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One of Boris Johnson’s key pledges in his first speech as Prime Minister outside 10 Downing Street was that “we will fix the crisis in social care once and for all.” A functioning social care system is vital for ensuring that vulnerable people receive dignified care, and with one in six people at age 65 and around half at age 85 struggling with daily living, social care is undeniably a major priority. 

On the diagnosis, Johnson is right: social care is in crisis. The system is underfunded, with the Local Government Association estimating that on current policy social care faces at funding gap of at least £1 billion in 2019/20, rising to £3.6 billion by 2025. In 2016, Age UK found that 1.2 million older people in England are not receiving the social care they need. Almost half of councils have witnessed the closure of domestic care home providers in their area, and a third have seen residential care homes shut down. 

Nor will these issues go away. As the UK population ages, demand for social care will continue to rise. Local authorities, which are responsible for delivering social care, are under increasing financial strain; it has been estimated that within 15 years, 60% of local tax revenues will need to be used for social care.

The past two decades are littered with abortive attempts to tackle this crisis. In 1999, the Sutherland Commission published its report on social care, the recommendations of which were adopted in Scotland but not in England and Wales. A decade later, Labour under Gordon Brown published a White Paper proposing the creation of a ‘National Care Service’, but the proposals did not survive the 2010 election. 

Following the report of the Dilnot Commission, the Coalition Government introduced a £72,000 cap on individual care costs in the 2014 Care Act – but in the end this change was never implemented. Most recently, Theresa May’s proposals to count a person’s home among their assets under means-testing for domiciliary care were infamously shot down as a ‘dementia tax’.

There is certainly no shortage of options for shaking up the system. The Government could fund state provision of social care through taxation. It could set up a mandatory social insurance scheme, such as those set up in Japan and Germany among others. It could ‘nudge’ people to insure themselves for social care via a voluntary opt-out scheme, similar to that used for auto-enrolment in pensions. Or, it could make changes to the amount people have to pay for care by introducing a cap on care costs and raising the capital floor for means tests. 

Ultimately, the question is which model Johnson should pursue if he is to avoid the fate of previous attempts at reform. Demos found that 31% think that individuals should pay for care up to a capped amount, while another 24% think the individual should pay what they can afford with the government stepping in to pay the rest. This finding was echoed by a report from the King’s Fund; 30% of respondents favoured means-tested social care, whilst a further 25% would prefer a means-tested and capped model of social care. 

In other words, most people support in principle a ‘partnership’ model, where responsibility for meeting the costs of social care is shared between individuals and the state. People accept that they have a responsibility to plan for potential care costs, but nevertheless expect the government to play an increased role in providing a safety net and would support moderate increases in tax to ensure this happens. 

This gives some indication of the overall strategy that reforms should adopt. But just as important are the tactics needed to make this happen. The first thing to note on this point is that the way funding is raised matters. The public are bitterly opposed to using housing wealth to cover care costs, as illustrated in the 2017 election campaign.

The idea of using taxation is more warmly received, but there is a clear preference for using a hypothecated social care tax in order to ensure that the government is more accountable. This leads onto the second point: the public want social care to be protected from the vicissitudes of politics, through ringfenced funding and potentially oversight by an independent body

As these findings demonstrate, people do not trust Westminster to deliver social care reform. It is therefore vital that the new PM is open with the public on the challenges and trade-offs ahead. This is especially important considering the widespread confusion still surrounding social care; polling from Ipsos MORI indicates that well over half of respondents incorrectly believe the NHS provides social care while 47% think it is free at the point of need. Unrealistic expectations around how social care is funded make already challenging reforms even more difficult to deliver.

If Johnson is serious about tackling social care, he must offer a clear vision of how he will deliver reform, be upfront with the public about the challenges involved, and make social care a genuinely cross-party issue. Failure to do so will come at a high cost indeed. 

Sam Robinson is a researcher at Bright Blue. Image licensed under the Open Government Licence v1.0.