The Dilnot review has come up with a far fairer way to pay for the care people need when they get old, which helps the squeezed middle-class and protects the family home. To get the necessary buy-in, politically and literally, for greater social care spending, the Government needs to do one more thing. It needs to come up with a far fairer way to help the millions of squeezed middle-aged carers, and protect the family itself.
Even if Dilnot's proposals were put in place, more people needing care means more people in families will be expected to give care. The number of older people requiring care from their adult children is projected to have almost doubled by 2041. We can expect to be short of a quarter of a million adult children able to care, even if current patterns of family care continue.
Whether people can continue to care for their elderly relatives is a big 'if'. A third of family carers unable to combine care with work are in poverty. They are losing about £5 billion of potential income a year. Half of women in their fifties are currently caring, while pension reforms mean they will need to work longer. Quite rightly, the squeezed middle-aged have higher aspirations for how fairly caring is shared. They are as worried about the strains on family life as they are potential drains on family wealth.
Even China, not a usual source for social policy thinking, is awake to this issue. A new law there obliges adult children to pay regular visits to their elderly parents. Britain did not need a one-child policy to wind up with a higher 'dependency ratio' of retired to working people than China. With one in five already over 65, even if government finds the £1.7 billion to finance Dilnot's recommendations, it cannot continue to fudge the question of family care.
Offering a better deal for family care would help make the case for higher spending on social care. As James Lloyd of the Strategic Society Centre has argued, it could be easier to persuade people of the need to insure against the costs of caring than the costs of needing care. People can more readily imagine giving care in middle age, than they can receiving it when very old.
However much families are asked to pay for care publicly or privately, as insurance or, at the point of need, it has to be the kind of care families want. The popular, properly funded social care schemes in Europe are those that support families caring. Germany's social insurance scheme can pay for family members to provide care, something three-quarters of older people there do. After introducing this, Germany saw an increase in both family and formal home care, and a major decrease in costly residential nursing care.
Some might choose to care more or less full-time in this way, but far more need support to offer some care and combine it with family and working life. Speaking to the squeezed middle-aged means better supporting the 5 million caring (and the 5% of those who claim Carer's Allowance). But it must also mean nudging the other 85% of men and women under 65 who form, as the Treasury might put it, the 'latent supply' of care.
There are ideas that tap potential care, and harness civil society. Compassionate leave from work is an undisputed principle. It needs to be taken further, giving people time with their loved ones when they are alive. Genuinely compassionate Conservatives would at a minimum have defended their manifesto commitment to extend the right to request flexible working to all. Last year, No.10 announced it was testing Japan's system of care credits, which helps people to reciprocally care for each others' elderly parents. Since then we've heard little as to how 'big society' might actually begin, as it often does, at home.
At the moment, families who choose to give some care get 'assessed' as needing less personal social care. One way to better share care within families and with services would be to offer more rather than less personal home care where families can offer some of the support. Under this 'matched caring scheme', a team of support around the older person's choices would often still be cheaper than hospital or residential care. A personal budget for the family carer as well as the older person would offer both more control and support.
It sounds good but is it affordable? Dilnot put the increased costs of meeting social care needs in perspective. £1.7 billion is a small sum when compared to the health services and benefits going to older people. The cost of supporting families to care is smaller still in comparison with the £60 billion it would cost to replace, hour for hour, their care.
Supporting families caring across the generations could help grasp this genuinely once in a generation chance to find desperately needed funds for social care. But it is important too because family care cannot be fully substituted. Some kinds of care money cannot buy. The emotional support, listening and love of caring relationships will be indispensable if we are, as individuals and a society, to age with dignity.
In resorting to a law to encourage family care, the Chinese government threatens the very respectful caring relationships people seek. Yet the direct translation of what people in China are expected to give their elderly parents is 'spiritual care' - hardly something the council, or the expensive private care home, offers.