Grasping the nettle of social care

May 28, 2009 at 8:35 pm | Posted in British Politics, Social Policy | 1 Comment

About 15 years ago, my mother decided that her parents had grown too frail to live on their own: her dad was so crippled by arthritis that he was barely able to leave his armchair, and her mother’s eyesight had all but vanished. The most basic things – cooking, washing, cleaning – were a daily struggle, and though there was some nominal, infrequent care provided by the local authority, it wasn’t enough to assuage mum’s fears that her parents were too vulnerable.

Fuelled by a sense of love, duty & tradition (she’d cared for her own ailing grandmother when growing up), she persuaded her husband to let them move in with us; we built an extension to the house, converted a garage into a bedroom and fixed-up a disabled bathroom. Though they only stayed for about a year before passing away, for mum there was at least some solace in knowing that they lived their last days in comfort & dignity.

Comfort and dignity; that’s the most we really want out of old age and the least that any of us deserves. But it’s become increasingly clear in recent years that we’re ill-equipped, both as a country and as individuals, to meet those modest standards.

In 2006, a report by Derek Wanless found serious shortfalls in the social care system: there’s a lack of joined-up service provision, delivery throughout the country was patchy and care providers are hampered by a lack of resources due to stretched council budgets. On top of that, the system of arbitrary means-testing is bitterly resented and many who fail that test are forced to sell their homes & move into nursing accommodation.

With an ageing population and rising life expectancy, Wanless warned that spending on social care would have to treble to about £30bn by 2026 just to meet the needs of the ‘baby boomer’ generation. That’s money we don’t have at present, and without it there’ll be millions of older people becoming wholly dependent on the care & charity of their families. That’s providing those families even have the ability to provide that care, of course; not everyone can afford to build extensions of the side of their bungalows.

In response to this mounting long-term crisis, the government’s in the midst of devising a Green Paper aimed at reforming the system. In anticipation of this, the IPPR has done a little research into the public attitudes to social care, what they expect from it and who they expect to pay for it. The results are a little muddled, conflicted and raise far more questions than they answer.

The first thing to take out of this report is that the public isn’t entirely sure what social care is; whilst a large majority of people can identify services like ‘meals on wheels’ or home visits, less than half were aware of the (fairly meagre) financial support for carers, and barely a third knew of the direct payments given to people needing care. This is important because the survey also found that care is an everyday part of many people’s lives, with just under a quarter of respondants claiming to offer help or support to someone close to them. Clearly, their lives could be made easier if they were more aware of the types of help available.

What’s slightly more concerning given the funding gap is the response to the question of what plans folk are making for their future care needs. Given the fact that around half of us aren’t putting anything towards a private pension, I suppose we shouldn’t be too surprised that a large majority of us either haven’t thought about it or haven’t done anything to plan for it. In a way, this is understandable; after all, we could all be hit by a bus tomorrow, right? Sure, but the problem is that lots of us aren’t getting hit by busses, and if we all live a lot longer without planning for how we’ll be looked after when we reach old age, then we’re going to have a bit of a problem.

plansforfuturecare copy

So if we’re not doing anything to plan for our own old age, who should be responsible for it? How about our kids? After all, think of all the money parents spend on them; a little TLC wouldn’t be too much to expect in return, would it? Well, apparently it would. The chart below shows that most people from 35-70+ don’t believe that their future care should be paid for by their offspring, most likely out of a wish not to be a burden on their future success & happiness. On top of that, a large majority believe that care should be provided by health/social care professionals, rather than family members.


And as for how this social care could be funded… well, it’s enough to give a libertarian a heart attack:


As you can see, the current method of means testing isn’t very popular, and the alternative proposed by Derek Wanless of having free basic care for all, but additional services paid for, doesn’t fare much better. The large preference seems to be for free, universal care based solely on the level of help needed, similar to the NHS. This obviously poses a huge headache for policy-makers because you’re talking about a massive amount of money (certainly more than Wanless’ £30bn estimate), a significant expansion in services and an increase in the size of the public sector.

The main conclusion made in the IPPR’s report is that the government should establish an independent panel to establish the possible courses of action for improving social care and then beginning a national debate about how to proceed. I think this is certainly needed. The public needs to become better informed about the choices facing us and there needs to be open discussion about what role local & national government can play, what role the private sector can play, and what our own responsibilities are as citizens. That discussion is probably the only way to better long-term policy.

Just returning to the anecdote at the top for a moment: whenever a loved one’s birthday rolls around, I find myself reminded of the extraordinary & selfless care my mother gave to her parents, and wondering whether I’d be able to give the same level of devotion she showed to them and her two sons. Right now, I’m not sure I could, and I’m equally unconvinced that they could pay for it themselves or that the state could provide it for them. This nagging fear that my own parents – and millions like them – might one day be robbed of the right to age in comfort & dignity is why we need to discuss the options open to us, and, because each of us is someone’s son or daughter, I’d hope we could have that discussion in good faith.


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  1. […] slightly to my post on social care from a few days back, Annalisa Barbieri wonders what would happen if we provided the care for our […]

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