Boris Johnson urged to appoint minister for social care to turn around crumbling sector

Boris Johnson has been urged to appoint a Cabinet minister for social care with the job of ensuring a "1948 moment" for the crumbling sector.

The chairman of the National Care Association said a politician with the necessary "vision and passion" for reforming social care must be given the clout to force through changes that have been consigned to the "too difficult" pile for decades.

Mr Johnson has pledged to publish his plan to "fix" social care by the end of this year, but Nadra Ahmed fears the deadline will drift once again if no one is put in charge of it.

She said: "We don’t have anyone who fights for social care and until we have a Secretary of State for Social Care I think this will keep getting kicked into the long grass."

Mr Johnson is expected to reshuffle his Cabinet this summer, providing him with an opportunity to create a new post of Social Care Secretary.

According to Parliament’s health and social care committee it could take "tens of billions" a year to bring about a long-term, sustainable solution to historic underfunding of the sector.

The Government insists it is committed to finding a funding model that will not only reverse a 10-year decline in spending, but will also provide for the 1.5 million people currently denied social care. The Government will also aim to put staff wages and status on a par with the NHS and allow for increasing demands in future from an ageing population.

To do so Boris Johnson will almost certainly have to break a manifesto pledge by increasing personal taxation and persuade Labour to back any plan he comes up with, against the backdrop of having to start recouping the £340 billion cost of the pandemic.

Those crying out for reform argue that Mr Johnson may never have a better chance of driving forward the painful measures needed to make social care fit for purpose.

With a huge parliamentary majority, enviable poll ratings and three years until the next election, Mr Johnson has the power, and the political capital, to make tough decisions.

The fact that the pandemic cruelly exposed the frailties of the social care sector also means public sympathy for reform, and the costs it will entail, are at a high water mark.

"Morally, the case for fixing social care has never been stronger," said Caroline Abrahams, charity director of Age UK. "The pandemic highlighted the fragility of our social care system and it also accelerated people’s need for care. This has to be the end of the shilly-shallying that we have seen for decades."

The prize for Boris Johnson is to achieve his own Bevan-style legacy by establishing a National Care Service or its equivalent, but the biggest obstacles lie within his own party.

Costly reforms

The health and social care select committee has said the "starting point" for reform should be a £7 billion per year increase - 34 per cent more than current spending - and potentially "tens of billions" to give it parity with the NHS.

The Health Foundation charity suggests an annual increase of £12.2 billion by the next election in 2024 is needed to deliver sustainable change.

Mr Johnson is understood to favour a cap on an individual’s lifetime contribution to their own social care costs, enabling him to keep his promise that no-one would have to sell their home to pay for social care. The state would still have to pay for any shortfall, meaning Mr Johnson will have little option but to increase personal taxation, breaking a separate manifesto promise of keeping the "triple lock" on income tax, National Insurance and VAT.

Chancellor Rishi Sunak is said to be wary of spending billions on any policy that could be criticised for not doing enough, and has ordered a detailed review of all the options.

As well as being supported by Tory backbenchers, any long-term reform must also have cross-party support, as Gordon Brown and Theresa May discovered to their cost.

Political stumbling block

In 2010, when Mr Brown proposed a £20,000 levy to be paid out of elderly people’s estates after they died, the Tories labelled it "the death tax", complete with posters featuring tombstones. The policy was quickly sent to its own grave.

Theresa May bravely tried to grasp the nettle in 2017, only for Labour to accuse her of imposing a "dementia tax". She abandoned the policy within days of announcing it.

Ms Ahmed warned: "Before we decide how to fund social care, we need to agree on what we want social care to be. It is healthcare in all but name, yet someone who is discharged from hospital, where it costs £2,000 per week to look after them, suddenly has to be looked after for just £550 per week.

"Their care needs haven’t changed, all that’s changed is the building they’re in."

Covid ripped through care homes last year partly because of staff working in more than one care home and spreading the virus.

For some staff, working in more than one home is necessary to make ends meet, as new starters are paid the national living wage (with a pay rise of just 15p per hour after five years, according to The King’s Fund). Others are moving between homes to help plug the gaps in a workforce that currently has 120,000 vacancies.

"We lose staff to the NHS," said Ms Ahmed, "because in the NHS there is better pay, a career pathway and recognised qualifications."

Tory opposition

The problem for Mr Johnson is that all solutions to funding social care have entrenched opposition among sections of his own backbenches.

A £10 billion increase in social care funding would require a 2p increase in income tax, or a similar hike in other personal taxes, but critics argue against young working families being burdened with yet another tax at a time when the Government needs to encourage us all to spend money to power up the post-Covid economy.

In a country that reveres home ownership, putting the burden onto those who need care - by making them sell their home to pay for it - is equally unpalatable.

A third alternative would be a form of private social care insurance, but it would take decades to build up enough capital to replace state funding.

If the moral case for fixing social care is not enough to convince Mr Johnson to act, there are those in the care sector who hope his instinct for self-preservation will force his hand.

With an independent public inquiry into the handling of the pandemic announced by Mr Johnson on Wednesday, he knows that doing nothing to mend a care system that lost more than 40,000 of its residents during the pandemic is not an option.

He also has a chance to neutralise one of Sir Keir Starmer’s most potent weapons before the next election.

One Whitehall source said: "If he can get Labour on board for reforms, he will earn the thanks of a nation for protecting our most vulnerable. If Labour oppose him, he can forever accuse Sir Keir of standing in the way of vital reforms."