Much has been said about the Conservative manifesto pledges on social care and Theresa May’s subsequent U-turn, but one issue that has so far escaped scrutiny is the Tories’ strange assumption that social care is all about older people. This is despite the fact that around a third of those who need social care services are of working age [pdf].
Social care affects all adults who need support because of a disability or long-term health condition. This might include a learning disability, a physical disability or severe and enduring mental ill-health. The failure of the Conservative manifesto to acknowledge any of this gives the impression of a party that is wilfully ignorant of the nature of adult social care and its beneficiaries.
Any means-testing policy has different implications for different groups. Those who use social care services for many decades, perhaps even most of their adult lives, will be affected differently to those whose need arises during the last few years of their life.
Social care support is vital to enable disabled people to live independently, with the same options as everyone else. The deliberate underfunding of local authority budgets over the past five years has compromised their independence and ability to participate in their communities. Although the Conservative manifesto includes a section on helping disabled people get back to work, no link is made between the party’s aspirations on employment and the state of adult social care – despite the fact that many would be unable to work, earn and pay taxes without social care support.
I have been involved in social care policy for several years, but a campaign in 2011 against changes to the charging policy in my own borough helped me better understand its impact on those with high-value care packages. The imposition of a £23,250 savings threshold for the first time (there had previously been no upper savings limit in our borough) was catastrophic for many people, because they had worked hard for those savings to ensure their financial independence in the future.
One friend was saving as much as he could because he knew that he would need to stop working in a few years because of his impairment. He – and his dependants, after his expected premature death – would need these savings for their future financial security. Another friend, who had needed social care all her adult life, was still working to save for the future well into her 70s. With care packages costing in excess of £30,000 per year, these people faced watching their hard-earned savings deplete rapidly, until only £23,250 remained.
A higher savings threshold, especially if combined with a cap on the amount they would have to pay for care over their lifetime, could be a considerable advantage to some disabled people, although the impact on those who own their home is uncertain. Yet the significance of these examples is that they illustrate the complexity of adult social care and the difficulty of assessing the impact of means testing. In reality, the wide variation in people’s circumstances results in a complicated system as policymakers attempt to achieve “fairness”.
There is another option. Our tax-funded NHS already spreads the risk of ill-health so that those who need to use the health service more are protected from large medical bills. We all know that well-resourced social care services reduce demand on the NHS, as well as enabling greater inclusion and participation, including economic participation for those able to work.
This creates a good argument for spreading the risk of costly social care packages. Funding social care through progressive taxation would mean that those with greater resources, rather than those with the greatest need of support, would pay more.
Real participation and equality for disabled people and others needing social care support should be seen as a public good, best achieved through fair taxation set at a realistic level to ensure services can be properly funded. If the Conservatives win the general election on Thursday, their green paper must suggest this option to put social care on a sustainable footing for the future.
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