Experts are unconvinced the party’s flagship pledge on free personal care will solve crisis
Wed 25 Sep 2019 14.39 BST
Last modified on Wed 25 Sep 2019 14.54 BST
The Labour party’s commitment to free personal care in England has been long in the making and hard-won by its advocates, notably the shadow social care and mental health minister, Barbara Keeley. So why has it not received a warmer and less qualified welcome?
Most experts acknowledge that the new policy is, in the words of the King’s Fund health and care thinktank, “a good step”. But they are far from convinced it would solve the crisis in social care at a stroke and they want to see more detail before accepting it would be the best use of the estimated £6bn a year cost.
The Health Foundation, another thinktank, commented: “Reform to the social care system is badly needed. But the immediate priority for any government should be stabilising the existing system, including by meeting growing demand for care and boosting staff pay.”
The first and most obvious reservation about Labour’s policy is that it would apply only to older people aged 65 and over, offering nothing to younger adults whose care accounts for half of councils’ social care spending. The Nuffield Trust, a third thinktank, describes this as a “missed opportunity”.
A second area of caution surrounds Labour’s claims that free personal care would “more than double the number of people receiving state-funded care and reduce the number facing catastrophic costs”. The King’s Fund reckons numbers of older people receiving fully-funded care would rise by just over 50%, while the jury will remain out on catastrophic costs until Labour clarifies how and where it would set a lifetime cap on personal liability.
Economist Paul Johnson, director of the Institute for Fiscal Studies, thinks Labour’s new offer is “rather less generous than it appears”. He has pointed out that the cap would apply only to care costs and would not cover accommodation or charges for activities in care homes.
Free personal care looks a clear and sellable proposition on the doorstep in an election campaign
The definition of “personal” care is a third source of uncertainty. It is not the same thing as social care and does not embrace cleaning, shopping or wider support to help people live independently. Would free personal care help people stay in their own homes? Simon Bottery, senior fellow in social care at the King’s Fund, says there is no clear evidence one way or another but it is “at least plausible”.
Free personal care was introduced in Scotland in 2002, but hard evidence of its benefits is scant. Bottery thinks it “difficult to say” that it has eased pressure on the NHS, for example, and the furthest he will go on its impact on family carers is that it “seems likely” to have helped them, although available evidence is mixed.
Labour may be unperturbed by all of this. By comparison with the complexity of other mooted social care reforms, free personal care looks a clear and sellable proposition on the doorstep in an election campaign. As the shadow chancellor, John McDonnell, put it when he unveiled the policy, it would “ensure people with dementia receive the same care as those with other conditions”.
However, the party will need allies in the social care sector. They will be looking for further detail on exactly how free personal care would sit with other policies, such as improving the pay and status of social care workers and – a big concern among disability activists – a continued right to employ personal assistants (PAs) through personal budgets. An estimated 145,000 such PA roles currently exist in England.
Above all, Labour will need to address concerns that bubbled up at the party’s annual conference in Brighton that it plans to take care provision back into local councils wholesale. Provision has passed almost entirely to for-profit and charity operators over the past three decades, so that only an estimated 3% of care home beds are managed directly by councils. The party’s new policy document talks of “rebuilding local authority capacity to deliver care” and enabling councils “to take over existing homes where they are failing or where it would benefit efficient and effective operation of the services”.
Despite this careful wording, several prominent Labour figures have been talking more ambitiously about “nationalisation” of the care sector. This threatens to frighten the horses. As the King’s Fund says: “A properly funded new system should have space for public, private and voluntary care sector care providers – a diversity that has been a feature of social care for 30 years.”
• David Brindle is the Guardian’s public services editor
Source: https://www.theguardian.com/society/2019/sep/25/labour-social-care-policy-lukewarm-response
