a-glance infographic allows us to see where the three main parties align and where they differ. All three parties are committed to increasing the asset threshold for means testing care. This is good news. The current means-testing asset threshold places the greatest burden of care costs on those in society with modest assets. Increasing the asset threshold to £100,000, as recommended by the Dilnot Commission, was legislated for through the Care Act 2014 and is likely to be a positive move for many. The Dilnot Commission also recommend a cap in personal contributions to care costs. Labour and the Liberal Democrats would also introduce this cap; the Conservative party have clarified that they would consult on whether to introduce a cap.
The question of which assets count towards the means test threshold highlights a major difference between the parties. The Conservative manifesto sets out a plan to include the value of a person’s home in their assets for the purposes of contributions to their care costs whilst living in the community. At present, the value of the person’s home is disregarded unless and until they move into residential care (remember: only a very small proportion of those who need social care live in residential care homes). The consequence of this change will be that the vast majority of home owners will not qualify for any help with care costs, even if they do not have liquid assets available to pay for care. Instead, the Conservatives would extend ‘Deferred Payment Agreements’, which were introduced through the Care Act 2014 to cover the costs of residential care. These publicly-funded loans are paid back when the care recipient dies, or the property is sold. As the loans are secured on the property, they are subject to fluctuations in the housing market. It is not clear how the system would ensure that a person who took advantage of a deferred payment loan would have £100,000 of assets remaining in a property at the point the agreement was paid back, given the combined effects of house price variation, interest, and fees.
A second major point of difference between the parties is that both Labour and the Liberal Democrats have committed to spending more on social care. They differ slightly in their plans for how to raise the necessary funds, and on the precise level of additional investment, but both stand in stark contrast to the lack of additional funding for care in the Conservative manifesto. This is somewhat surprising, given the Conservative policy to introduce means testing on the winter fuel allowance, reserving this payment for the ‘least well-off’ older people. The exact effects of this policy will depend on where the means test threshold is set, but if it is aligned with other benefits (e.g., Pensions Credit) it may result in fuel poverty for some older people, and an increase in vulnerable people having to make the choice between heating and eating in the coldest months of the year.
The final strand of Conservative social care policy focuses on giving workers the right to take a period of unpaid leave to provide care for a relative. My research with carers of people with dementia exposes the very great social, emotional and material investments that familial carers already make. Giving up paid employment to care creates significant challenges for carers, particularly women in their 50s and 60s. These proposals simply serve to further privatise responsibility for care in to the family, which will inevitably lead to a retrenchment of gendered patterns of employment and income. In contrast, both Labour and the Liberal Democrats stand their longer-term solutions for social care on cross-party consensus and collective responsibility for care towards either the foundation of a ‘National Care Service’ or through bringing social care into the remit of the NHS, whilst also limiting the amount any individual has to pay towards their own care.
Perhaps for the first time, voters in England and Wales have a genuine choice to make about the future development of care policy. That choice has been set out in the manifestos for 2017. It is a choice between further privatising responsibility for care or setting social care on a foundation of collective social responsibility. We have to choose between leaving the costs of care to those who find themselves in the unlucky position of needing it (through long term disabilities and conditions like dementia that mean people need help with the activities of daily living), or spreading the risk of bad luck across society in the way we do with other aspects of health.
That choice is yours: use your right to vote to make your voice heard.
 Care is funded differently in Scotland and Northern Ireland.
23-5-17 Author’s Note: the infographic has been updated to account for the post-manifesto announcement that the Conservative party will consult on whether to place a cap on care costs.