The year ahead: ‘The social care system needs to be replaced with something fairer’

In our January issue, CSW asks experts to give their thoughts on the new government’s policy priorities. In this entry, Camille Oung of the Nuffield Trust considers whether the government’s majority will lead to action on social care


By Camille Oung

30 Jan 2020

In his first speech as prime minister, Boris Johnson pledged to “fix the crisis in social care once and for all”. Yet the Conservative Party manifesto and December’s Queen’s Speech provided few specifics, beyond a pledge of an additional £1bn in funding every year to prop up the current system – not enough to match rising demand let alone improve quality. In the longer term they promise a “cross party consensus” on more fundamental change, with protecting the family home as an overriding goal.

It’s possible that a newfound majority will enable the government to finally succeed in publishing a green paper or even a white paper for reform, something its predecessors repeatedly failed to do. The different options are well understood and appear to have champions in the cabinet, with Matt Hancock reported to favour a voluntary insurance scheme with no cap on care costs while Jacob Rees-Mogg has publicly endorsed free personal care.

Free personal care, funded from general taxation like the NHS, seems a potentially attractive option. But it would not cover all care. Scotland’s experience over the last 18 years has highlighted the need to be clear about what is included in the package and how other social care activities will be paid for. Special attention would need to be given to younger adults or people with dementia whose needs often fall outside of the boundaries of personal care. 

Delivering the long-term plan for the health service, another Conservative pledge and an area of concern for both MPs and the public, will be largely reliant on a funding settlement for social care.

There is a risk that a narrow solution to protect family homes loses the wider vision needed to address social care’s many urgent problems. Reform of funding matters greatly, and we need a system that protects everybody, not just homeowners. Many care homes and other providers are on the edge of bankruptcy: the sector needs a source of stable, reliable funding for the future. It also has an underpaid and insufficient workforce, at severe risk from any tightening of immigration policy.

For both practical and political reasons, the system and its funding mechanism need to be replaced with something that is fairer and easier to understand. Our own research into social care in other countries such as Japan and Germany, and in the other nations of the UK, highlights that transparency and buy-in from the public – not just political parties – are important for creating change that lasts.

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