Owl has recently posted the extraordinary news that the Tories had no plans on how to solve the social care crisis. This article paints a vivid picture of the problem and gives an insight into what might be going on. A long read but worth the effort.

Rachhel Sylvester  www.thetimes.co.uk

It’s like putting a broken leg into plaster then kicking away the crutches on which the patient is leaning. Rishi Sunak, the chancellor, has promised “whatever action is required” in the budget to help the NHS cope with coronavirus and yet the government still has no answer to the crisis in social care.

The Covid-19 outbreak is another reminder that the divide between the health and social care systems is not only artificial, it is counterproductive. With elderly people more vulnerable to the disease, the pressure on hospitals is sure to grow but what could turn difficulty into disaster is the lack of social care for those who are well enough to go home.

Already NHS wards are full of elderly patients who have no medical need to be in hospital. More than 148,000 bed days were lost in December alone as a result of delayed discharges. There has also been a 35 per cent rise in the number of dementia patients turning up at accident and emergency departments over the past five years following day care centre closures.

The system is driven by perverse incentives. It costs about £250 a day for someone to be on a hospital ward and £100 for a domiciliary care package, so from the point of view of the NHS (and the taxpayer) it makes sense for elderly people to go home quickly — but councils, which are responsible for funding social care, have a financial motive to transfer the cost to hospitals. Although health funding has been ring-fenced, local authorities face a shortfall of almost £4 billion by 2025 in social care budgets.

According to Age UK, 1.5 million elderly people are not getting the care and support they need. More than 1,600 residential and nursing homes have closed in the past five years and the government’s post-Brexit immigration policy, which includes a minimum salary threshold, will only make matters worse. There are already 122,000 vacancies in the sector and one in 11 care workers is from the EU.

Social care provision is also confusing and unfair for elderly users. People with assets worth more than £23,500 have to pay for their own care and these “self-funders” are charged 42 per cent more on average than local authorities for the same service. Care “black spots” have developed in poorer parts of the country where there are not enough self-funders to cross-subsidise the council provision. Many of them are, of course, in the so-called “red wall” areas that the Tories won from Labour at the last election. This will soon be a political crisis as well as a public policy catastrophe but, although the prime minister declared on his first day in No 10 that he had a “clear plan” for social care he has still not set it out.

Last week the government announced cross-party talks. Ministers, however, cannot agree a position between themselves. The dilemmas created by an ageing population have challenged traditional Conservative assumptions. The Tories have gone round and round in circles trying to find a market-based solution that would involve the private sector, encourage self-reliance and reduce people’s dependence on the state. The problem with this approach, though, is that social care is a broken market that defies the capitalist desire for individual responsibility. Half the population will end up spending less than £20,000, but one in ten will, through no fault of their own, have care costs of more than £100,000.

Insurance companies will not get involved because the costs are completely unpredictable. And, although Conservatives like to say that they support those who “work hard and do the right thing”, old age has become a condition lottery in which those with cancer have their treatment funded by the NHS while those with Alzheimer’s have to pay for the cost of their care. The only fair response is to pool the risk among as many people as possible.

Last year a report from Policy Exchange, the centre-right think tank founded by Michael Gove, proposed bringing social care into line with the NHS and making it free at the point of use. The £11 billion cost should, it argued, be funded from general taxation, with a £5,000 means-tested annual contribution from those who need social care. The plan was even more generous than Labour’s manifesto pledge to introduce free personal care (help with washing and dressing) but it is now being taken seriously by ministers.

It is significant that the foreword was written by Jacob Rees-Mogg, the Commons leader who is hardly a champion of socialism. “This is one area, it is clear, where the state has a significant role to play,” he argued, insisting that the policy was “something we can afford as a nation”.

Another proposal being considered by Matt Hancock, the health secretary, is for people over 40 to pay an extra social care tax. The third model under consideration — referred to in Whitehall as “free personal care plus” — would give the elderly help with washing and dressing and also remove the value of a home from the means-test for residential care. Senior Tories accept, however, that there is a simplicity in creating a universal system that creates a level playing field between those with different conditions.

No decision has been made but the balance is shifting in government away from a private or voluntary scheme to a publicly funded system. The merger of advisers between No 10 and No 11 would make it easier for the traditional Treasury concerns about additional spending to be overruled. Under Sajid Javid, the Treasury was pursuing a version of the Dilnot Commission proposal for a cap on individual care costs, but Downing Street fears that even a £100,000 limit would mean many of the new Tory voters in the north and the Midlands potentially having to sell their homes to pay for care.

Cabinet ministers are also adamant that the manifesto commitment to protect the family house should apply across the generations, meaning that care home fees cannot be charged to somebody’s estate after their death. “It’s an emotional rather than a rational thing,” one says. “People want to leave their home to their kids.”

There is in fact already a broad cross-party consensus on social care: Labour and the Liberal Democrats agree that taxes must go up to pay for improved provision and they support a cap on care costs paid by individuals. Until now the agreement has excluded the Tory party, but that could be about to change.