Boris Johnson’s missing social care plan

LONDON — Fresh from his latest electoral triumph, Boris Johnson’s government is setting out its legislative agenda for the year ahead. But there’s a crucial piece missing: a plan to fix England’s broken system of adult social care.

Recent reports that standalone legislation on social care will be missing from the queen’s speech are true, POLITICO’s London Playbook hears, despite people in care facing crippling costs and amid desperate underfunding in the sector.

Johnson didn’t know a pandemic was going to hit when he stood on the steps of Downing Street in 2019 and promised to fix the crisis in social care “once and for all.” But he did say there was a “clear plan we have prepared,” and two years later that plan is nowhere to be seen.

So what’s the hold-up? “The more you look at the plan, the more difficult it becomes,” one minister said, and the central question is how a new regime is paid for.

Under the current system, people with assets over £14,250 have to pay for some of their care costs, while those with assets over £23,250 must meet their bills in full. It means people unlucky enough to need lengthy or intensive care face eye-watering sums. The Daily Mail estimated that around 17,000 older people have to sell their properties every year in order to fund their care. Reform will cost a lot and will need a sustainable funding model, but there are fears in Whitehall about whether proposed solutions are guaranteed to deal with the problem. Ministers accept it’s a complex issue — even more so than the post-pandemic health and economic crises.

It’s complex, but the issue is nothing new, seeing as reform has been promised for decades and the crisis was at breaking point even before the coronavirus pandemic.

Demand has increased faster than funding and councils faced deep cuts during the David Cameron era, meaning cash is forever further stretched. The older population keeps increasing and needing care for longer, while the prevalence of disability among working-age adults, which is a massive and often forgotten load on the care sector, has also risen. But the Health Foundation said spending per person on adult social care fell in real terms by around 12 percent between 2010 and 2019. The U.K. spends less on social care than the EU average, according to OECD figures, and while demand goes up, the cost of provision also increases.

Take just one example. The health committee highlighted the case of Daphne Havercroft, whose mother Dorothy wanted to return home with a care package rather than move to a nursing home after a stint in hospital. Despite more than 100 people attempting to coordinate the plan, it never happened, and she remained on the wards until being discharged to a nursing home, from where she had three emergency admissions back to hospital. Daphne guessed that neither the NHS nor the local authority were willing to fund the package, so Dorothy got a raw deal.

She wasn’t alone. Age U.K. reckoned in 2018 that around 1.4 million older people are not getting the care they need — up 19 percent in two years. Even before the coronavirus pandemic, some 43 percent of care directors said providers in their areas had closed or cut services, according to the Association of Directors of Social Services. The health committee recommended last year that, as a starting point, the sector needed an additional £7 billion per year by 2023-24 to cover demographic changes, improve dismal pay rates for carers and protect people who face “catastrophic” social care costs. That would mean an extra 34 percent on the 2023-24 budget.

As if the picture wasn’t bad enough, the coronavirus has made the crisis in social care all the more acute. Research from Age U.K. released Tuesday showed 23 percent of people aged 60 and over found their ability to carry out everyday activities without support had worsened since the first lockdown. ADASS found a third of adult social care providers said there had been an increase in unmet need due to the pandemic, while fears that budgets aren’t enough had shot up. It estimated last summer that COVID had reduced care provider incomes by £190 million and that £520 million in additional funding would be needed to meet the same level of need in 2021 compared with the previous year.

Spare a thought for unpaid carers, who Carers U.K. estimate save the public purse some £530 million a day. Research toward the start of the pandemic found carers were taking on bigger burdens, due to local services closing and the need to isolate. Two-thirds said they had not been able to take breaks during the pandemic, and around the same number said their own mental health had worsened. “I am exhausted,” one carer said. “I was caring for two people at the start of the lockdown, sadly one person has now passed away, but the health of the second person has deteriorated further so there is no let-up in the amount of caring required.” Another said their depression had “spiraled since this virus started ruining the world.” Bear in mind, carers allowance is just under £70 a week.

No ‘political capacity’

Despite all of this, the pandemic has made the chances of reform in the near future even slimmer. Social Care Minister James Bethell told the Lords last October that “there simply is not the management or political capacity to take on a major generational reform of the entire industry in the midst of this massive epidemic.”

The options: Johnson is said to favor Andrew Dilnot’s 2011 reform recommendations, which keep being kicked into the long grass. Dilnot suggested a lifetime cap on the cost of care for individuals, alongside more generous means-testing. The cap was taken on by the coalition government with cross-party support — though at double the level Dilnot recommended — but the plan fell apart.

Dilnot had an article in the Mail Tuesday in which he argued “to do nothing can no longer be an option” and urged ministers to “bite the bullet” now. “Boris Johnson talks of leveling up the economy. This would be a tangible demonstration of his policy,” he said. The Conservative-supporting Daily Mail’s leader says the queen’s speech must address “the abject failure over two decades to tackle our deepening social care crisis. On his first day in office, Mr. Johnson said he had a plan. He must produce it.”

Other reformers point to the regime in Japan, which has one of the oldest populations in the world. Under the plan, everyone pays in from 40 years old through general tax and social insurance premiums. The 6 million users themselves pay another 10 percent of the cost at the point of use. Yasuhisa Shiozaki, a former Japanese health minister, told the health committee the system is “accepted as an indispensable part of the social infrastructure.” Also lauded is the German model, in which the entire workforce puts in 1.5 percent of their salaries, with employers matching the sum. The system is less generous than Japan’s however, covering basic needs on a universal basis and offering means-tested benefits for those who need more.

The Local Government Association wrote to Chancellor Rishi Sunak and other ministers yesterday this week a failure to act on social care in the queen’s speech “will be a bitter blow” to the sector. Labour is piling in too. Shadow Social Care Minister Liz Kendall told POLITICO social care is “as much a part of the country’s infrastructure as the roads and the railways,” adding: “The government needs to wake up and realize that in our century of aging you cannot build a better Britain as we emerge from COVID without a long term plan for reforming social care.” Shadow Health Secretary John Ashworth added: “Johnson made a solemn promise to the British people on the steps of Downing Street that he would quickly bring forward a solution to social care. The test of the queen’s speech today is whether he delivers on his word. The pandemic has shown the tragic folly of failing to invest in and reform social care.”

Conservatives are weighing in too. Health committee chair Jeremy Hunt (a former health secretary and Conservative leadership hopeful) said: “It’s not as if the government hasn’t had time on this one, so I can’t pretend it isn’t a big disappointment not having concrete plans.” He added, however, that “the real decisions were always going to be taken ahead of the spending review in the [fall].”

And yet, no plan for social care appears to be on the horizon.

Every prime minister since Tony Blair has stood on the steps of Downing Street or made speeches at party conferences promising to reform or fix the issue, but it never happens. There is agreement about the need for reform, but it remains forever stuck. In the meantime, lives are being blighted, and politicians are failing to deliver the care they would want for themselves and their families.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.