Social Care: Funding

Lord Parekh Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Parekh (Lab)]

My Lords, I congratulate the noble Baroness, Lady Brinton, on securing this debate, although it is slightly overshadowed by the following debate, which seems to be concerned with the same issue. As a result, attendance in this debate is slightly thinner than it should be. Nevertheless, the noble Baroness has addressed an important question and I am happy to participate in the debate.

For purely historical reasons, healthcare and social care have been separated in Britain. Both were established in 1948 but under different Acts and based on different operational and funding models. The NHS was largely free at the point of delivery, whereas social care was needs or means tested. That created inequality. For example, a cancer patient could get full state funding, whereas somebody suffering from dementia could not. The question is how, in the eyes of neutral people, to justify this moral or medical asymmetry.

There is a further question. NHS funding came from central government taxation, whereas social care funding came from non-ring-fenced local authority budgets or private individuals. That was contingent, as local budgets change a great deal and do not have the same degree of certainty as central government funding does. For all those reasons, we have two separate streams with different consequences. The lack of integration between the two has cost quite a bit of money. In October 2017, there were 145,000 delayed days, as they are called, when hospital beds are taken by people for whom no home help can be found for them to be discharged to. There is a need to look at this binary distinction and see how the two can be brought together.

Need will be greater, because the population is ageing and younger people with a disability are living longer. The number of adults aged 85 or over has increased by 31%, whereas the population as a whole has increased by only 8%. So the question of social care is important. How should we handle this? What are the means to deal with it? Should we look to central taxation, which would be my suggestion? The question is whether such care should be entirely free at the point of delivery, in the same way as healthcare. I am not entirely sure that it can be, for at least two important reasons. The first is the issue of intergenerational fairness. Older people are wealthy, own houses, have assets and savings, and receive pensions, while many young people are paying off student loans, have family commitments and face higher housing costs, so they are not as well off as some elderly people. The second reason is that the personal care component of social care is different from the other components, and while that care can be guaranteed by the state, factors such as the accommodation cost component of social care perhaps need not be. We have to discuss these matters because they involve issues of moral principle. The two parties are bound to disagree, but it is important to build a cross-party consensus in this area.

There is a further question: when social care payments are made, what are the best ways of handling that? You could give cash to the individual being cared for, and in turn she or he might give that cash to the friends and relations who work for them. There are ways and means of handling social care and of getting the funds required, but again, some kind of cross-party consensus needs to be established. For me, that is a priority.