When Boris Johnson criticised care homes last week, he was trying to talk about the need to reform social care. That effort which followed a plea from Simon Stevens, head of the NHS, that adequate funding is needed for social care and that this must be provided with a year, was lost in reporting, with more attention given to the prime minister's criticism.
Unlike health care, social care is funded mainly by individuals rather than the state. Politicians of all colours have talked endlessly for years about the need to reform this model but with absolutely no action. For all that has gone wrong in care homes during this pandemic, the upside is that we are all now aware of the need for what they provide. This may seem obvious but prior to Covid-19, while we might have been aware of the existence of care homes, we were unlikely to pay much attention until one of our own needed one. So, this rare moment of social consciousness and conscience will be lost for another generation if we collectively fail to agree to reform now.
Despite what politicians would have you believe, reforming social care isn’t complex, but it will be eye-wateringly expensive. We’ve become used to billions of pounds being spent to offset the effects of coronavirus, but we’re still yet to feel the impact of paying for this spending via tax hikes or cutbacks in state spending. The staggering amounts needed to adequately fund social care will surprise many of us, unlike Americans, we aren’t familiar with the true costs of health care and it is only those who’ve had to find the money to pay the fees for a care home who will appreciate the individual costs of social care. In many cases, the difference between health and social care is unclear and arbitrary. Add to this our fast-growing elderly population and it becomes apparent that the future minority in employment will be funding the majority in care homes, if we decide to fund this through taxation.
Alternatives to the current way of funding social care are straightforward even if they are unpalatable, through taxation or some form of private insurance. The latter has so far not materialised and would have if it were at all feasible. So, taxation it is, and this is where it's us, rather than our politicians, who are to blame for the decades of inaction. We only need to look at what happened to Theresa May’s "dementia tax", which was quickly dropped due to perceived voter disdain in 2017.
Rarely do politicians act ahead of voter opinion, that’s why they spend time on focus groups and surveys not only to tune into public views but to float ideas like Johnson's. So, while many of us publicly support the idea of collectively funding social care, we privately baulk at the idea of paying our share towards it through taxation.
The only chance of breaking this stalemate is by a political cartel, where the main parties agree to collaborate, in effect protecting us from ourselves by leaving us no option at the ballot box, as no matter how we voted we’d be committed to reforming and funding social care now.
The obvious flaw with this is we aren’t due a general election for years and by that time we’ll likely have lost this sense of urgency for reform. The only way we can gain collective permission is via a referendum and we know from recent experience how those can play out. What appears to be a simple binary choice gets fiendishly complicated and divisive very quickly.
So, while we have this once in a lifetime opportunity to act on the momentum that Covid-19 has provided to tackle social care funding, there are some big if’s underpinning the route to achieving this. Can we get our politicians to truly collaborate in our collective interest? What will the funding model be? How do we effectively get public permission? And are we willing to put our money where our collective mouths are, spouting a desire to support social care? Failure in any one of these will leave social care unreformed until the next time something prompts our conscience to realise we must value and care for each other when we can no longer do this for ourselves.