It's now or never for social care reform, says Jeremy Hunt

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Jeremy Hunt - Neil Hall/PA Wire
Jeremy Hunt - Neil Hall/PA Wire

Ministers must accept that it is “now or never” for social care reform, Jeremy Hunt has said, as he suggested such changes were facing Treasury resistance.

The former health secretary urged the Prime Minister to make good on his promise to “fix social care once and for all” and introduce a cap on costs, so no one faced bills of more than £45,000.

Writing in the Telegraph with Sir Andrew Dilnot, who drew up proposals for such a plan more than a decade ago, Mr Hunt said politicians needed a “boldness of vision” to make Britain a place where people could grow old with dignity.

They said 50,000 people a year were now being forced to sell their homes to pay for help, in a lottery which meant cancer sufferers could expect free care, while those with dementia must pay.

With one in 10 facing costs of more than £100,000 and some facing as much as £1 million, some kind of cap on costs, based on risk pooling, was required, they said.

As Britain recovers from the pandemic, it requires a “1948 moment” – similar to the NHS being set up after the Second World War despite the country being almost bankrupt.

“Giving an ageing population dignity and security for their future would be the best possible way to do just that,” they wrote.

“After the heroism we have seen from people working in the care sector during the pandemic, it really is now or never for social care reform.”

In a separate address to council leaders, Mr Hunt, now chairman of the Commons health and social care committee, suggested that the Treasury was resisting such changes.

“There's a strong sense inside the Government that this is unfinished business, it needs to be addressed,” he told the association of directors of adult social services' spring conference.

“I know that's what the Prime Minister thinks and I think the Chancellor recognises there's a manifesto commitment; there is traditional Treasury concern about the impact on public finances, but my own view is that it isn't a choice as to whether we spend this money or not, it's a choice as to whether we spend this money in a planned strategic way or in a haphazard way.”

Mr Hunt said he would back tax rises, if the Chancellor deemed them necessary.

“I think the sums of money we're talking about are the kind of sums of money that the Treasury could find, if it chose to, without tax rises, but that might mean that there's no money for any other priorities at all,” he said.

“That's why my argument to the Treasury is, if you think a tax rise is necessary, I would support that and I think it would be popular with the public,” he said, suggesting there was “widespread support” for such changes.

Government insiders hit back on Friday night against Mr Hunt’s suggestion that the Treasury was resistant to reforming social care, but warned that “trade-offs” were needed to fulfil the manifesto commitment.

A government source said: “The Dilnot reform is, at the moment, the frontrunner in the Prime Minister’s mind about what he wants to do.

“The levers you have to pull in terms of paying for it are things that involve breaking the tax lock promise we made, because it is so expensive.”

The Conservatives made a manifesto pledge at the last election to avoid increasing income tax, national insurance contributions or VAT.

The source added: “You can’t just spend the money [to reform social care] and not find it in other areas. The thing the PM needs to decide is whether he's prepared to pull some levers to pay for it or not.”

It's now or never for the reform of social care

By Jeremy Hunt and Sir Andrew Dilnot

Boris Johnson - Alastair Grant /PA
Boris Johnson - Alastair Grant /PA

What are the words you most dread hearing? For many older people they might include “I’m afraid your husband has Alzheimer’s.” Or perhaps “it’s not safe for you to live at home with your arthritis”. Or even “if you want to live at home you are going to need professional help, maybe for the rest of your life.”

Hard words for any of us to hear – but words heard by thousands every week across the country. Then they face finding a way through the social care sector, which Covid has exposed as fragile and far from perfect despite the heroic efforts of the one and half million people who work in it.

The result is that every year an estimated 50,000 people have to sell their homes to pay for the cost of their care.

These problems are not new, and the last 25 years have seen repeated inquiries, commissions and even ignored legislation that has not been implemented. But there are some signs that this time could be different.

The Prime Minister committed himself to solving this on his first day in office, and recently told senior MPs on the Liaison Committee that a 10 year plan would be published later this year. Although there was widespread disappointment that nothing was mentioned in the Budget, the Queen’s Speech in a week’s time gives the Government a perfect opportunity to show its commitment to long-term reforms that help keep all of us healthy and independent for longer alongside a financial safety net when we are not.

What needs to be done? First, stop treating social care like a poor relation. Good care for older people helps them to lead fruitful lives and spend less time in expensive hospital beds when things go wrong. Last year for the first time, there were more people aged over-65 than under-five – we must make sure that the ageing society is something to be celebrated not dreaded.

But because some of us end up with very high cost needs and others less so, it will need boldness of vision to create the security necessary to make Britain a place where everyone can grow old with both dignity and confidence. That means a long-term plan that reduces the demand for expensive hospital and care home beds by helping people to live safely at home for longer.

We must be honest that local authorities do not currently have the resources they need to do this. Rather than allocate them money in a piecemeal way, Budget after Budget, we will get far better results if we offer them a long-term funding deal in the way that seems to have made such a difference to the NHS since its own 10 year plan was agreed in 2018.

Indeed, one of the reasons Theresa May and Philip Hammond agreed to that deal was to secure long-term reforms in exchange for not having to top up the NHS with emergency bail-outs every year. Exactly the same approach should be taken with social care.

One in 10 of us will need a lot of care, perhaps more than £100,000 worth. For those with the most intense needs it can be £1 million. Faced with that kind of risk, the most natural response of a civilised society is to pool the risk, just as we respond to the risk of a car crash or our house burning down.

But currently social care is the one big risk we all face where no risk pooling is available. Private insurers will not step into the breach because of the huge uncertainty. In the face of the market not being able to work, this is a problem that needs to be addressed, as Churchill said, by “bringing the magic of averages to the rescue of the millions”.

So any plan should start with a cap on the total care costs anyone has to pay. This will remove the postcode lottery of diseases which sees cancer sufferers have all their costs met while those with dementia sometimes have to sell their home.

If costs were capped at – say – £45,000 that unfairness would be removed. That would give certainty and so remove the fear of losing everything, while leaving people still responsible for the first part of their care needs and allowing space for financial markets to develop new ways of helping people to save for their social care.

In 1948 the Attlee government had the vision to set up the NHS, with cross-party support, despite the country being left nearly bankrupt after the war. The national finances are stretched today as well – the question is whether this generation of politicians has the vision for our own “1948 moment”.

Giving an ageing population dignity and security for their future would be the best possible way to do just that. After the heroism we have seen from people working in the care sector during the pandemic, it really is now or never for social care reform.

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