The unpalatable truth about adult social care

With adult social care set to get additional funding in the Budget to ease the pressure on cash-strapped local authorities, it seems that central government is waking to the precarious financial position of many councils.

Historic pressure to keep council tax frozen combined with rising elderly care costs has left many local authorities at breaking point. Spending on adult social care already accounts for 70p out of every £1 in my local authority, Swindon. With this forecast to rise to 80p by 2020, no amount of emergency funding is going to make the current situation sustainable long-term. Demand, not simply supply, has to be addressed.

The unpalatable truth is that it is not primarily the state’s responsibility to look after our elderly relatives, but families’. The challenge is that the current system does not not see the family, only the individual. Worse, it punishes responsible behaviour. There are many families who care lovingly for sick relatives with little or no help, and others who leave care to the state, that dutifully steps in to absolve family of its responsibilities.

This is at odds with other areas of policy. We do not assume that it is the state’s responsibility to bring up children of low income households. We do not assume that if a relative is sick that family should step back. Yet when it comes to elderly care, the state is blind to family.

Under the current system, anyone with assets over £23,250 has to cover the full costs of their care. Below that, however, the state steps in on a sliding scale until the full costs of care are provided once assets drop below £14,250. The value of your home is only considered if you need to move into a care home.

The system sees only the individual in isolation. You may have children who are multi-millionaires, but if you have assets below £14,250 the taxpayer will pick up the care bill. The challenge with this approach is that the very concept of care is not one that is applicable to an individual. It necessitates a relationship of dependence, and that relationship should primarily be one of family, not a dependence on the state. Full state funding should be a last resort, an important lifeline rightly there for people with no family, or for families who cannot (rather than would prefer not to) care for their relatives.

So what is the solution? The government rowed back from the introduction of a cap on the costs of care in 2015, delaying the move until 2020. Local authorities were supportive of the principle, but the decision to simultaneously raise the asset threshold from £23,250 to £118,000 threatened £6bn black hole in local budgets. By capping costs, it was hoped that an insurance market could be stimulated, allowing people to insure themselves against the capped £72,000 cost of care.

The basic idea was a good one, and it should be revisited, but only as part of a wholescale reform of the fundamental principles of state care of the elderly. The “means-testing” of care must look beyond the individual to take into account the capacity of the whole family. There is certainly a distance issue here, with children often living far from parents, but the system must evolve to reflect societal change.

The principle of family first, state as a last resort must be embedded. If your elderly parents need daily care visits at home, then if the wider family can afford to contribute, they should be compelled to, rather than shifting responsibility to the state.

The threshold, at £118,000, was plainly too high, significantly increasing, not reducing, demand, and, particularly when looking at own-home care costs which exclude the value of the property, threatened to be an unsustainable catch-all. The threshold needs to be a control on demand, and far more nuanced depending on the the care required (e.g. residential vs. non-residential care) as well as reflecting the capacity of the immediate family.

The greatest power of the care cap, however, is the choice it gives families. The stimulation of an insurance market to cover those fixed costs is not only an important step towards the sustainability of care costs long-term as the population ages, but also a potent driver of choice.

Families could make the choice: will costs be paid out of assets (e.g. property) or will they pay the premiums to insure themselves against the risk? It even opens the possibility of local authorities being able to insure themselves against picking up the costs of care for the poorest with no assets and no family means of care.

There will need to be consideration about the phasing of the policy in the short-term, with enough time given for those nearing retirement age to plan for future care costs, but in the long-term, the cap has significant potential.

Rather than simply seeking a short-term fix through the Budget, government must be bold enough to tackle the issue head on. This means more than just considering how to fund the supply of care needed as the population ages, but looking at demand too.

Only a radical solution will match up to the challenge in the long-term and that means difficult questions for society about who takes ultimate responsibility for those closest to us. It may be unpalatable, but the answer is that the state simply cannot afford to do so anymore.