While the snap election appears to be about getting a mandate for Brexit, the controversy over social care proposals in the Conservative manifesto has ignited the issue. The three major political parties all have something to say about social care, which has been unfinished business through successive governments for at least the past 20 years.
Both the Liberal Democrat and Labour manifestos describe social care as being in a state of crisis, and the funding shortfall is well known (estimated at £2bn this year alone). The Lib Dems would introduce an immediate 1p rise in all rates of income tax and ringfence the additional revenue (which they calculate at £6bn) for NHS and social care services. In the longer term this would be replaced with a hypothecated health and care tax. The manifesto also pledges to “finish the job of implementing a cap on the cost of social care, which the Conservatives have effectively abandoned”.
Labour’s manifesto, meanwhile, commits to “lay the foundations of a National Care Service for England”, and the party will ensure there is a limit on lifetime contributions to care costs. Labour says it will “seek consensus on a cross-party basis about how it should be funded, with options including wealth taxes, an employer care contribution or a new social care levy”. Despite the considerable length of the Labour manifesto (128 pages, compared with 100 for the Lib Dems and 88 for the Conservatives), it has little to say on the detail of the different options. The Conservative manifesto, by contrast, presents the costs of ageing and care as currently all “borne by working people through their taxes”. This is in spite of the fact that older people have spent a lifetime working and paying taxes, that they are significant providers of childcare for grandchildren and that much of the care provided in the family for older people is often supplied by spouses or partners.
The Conservative plans for long-term care (which talk only of elderly care and have nothing to say about other people who may also need long-term social care) read as if the Tories have been nowhere near government for years. The system of care, they state, “is not working”. “Where others have failed to lead, we will act,” the manifesto declares. This is a slash and burn approach that carries considerable risks.
At first glance the manifesto’s proposal to raise the means-test threshold to £100,000 (more than four times the current amount) appears positive, but there are two caveats. In the manifesto there is no mention of a cap on what a person may have to pay for care before this threshold and – for the first time ever – the value of a person’s home will also be included when means-testing for support in the home. People will be able to remain in their homes, but will be forced to release equity or defer payment until the house can be sold after their death. The demands made on informal carers could also increase if people are more reluctant to seek help from costly services that will drain their savings.
The policy – which will be further explored in a green paper – differs little from Labour’s plans for a “death tax” two years ago and has forced the prime minister, Theresa May, into a series of clarifications. May now states there will be “an absolute limit on what people need to pay”.In all the manifestos the distinction between health and social care remains an opaque, isolated attempt to overcome fragmentation by focusing on integration and “more joined-up care” notwithstanding. People with cancer or acute illness have their needs met by the NHS but those who develop dementia, or have chronic long-term neurological conditions or disabilities, are deemed to have social care needs. In between the two is a grey area of “continuing healthcare”. The disputed boundary between fully-funded and means-tested care would become even more contentious under Conservative plans.
Those who advocate inheritance tax or hypothecated national insurance-based care taxes point out that this spreads the risk across the population. The Conservatives, by contrast, seem to want to tax only pensioners and those who need care. It is also unclear how the Conservative model would be sustainable; there is no mention of the resources being ringfenced and, perhaps more significantly, this pot of accumulated housing wealth may not exist in the future. What then?
The need to clarify the policy so soon after the manifesto’s publication underlines that social care is complex, challenging and bound to be the focus of further dispute between the parties.
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