Illustration by Ian Morris

How to fix elderly care

Most of us will need it at some point—so why not share the costs? The man who led the 2011 care commission makes the case
July 13, 2021

Three quarters of us will need social care as we grow older. That means passing the eligibility test administered by local authorities, judged not by a bit of stiffness on waking, but by not being able to feed or dress ourselves or get to the loo. With support, many people needing social care can have a fulfilling old age. Without it, life can be miserable. We need a system to be proud of, but in England for the last 25 years we have had repeated promises with precious little progress. Social care struggled badly through the pandemic and desperately needs change. What should we do?

First, this is about much more than money. Our attitudes to those who need support, and to those who provide it, must change. We should be celebrating increased longevity and paying attention to older people and those who help them, both formally and informally—they’ve been invisible for too long.

But it is about money too. Social care in England is entirely means- and asset-tested—you only get state support if you don’t have income and wealth of your own to pay. For this group, who simply cannot pay for themselves, surely we should have a generous, well-funded system. But in the last 10 years, real levels of funding have fallen and the pressures on local authorities have become intolerable. Those running the system have too little to spend, and end up having to make judgments about who to support that would be beyond the wisdom of Solomon. We need to increase funding now, and we should have a 10-year strategy so that local authorities can plan sensibly rather than having no idea of how they will make ends meet next year.

Decent care for those without resources of their own has to be the starting point, but what about the rest of the population? Most of us will need social care; we just don’t know how much. On average, it might be the equivalent of around £30,000 or £40,000. But it could easily be several hundred thousands of pounds, or even a million—amounts that almost none of us can afford.

When it comes to driving a car, owning a house, or sudden sickness or injury, we deal with large and unknown risks by sharing them—whether through private insurance (for driving and homes) or, in the case of health, social insurance through the NHS. With social care, private insurance is not an option because the uncertainty is too great for insurers to offer policies. So we need to introduce a form of social insurance.

In a speech in March 1943, Churchill said: “you must rank me and my colleagues as strong partisans of national compulsory insurance for all classes, for all purposes from the cradle to the grave.” In 1948, the next government delivered this in almost all areas. The one critical area left out was social care, and we should correct that now. We should move to a system where everyone knows that if they have high social care needs they will be protected, with the state taking over once your lifetime social care needs have exceeded, say, £50,000. The Cameron government legislated for exactly this principle in 2014, but then immediately after the 2015 election pulled the plug on it.

Caring for people in need is a sign of a thriving society. In social care we have let one another down. Now is the time to act: to provide adequate funding for those who cannot look after themselves, and to deliver a system that gives the whole population a way to prepare. Come on Boris Johnson.