Social care is in crisis, but government has been paralysed for 20 years by the toxic debate around the issue and it has failed to act, despite numerous Commissions, reports, White and Green Papers. This government promised a Green Paper for delivery two years ago: nothing has happened.
Misrepresentation of what social care is - and failure by the public to appreciate the severity of the current means testing - has left people scared of new proposals that have been characterised on one side as a death tax and on the other as a dementia tax. The reality is that any proposal would be better than our current system of social care.
The system currently means that for people who need care, help to get out of bed in the morning or make dinner in the evening, often do not receive the appropriate care. Unpaid carers, the families and friends of people with care needs, instead have to take on the responsibility of showering loved ones, dressing them, preparing their meals.
We have 800,000 people with dementia at the moment, this will rise to one million in 2025, and to two million in 2030. For dementia alone there are 350,000 unpaid carers, of whom 110,000 have had to give up their job. Not only is there a personal financial cost for all these individuals, and a wider cost to the economy – but the mental health and wellbeing of carers who have to give up their jobs is also impacted. And dementia is only one long-term condition requiring carers; others are Parkinson’s, arthritis and severe stroke.
This Tuesday I led a debate in the House of Commons on social care funding. Members from across the parties contributed with ideas and passion to resolve the problems in the funding of social care. My aim was to lead a constructive and collaborative debate with all parties and the Government, to contribute in some way to thawing the paralysis that has existed in this area.
In 2017 the Conservatives proposed social care reform which was dubbed the dementia tax. They were politically burned and may well have lost their majority in 2017 on this specific issue. Given the fractured nature of politics since then on the issue of Brexit, the Conservatives have kicked the issue into the long grass.
There are fundamentally two issues. One is the funding by local authorities of – mainly – domiciliary care to help support those requiring care in the community. Funding per head has fallen for over a decade and growing numbers fail to receive care, some deterred by a means-test. Many are stuck in hospital, unnecessarily. The other is the financial burden on those who need residential care for a long time and who are forced to sell their home to pay the fees.
The first of these requires a commitment to additional public funding. Lib Dems propose spending the proceeds of 1p in the £1 in income tax which would raise £6billion to £6.5billion, mostly for social care. That could prevent further deterioration in service and go some way to return it to the level of a decade ago.
The second requires some form of social insurance, possibly based on a reform on National Insurance contributions which could create a dedicated health care tax.
The remaining disagreements are around such issues is how much social care should be ‘free’ (as in the NHS for healthcare and for social care in Scotland) or subject to a means-test of some kind. But it is clear that if social care and health are to be integrated, as all agree is necessary, there will have to be a move to some alignment.
This is what I proposed to MPs in my debate. I challenged us all as politicians to stop weaponising social care and instead work together.
I truly believe we can do this. During my time as leader of the Lib Dems, I saw a change in the way MPs worked together. The Liberal Democrats have led the way in developing relationships across parties and with MPs. It was our MP Wera Hobhouse who secured cross-party and government support to ensure the passage of her upskirting legislation, and Lib Dems worked with other opposition parties to lobby the government to bring back the Domestic Violence Bill which had its second reading just this week. Our party too were a key player in cross-party work to pass the Benn Bill which delivered on sovereignty for Parliament. We must use these relationships to secure the future of social care.
Vince Cable is the Lib Dem MP for Twickenham and party shadow health secretary