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The UK’s problem with long-term care: short-term thinking

Posted on 23/11/2017 by

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Long-term care regularly resurfaces as unfinished business, and with the announcement of another Green Paper by summer 2018, familiar arguments are once again being aired. Melanie Henwood examines the latest development and considers why this policy challenge remains so apparently intractable.

Long-term care is a policy chestnut which seems to resurface every couple of years, under UK governments of all colours. Each time there is extensive analysis and review undertaken; much handwringing about how costly any approach will be; and various options are considered and rejected. Green Papers, White Papers and even legislation may follow, before the process grinds to a halt once more, and the issue is parked in the ‘too difficult’ red box until such time as it becomes expedient to have another go. So here we are again.

The launch of the Conservative Party manifesto during the general election campaign in May 2017 saw Theresa May signalling a volte-face on long-term care and shelving the implementation of the capped cost model, only recently enshrined in the 2014 Care Act, and yet to be adopted. The chaos which followed, with attempts at offering ‘clarification’ on the policy, underlined the lack of any coherent policy or any evident grip of the issues. The bear pit which the manifesto had unwittingly dug for the Party was apparent in the critical reaction to the so-called ‘dementia tax’, and the failure to resolve the matter was probably at least in part responsible for the Conservatives’ fall from grace and the loss of a majority at the election in June.

Since the summer, what should be done about long-term care has been the elephant in the Cabinet room. Like many other issues, it has been overshadowed by the ongoing uncertainty, confusion, and turmoil of Brexit, to which everything else continues to play second fiddle. Nonetheless, the Queen’s Speech had acknowledged that the government would “bring forward proposals for consultation” on the future of social care. Since the speech there has been little or nothing to indicate when or if such a consultation would occur; there was considerable speculation that a paper might appear in the autumn, but nothing emerged.

Credit: Ales Krivec/Public Domain.

Finally, on 16 November a written statement to Parliament from First Secretary Damian Green  announced that the government will “publish a green paper on care and support for older people by summer 2018. The paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population.”

This is not a social care green paper. As other commentators have also pointed out, the focus is solely on older people. Care for younger disabled adults, including people with a learning disability will not be part of the green paper but will be addressed by a parallel programme of work across government. Failing to address the entire population needing care and support – or who may do so in the future – is short-sighted; many younger adults with disabilities or long-term conditions will become older people with those conditions – how will the transition between those age groups be managed? There is already considerable disquiet about age inappropriate facilities for younger disabled adults; people with degenerative conditions who find there are no residential facilities for their needs and that they are placed instead in care homes for older people lacking specialist facilities for their needs.

There are risks too that a segmented approach to long-term care policy will deepen divisions between generations and encourage the already entrenched and negative view of older people solely as a burden on the rest of society. There is an opportunity for a new social contract to be developed that unites generations and spreads risk across populations, but it won’t be addressed by an approach that salami slices needs in this way.

A further glaring omission from the green paper announcement is any mention of family carers. A new national carer’s strategy had been in development in 2016, and involved extensive on-line consultation. The website for the strategy states blandly ‘we are analysing your feedback’, but was last updated on 2 June 2016, so that seems unlikely. It was widely anticipated that the delayed strategy would instead be incorporated within the green paper, but there is no sign of it, and the failure to address the needs of family carers who continue to provide the majority of care and support is deeply troubling.

The green paper is not imminent; Damian Green’s statement indicated it would be published “by summer 2018”, so there are several more months of inaction, uncertainty and worry for people concerned about whether and how they will pay for care.

The failure to square the circle on social care and develop a solution that is equitable, affordable, transparent and sustainable, is of long-standing. The repeated dodging of the issue dates back at least two decades, and indeed the fault line between health and care established in 1948 is, in many ways, at the root of the difficulty of distinguishing between universal and means-tested health and care services.

It is increasingly evident that short-term patching of the system cannot work. The much-cited ‘additional £2bn’ allocated to social care over three years barely touches the sides and fails to address the underlying deficiencies. At the same time an attempt to develop a non-partisan cross-party solution is in play with 90 MPs signatories to a letter to the Prime Minister on 18 November urging a new approach. The need for the Budget to address short-term pressures on the system is part of the demand, but more fundamental is the “proposal to establish a cross-party process in the form of an NHS and Care Convention in order to deliver a sustainable, long term settlement”.

Without such a fundamental approach it is hard to see how the challenge of funding social care will be resolved. The history of the past two decades – from the Royal Commission on Long Term Care established in 1997, through multiple Green Papers, White Papers, Commissions, reviews and legislation – points to the complexity of the task and the failure of successive governments.

The Local Government Association has acknowledged that “difficult, brave and even controversial decision-making will be required to secure the long-term future of care and support” for adults of all ages, and for carers who support them. But there is no alternative; politicians have circumnavigated this issue time and again; failure to find a lasting solution which has genuine cross-party commitment will lead inevitably to a replay of broken commitments, flawed legislation, and short-term political opportunism. This is unfinished business crying out for resolution, not another version of Groundhog Day.

Source: LSE