Care after Coronavirus: Avoiding a fatal breach of trust

Introduction:

In Boris Johnson’s first speech as Prime Minister he made a promise to the nation that he would “fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve”.

Just six months later the UK announced its first known case of Covid-19. The pandemic that has followed has put immense strain on the social care system. Official statistics suggest that 19,000 care home residents died in the first wave of infections.

Covid-19 has made the need for social care reform even more urgent. Yet we have seen little progress. In a recent debate in parliament Lord Bethell, the Parliamentary Undersecretary at the Department for Health and Social Care said “there simply isn’t the management or political capacity to take on a major generational reform of the entire industry in the midst of this massive epidemic”.

At first glance this may seem reasonable: the middle of a global pandemic and economic crisis might not feel like the moment for taking on complex policy and pay reform. Yet the truth is - with care at the epicentre of the crisis - there is no better time.

New research released this week demonstrates growing public impatience. This polling, carried out by Hanbury Strategy, draws on the views of 1,678 voters in England, to understand how they view the social care funding debate. This short blog summarises the findings.

1. The public would see a failure to deliver a social care funding solution as a breach of trust

Successive governments have promised to find a funding solution for social care - but none have succeeded. The public appear to be tiring of empty promises from politicians on this issue. They see the Prime Minister’s promise as a commitment he has to keep. Our polling finds that two thirds of voters polled (68 per cent) would see a failure to do so as “breach of public trust” (see figure 1).

Figure 1 - Question: In its 2019 manifesto, the Government committed to finding a long-term funding solution for social care. If the Government does not deliver on this commitment by 2024 would you see it as a breach of public trust?

2. There is a risk for the Government that such a failure would be reflected in their future electoral prospects

Our polling shows that the public hold both main political parties responsible for the failure so far to address the social care funding crisis. Two-fifths (39 per cent) blame both main political parties equally for the failure, compared to 27 per cent and 15 per cent who hold the Conservatives and Labour Party responsible, respectively.

Regardless, a failure to correct this in the coming years could pose the Conservative Party a significant electoral risk at the next general election. Our polling shows that nearly a third (31 per cent) of Conservative voters from 2019 would be less likely to vote for them if they don’t deliver a new social care funding settlement (figure 2).

Figure 2 - Question: Imagine that the Government has not managed to find a long-term funding solution for social care by the next election. Would you be... (to 2019 Conservative voters)

3. The public support the extension of the NHS’s ‘free at the point of need’ principle as the foundation of a solution

There are a number of policy solutions thought to be on the table within government to the social care funding challenge. These include a cap on care costs as proposed previously by Sir Andrew Dilnot and a pensions style system where people contribute some of their income to help with care costs later in life as proposed by CPS.

Our recent polling seems to suggest that the public are less receptive [RE1] to both. Instead, we find that the most popular solution - backed by two-fifths of voters - is IPPR’s proposed extension of the principle of ‘free at the point of need’ from the NHS to social care (figure 3). (This is sometimes referred to as 'free personal care').

Figure 3 -Question: The Government is exploring options for a long-term funding solution for social care. Which of the following options would you prefer? Select one.

Conclusions

Our research suggests that as we enter the next phase of the pandemic, the government must prioritise its promise to “fix social care”. Failure to do so risks a fatal breach of trust. Building on our previous work on the topic IPPR recommend:

• Immediately introduce free personal care alongside an emergency social care funding package (phase 1)

We argue that the foundation of the Government’s funding and reform package should be the introduction of free personal care in England. The Health Foundation has estimated that this would cost £5 billion per annum (though previous IPPR research has shown that some of this cost could be offset through savings elsewhere in the health and care system).

Alongside this, we recommend the introduction of £3.9 billion funding package to account for growing demand and ensure that social care workers receive a pay increase in line with the 2018/21 NHS pay review. Combined these reforms would cost around £9 billion per annum - less than 0.5 per cent of GDP, or 1 per cent of total public spending.

In the short term we argue that this should be funded out of borrowing as part of the Government’s Covid-19 stimulus but in time (once the recovery has taken hold) it could be funded out of general taxation. The evidence is clear that the public support this approach - and would even be willing to pay more tax in order to secure this new settlement.

• Deliver a wider ‘long-term plan’ for social care to address issues such as accommodation costs in consultation with the public (phase 2)

In the wake of this funding announcement the Government should launch a wider consultation with the sector and policy community in order to inform an NHS-style ‘long-term plan’. This plan will need to address the issue of accommodation costs which are not entirely resolved by the introduction of free personal care. Solutions could take the form of a universal risk pool as proposed by Policy Exchange or a cap as proposed by IPPR.

It will also have to address a host of wider reform issues including the fragility of the provider market, the need to drive up the quality of care, and the opportunities posed by new technology and new models of preventative, community-based care. As IPPR has highlighted previously care ‘free at the point of need’ is the starting point for reform, rather than the conclusion.