The costs of solving the crisis in social care are eye-watering, and whatever decision a government makes is likely to upset huge swathes of the population.
Little wonder no government has had the grit to solve it. Trying to tackle social care almost cost Theresa May an election.
There have been more than 17 white and green papers and independent commissions on the social care crisis over the past two decades.
• Why a cap on bills won’t fix the care crisis
Rachel Reeves, the new chancellor, has controversially scrapped the £86,000 cap on lifetime care costs that was due to kick in from October 2025 — throwing care plans into disarray with just over a year’s notice.
But a cap on costs would only be a sticking plaster, not a solution to what is actually causing the care crisis. Nor would it have spared the vulnerable from six-figure care bills.
The £86,000 cap applied only to personal care costs — such as help washing and eating — and not accommodation, food or energy bills. Had the cap come in, anyone paying for their own residential care would still spend an average of £166,000 before the amount spent on personal care reached the cap. After that, they would still pay about £28,500 a year for living costs outside of the cap.
A nominal cap on care costs will not fix a broken system that is failing the most vulnerable. It needs a complete overhaul from the bottom up and a seismic shift in how we approach later life and the accumulation of wealth.
Adults with complex health needs are entitled to free care under a system called NHS continuing healthcare. But this help is dictated by integrated care boards with conflicting criteria, which are so complicated even healthcare professionals misinterpret the rules. Patients with cognitive conditions and dementia are particularly likely to fall foul of its tick-box assessment.
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The funding system needs to be centralised to end the postcode lottery and ensure the most vulnerable get the support they are entitled to.
Being old and frail should not automatically qualify you for free accommodation and food — costs that we must all budget for, no matter our age. If you cannot afford these costs, it is right that the state supports you. But too many people are reluctant to pay care bills because it would mean selling their home or dipping into money they had intended for the next generation. To ring-fence wealth like this only takes money away from people who need it the most.
Using the public purse to cap lifetime care costs will not deliver cheaper or higher quality care. But investing in the people at its core will. The new government’s promise to increase the minimum wage for care workers is a start.
With low wages and virtually no career prospects for an often thankless job, it is no wonder that 30 per cent of staff leave the social care sector each year. Patients who are well enough to be discharged from hospital end up staying there far longer than needed because there is no availability for care at home or in a residential or nursing setting.
The NHS spent almost £3 billion on agency staff in 2021-22 in a bid to fill its vacancies — money desperately needed elsewhere and a threat to continuity of care for patients.
The social care can has been kicked down the road too many times. The government cannot just scrap the cap on lifetime costs and push the issue to the bottom of its intray. It must now carry the can and solve this looming crisis once and for all.
Johanna Noble is away