There is one pressing issue that affects millions of people and has been conspicuous by its absence from the general election campaign so far. The dire state of social care in England – a system that has been described as in crisis for more than a decade – is leaving too many older and disabled people without the personal care they need to live full and dignified lives to lead. their relatives have difficulty filling in as much as possible.
Yet none of the main political parties seem willing to have an honest conversation with voters about the costs of a healthcare system that caters to an aging society, and on whose shoulders this should fall.
Age UK estimates that 2.6 million people in England over the age of 50 do not have access to the help they need with tasks such as going to the toilet, eating and washing, a number that has grown significantly over the past decade. That is a product of two factors: firstly, anyone with assets over £23,250 must cover the costs of their own care, a threshold that frozen in cash terms since 2010; secondly, government funding for municipalities, which are responsible for providing income-related support for healthcare costs, has fallen since 2010.
This has particularly affected municipal budgets in the most deprived areas. While real municipal spending on social care increased by 9% between 2010 and 2022 – taking up a larger share of municipal budgets – the population of over-85s increased by 16%. This means that the need threshold for state-funded care has actually risen over time, leaving people who need care without it.
There are many more problems. The government does not pay providers enough for state-funded care, and the Competition and Markets Authority noted a few years ago that private residents typically paid 40% more than residents of municipalities for the same care, which indicates that there is cross-subsidy. Private equity companies own a significant share of the care housing market; Nearly half of the beds in for-profit nursing homes are operated by private equity firms, effectively shifting the additional cost of the return investors expect on their investment onto residents. Caring for people with complex needs is highly skilled work wages are too low and significantly less than equivalent roles in the NHS.
The consequences of a failing system are terrible for the elderly who do not have access to the care they need, with consequences also for unpaid informal caregivers – often women with poor pension provision – who struggle to combine their duties with their own paid work . More broadly, underfunded care is impacting the NHS, as patients remain in hospital wards long after they should have been discharged, and older people end up in hospital dehydrated or after a fall, due to a lack of care.
The past 30 years There have been eight green papers, four white papers, two government-commissioned reviews and many more independent reviews of social care, but no government has been brave enough to implement reforms on the scale that is needed. The first principle of funding personal care on the same basis as the NHS – free at the point of need, paid for by general taxation – is even stronger than in healthcare.
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It is not right that the costs associated with developing cancer are largely borne by the state, but the costs of dementia for so many are not. But financing such a system will require new sources of revenue, and neither side is willing to be honest about the costs of even incremental reforms. It can no longer be ignored.