The founders of the NHS could not have realised it would be so successful that 70 years later care for the elderly would be vital. Let’s finish the job, writes LIZ DAVIES
My local Momentum group recently discussed social care. The speaker, talking about her mother who had dementia, asked how many people in the room had personal experience of relatives with dementia. Over half the meeting raised their hands. As we get older, more and more of us will need personal care and ask society for help in providing it.
The crisis in social care is the part of the welfare state that Beveridge never tackled, because in the 1940s no-one predicted how long we would live. We enjoy longer lives than any previous generation did, thanks to the NHS, modern medicine and the welfare state, but at a cost: the associated illnesses, principally dementia. The 1945 Labour government abolished workhouses and the Poor Law, in the National Assistance Act 1948, so that was something of a revolution. The next policy shift was Thatcher’s “care in the community,” contained in the National Health Service and Community Care Act 1990.
The principle, had it been properly funded, was not such a bad idea, releasing people from institutions and treating them as individuals to be supported rather than problems to be contained. But without adequate funding, the consequences were always going to be increased reliance on family carers, overwhelmingly women, people left isolated as their conditions deteriorated and means-tested care services, delivered too often by private providers.
All of us, at some time in our lives, are likely to need the services of the NHS. These days, most of us are also likely to need some social care services. Even allowing for the dreadful impact of cuts and re-organisations in the NHS, the contrast in treatment is striking. A cancer patient receives free health care, free prescriptions, free aids, services at home and free hospital stays, and is (theoretically at least) entitled to the same level of care wherever in the UK she or he lives.
Someone with dementia must pass their local authority’s eligibility criteria (which might be different to those of the local authority next door), pay for services at home and for residential care (including by selling their home) and only receive state support after a demeaning means test.
Both major political parties have tried to grapple with how to fund social care. The Tories’ 2017 election manifesto originally sought a mandate for the “dementia tax” – recipients of services would continue to pay for care, but the cost could be deferred by way of a loan on the house, repayable after death. The outcry was such that Theresa May had to withdraw it.
The Tories have repeatedly promised Green Papers on social care but have postponed publication five times since 2017. The most recent announcement was that a Green Paper would be published “before April” – ie now – but there is no sign. The Tories’ difficulty is that it is impossible to fund social care fairly without treating it as a universal entitlement and funding it from taxation, but of course that runs contrary to their ethos.
Labour under Blair and Brown similarly struggled with how to pay for social care. In 2010, Labour took a huge step forward when it proposed a National Care Service that was universal, free when people needed it, and integrated with the NHS. But the White Paper ducked the question of funding.
In Scotland, personal care has been free for those over 65 since 2002 when it was introduced by a Labour administration. As of 1 April 2019, the minimum age has been abolished and free personal care is available to all assessed as needing it.
Labour’s 2017 manifesto promised to lay the foundations for a National Care Service for England. Labour would increase social care budgets by a further £8 billion over the lifetime of the next Parliament so as to pay care workers a real living range, adopt the Ethical Care Charter, end 15 minute care visits and pay for travel time and training. It would also increase Carer’s Allowance for unpaid full-time carers. Labour will limit the maximum amount paid under the means-test for care, increase the asset threshold (so that recipients keep more of their savings or their home) and provide free end of life care.
These measures are a necessary first start for Labour to work towards a National Care Service, free at the point of need, universally available, and paid for by taxation. Let us also move away from private companies making profits from the provision of essential caring services and keep care services in the public sector, or use Labour’s new, innovative models of enterprise such as democratically owned and not-for-profit companies.
I looked after my late partner who had a serious physical illness, an experience made more bearable because at no time did we have to worry about funding his medical care. We had plenty of other things to worry about. I would happily pay taxes so that those now needing care do not have the burden of worrying about money, and in the expectation that the same will apply to me when I too need society’s help.
Liz Davies is a barrister specialising in housing and homelessness rights, a member of Southampton Test CLP and an honorary vice president of the Haldane Society of Socialist Lawyers. She writes this column in a personal capacity.
Liz Davies is a Labour Party activist and housing rights barrister. Member of Southampton Test CLP and Unite the Union. Previously secretary for Hackney North CLP (2017–2018). Co-author Housing Allocation and Homelessness law and practice (Luba, Davies, Johnston and Buchanan, 2018, LexisNexis) and Honorary Vice-President of the Haldane Society of Socialist Lawyers. Her professional profile is here. She cannot respond to queries about legal cases through this website.Read full bio