The public is ready to pay for better social care—are politicians the final stumbling block?

Official data released this week provides further evidence that the social care system in England is broken and needs fixing. The figures illustrate the mismatch between demand for care and the services available—more people are asking councils for support, but despite small increases in the number of working-age adults getting long-term help, fewer older people are receiving it. For those not eligible for publicly funded services, there is no protection against potentially catastrophic care costs. Around one in 10 people aged 65 face future lifetime care costs of over £100,000.

Fundamental reform is needed to fix a system that everyone agrees isn’t fit for purpose, but after two decades of attempts, could a breakthrough soon be on the cards?

In 1998 Tony Blair rejected the central conclusion of the only Royal Commission he established during his decade in office. Free personal care was the majority recommendation of the Sutherland Commission on the future of adult social care, which Blair said was too expensive. Two years later, the inaugural Scottish government introduced free personal care; a totemic, post devolution policy difference between England and Scotland.

Much has changed since 1998, but a viable plan to fix social care in England remains elusive. Numerous politicians, including Andy Burnham and Theresa May, have had their fingers badly burned trying to reform the system. History suggests it would be foolish to expect progress any time soon.

But this view is almost certainly too simplistic—perhaps social care’s time has come. The last few months have seen all three main parties promising that they will sort it out. John McDonnell has committed Labour to free personal care, the Liberal Democrats have said they will establish a cross-party commission to settle the matter and introduce a dedicated tax, and Boris Johnson’s Conservatives have elevated the previous government’s green paper promise to an imminent white paper.

So, what are the chances of reform? A few years ago, the OECD looked at efforts to reform pensions and employment across several countries and identified the common characteristics of those that succeed and fail. Major reforms stand or fall based on public recognition of the need to change, good evidence of what needs to happen and, crucially, effective political leadership to see reform through.

A more nuanced reading of the last 20 years suggests that the conditions for reforming adult social care have changed. With skilful political leadership, reform might have shifted from mission impossible to mission possible.

The 1998 Royal Commission issued a split report—the majority in favour of free personal care but a minority against. The fault line dividing the two sides was the role of the state versus that of the individual, with the dissenters arguing that individuals should pay for the personal care they receive. Whatever the exact rationale of these particular commissioners, attitudes to disability and society’s role in supporting people have shifted markedly since 1998. Already well underway, these shifts were cemented by the spectacle of the 2012 Paralympics, which showcased the potential of all people to contribute to society and live fulfilling lives.

But this is only possible with the right support—and the social care system has a crucial role to play. While the focus of public debate is often on care for older people when illness or frailty means they can’t manage the basic activities of daily life, around half the adult social care budget is devoted to providing services which help working-age people with physical and learning disabilities.

Beyond attitudes to disability, a new study, undertaken by RAND Europe on behalf of the Health Foundation, shows that there is a remarkable degree of public agreement that in future, additional funding for social care should be raised in the same way as additional funding for the NHS. Across all groups—old and young, rich and poor—there is a strong preference to meet social care costs collectively and most would like extra funding to come either from tax or a system of mandatory insurance linked to ability to pay.

Public opinion is backed by evidence. The 2010 Commission on social care funding, set up by the coalition government and chaired by Andrew Dilnot, former head of the respected Institute for Fiscal Studies, showed that lifetime social care costs are unpredictable and can be very high for those who develop long-term care needs. In other areas of life, we are protected against such unpredictable risks through insurance—against health costs by the NHS, against fire by house insurance. In social care there is no way of protecting against these risks and this creates fear and unfairness. Voluntary private insurance for social care doesn’t work—it doesn’t exist in the UK and experts, having trawled the globe, can’t find a working model. The conclusion is therefore that the state needs to step in. Report after report over recent years from different ideological perspectives indicates that this is broadly accepted.

So, the research evidence and public opinion align; in future the state needs to play a greater role in funding adult social care. Which leaves the final barrier: political leadership. The Conservatives, Labour and Liberal Democrats are all promising reform. To be successful, that reform needs to build on the clear public desire for government to make the system fairer. But it also needs to be a comprehensive response to the problems facing adult social care today. A fairer system of funding is necessary but will not be enough on its own—after years of cuts, major investment is needed to ensure quality is improved and that people in need of care don’t fall through the cracks.

Anita Charlesworth and Charles Tallack, the Health Foundation