Social Care Funding (EAC Report)

Lord Hunt of Kings Heath Excerpts

Thursday 28th January 2021 Grand Committee

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, this is an excellent report and its stark conclusions are as relevant today as when it was first published. Social care is severely underfunded, with the most deprived areas being the worst hit. More than a million adults who need social care are not receiving it and the system is riddled with unfairness. We are in a vicious cycle. After decades of reviews and failed reforms, the level of unmet need rises, the pressure on unpaid carers grows, the supply of care providers diminishes and the strain on the undervalued care workforce ever increases.

The core recommendation of £8 billion to be spent immediately to restore quality and access to adult social care has been widely supported. So, too, has the recommendation to introduce free personal care, such as help with washing, dressing or cooking, to be funded through general taxation over a period of five years, at a cost of £7 billion per year. The committee argues that this is simple, fair and not much more expensive than other proposals for reform. But, given the history of many reviews, we should not underestimate the barriers to its adoption, and I would like to mention five of those barriers.

First, adult social care has never commanded the priority that it deserves. The way that care homes have been dealt with over the pandemic is of course illustrative of this, with a lack of priority given to them in relation to PPE, testing and the movement of infected patients from hospitals to care homes.

Secondly, those in care homes would still pay for their accommodation and assistance with less critical needs like housework or shopping, so it is not the whole deal.

Thirdly, I am by no means certain that the costs of even limited free social care have been fully quantified. The experience of the NHS at its beginnings is instructive. Nye Bevan had assumed that, after a few years, the costs of the NHS would come down as the NHS caught up with the backlog of patients who had been unable to afford treatment before. That proved to be a trifle optimistic.

Scotland’s experience is relevant. The King’s Fund and Health Foundation 2018 report A Fork in the Road warned that the introduction of free personal care in Scotland had

“created unexpected levels of increased demand for domiciliary care which we might also expect to occur in England.”

They estimated that, with free personal care, the number of people receiving publicly funded domiciliary care in England would almost double. My concern is that free personal care would be underfunded and long waiting lists would be the result.

The fourth issue is that, in arguing for a mainly publicly funded solution, the committee’s hope for a market for private care insurance would be likely to develop in a system where personal care costs are funded by the state. This was the hope of Sir Andrew Dilnot who argued in his report, which the Government accepted, legislated for but never implemented, that limiting the risk for insurers by a cap on individual costs could help to provide a sustainable market for private social care insurance. The insurance market was unenthusiastic and I would like to hear more from the chair of the committee about how the committee thinks a more positive response would come from these proposals.

Fifthly, the committee says that cross-party co-operation will be necessary if progress is to be made on reforms to social care funding. I wish the committee well on this. Ever since Andrew Lansley’s description of Andy Burnham’s proposals in 2010 as a “death tax”, cross-party consensus has looked an ever distant dream, though I accept that it is desirable.

None the less, and despite the evident challenges, this is surely a good basis on which the Government can build their long-anticipated Green Paper.