Chris Skidmore is the Member of Parliament for Kingswood and a Member of the Health Select Committee. Follow Chris on Twitter.
The gathering storm over how we best care for our rapidly aging elderly population has been brewing for some decades. The arguments over an aging population, over funding and over quality of care are familiar ones- it remains the case that to date there are too many questions and too few answers to the problem. One thing that no one can deny is that the challenge we face in tackling the funding of social care for the future is a challenge created by the Labour Party’s determination in government never to grasp the nettle of reform.
Indeed, the scale of inaction and procrastination that took place under the previous government is the subject of a report that I have published today—Thirteen Years in the Long Grass: Labour’s Social Care Failure. In 1997, a Labour government swept into power on a landslide, with a mandate for change, ambitious pledges and a booming economy. Thirteen years later, as Gordon Brown tendered his resignation to the Queen, the social care system remained unreformed – with Labour’s last contribution to the debate a wildly impractical and uncosted National Care Service.
Labour's 1997 General Election manifesto pledged to ‘establish a Royal Commission to work out a fair system for funding long-term care for the elderly.’ This commission on Long-Term Care for the Elderly reported in 1999. Its main recommendation was that ‘The costs of long-term care should be split between living costs, housing costs and personal care. Personal care should be available after assessment, according to need and paid for from general taxation: the rest should be subject to a co-payment according to means.’ When in 2000 the government responded, they rejected the Commission’s findings.
All was then quiet on the social care front until 2005, when the Department of Health published a Green Paper on social care, which it said would provide ‘a vision for adult social care over the next 10 to 15 years’. However, the paper contained no mention of the funding problems in long-term care and how they would be addressed. The subsequent 2005 Labour General Election manifesto was completely silent on social care funding.
Moving on to 2006, and Sir Derek Wanless published the conclusions of his independent review of social care for the King’s Fund after the Government declined his requests to review the issue. He said of the Government that a ‘missing piece of the jigsaw is an analysis of the long-term demand for and supply of social care for older people in England’. On the same day as the publication of the Wanless Review, then Health Minister Liam Byrne announced a departmental review of long-term care funding to ‘inform the Department’s plans for social care funding, which will be submitted to the Treasury as part of the comprehensive public services spending review in 2007’.
Labour pledged that the 2007 Comprehensive Spending Review would bring change on social care. Health Minister Ivan Lewis said: ‘We will assess proposals for the future provision of long-term care services as part of the long term vision of the comprehensive spending review 2007’. However, the Comprehensive Spending Review just promised more consultation.
In 2009, yet another consultation was launched. The Green Paper set out three potential options for funding long-term care in England through the creation of a National Care Service, but none of them were costed and the Government came to no conclusions on the best model. In his speech to the Labour Party Conference in 2009, Gordon Brown promised to give 280,000 people free personal home care, which he claimed would cost £670 million per year and would be the ‘first step’ towards a National Care Service. Lord Lipsey, a member of the 1999 Royal Commission, dismissed this as a ‘gimmick’.
And finally, in 2010, Labour’s social care policy came full circle. A vague manifesto pledge was issued to create a National Care Service from 2015, which would be preceded by yet another commission. ‘At the start of the next Parliament we will establish a Commission to reach a consensus on the right way of financing this system.’ It marked the end of a dark dishonest decade, in which millions of elderly people were denied the opportunity to have an open and honest debate about how we best fund social care.
The number of over 85 year olds is predicted to almost double by 2030; in the course of this parliament over 1.4 million people will turn 65, one in ten of whom will need long term care that will cost over £100,000. The Personal Social Services Research Unit’s modelling of future expenditure for Dilnot predicts that by 2030, the total annual spending on long-term care for people will have risen from £20.6 billion to £44.8 billion, of which £26.3 billion is state funding. This would constitute a rise in spending in services as a % of GDP from 1.63% to 2.31%.
This is also reflected in hospital activity data. Between 2006 and 2011, the number of Finished Admission Episodes for over 65s rose from 4,194,408 to 5,072,951. There has also been a similarly proportioned increase in A&E attendances.
As an aging nation then, where demand for health and social care services will continue to rise, it is vital that we put in place a system of funding that is sustainable. Under the last Labour government- which had the power and the means to rescue social care- we saw little to no progress. It rings a little hollow to hear Labour politicians now standing up and talking about the urgency of reform. For it was an urgency entirely of their own party’s creation.