Straight Talk
Simon Bottery • Senior Fellow • The King’s Fund

With a Conservative win in the recent General Election, what does this mean for social care? Simon Bottery of The King’s Fund shares his insights.

The physicist Niels Bohr is famously supposed to have said, ‘Predictions are difficult, especially about the future’.

Exploring the future for social care just weeks after a seismic election is therefore fraught with danger, especially as, in truth, there is little by way of policy in the Conservative party manifesto to guide us.

Its three point plan promised merely a small amount of extra cash for the current system, along with a commitment to cross-party talks on reform, which in turn would be focused on avoiding people having to sell their homes to pay for care.

These three points merge – as is often the case – two somewhat different issues: ensuring enough money to run the current system and the need for more fundamental reform of that system.

If we focus first on the issues of wider reform for a moment, two immediate, diverging scenarios present themselves from this morsel of evidence.

The first, worst case scenario (though social care folk will be able to invent even ‘worser’ ones, having had long experience) is that social care policy reverts to type and real reform is shelved again. This was its fate during the Blair, Brown, Cameron and May governments. The persuasive, if depressing, argument for this scenario – made recently at a King’s Fund event by former Conservative special adviser, Bill Morgan – is that its cost to the Treasury will always prevent serious reform unless it is driven hard by number 10 and preferably has a clear manifesto pledge to keep it firmly in the political headlights.

We know there is no manifesto commitment and only time will tell whether this Prime Minister feels as strongly about it as he apparently did when he first won office, when he promised to ‘fix’ social care.

If he does, the second, optimistic scenario comes more credible. In this, the Prime Minister remains committed to his vision of radical, ‘Beveridge’-scale reform and – because the options for reforming social care are really not that complicated – finds his way to the policy to implement it.

Given the focus on avoiding home sales, some form of cap on lifetime care costs seems a likely option, but he might also be guided by Conservatives such as Lord Forsyth, whose Economic Affairs Committee recently backed a much more radical tax-funded expansion of social care. This (plausible?) argument for the possibility of wider reform was made by another Conservative former special adviser, Richard Sloggett and is by no means entirely pie-in-the-sky. Certainly, as a result of his spectacular election victory, Johnson would have the Commons majority to deliver reform.

That in turn begs the question about the need for, or indeed feasibility of, the ‘cross-party talks’ that appear in the manifesto. These were included as a 100-day priority for the government, so by the time you read this, they should in theory be edging towards fruition.

Yet even if they were, it seems improbable that meaningful discussions can happen when the two other, devastated, main parties are in the midst of leadership elections. A cynic might argue that cross-party talks are therefore as likely to provide a convenient excuse – through their likely failure – for delay or abandonment of reform as they are – through their success – to provide a route to its implementation. An optimist might however counter that there are other routes to cross-party discussion than Parliament – local government, for example.

Certainly, while all this top level policy reform is being considered, the equally fundamental question of how to get enough money into the current system will not go away. Here, the more recent historical trend suggests that there may be more movement.

Since 2014/15 funding has been increasing in real terms as governments acknowledged the dire state of the sector and worried about its consequences. It has been short-term, poorly targeted and there has not been enough to keep pace with demand, but it has staved off full-blown crisis.

The extra cash promised in the manifesto would not maintain this upward trend and a Johnson government will need to quickly decide what to do about that. A step towards positive recognition of the value of social care, not just its cost, would be a bonus.

What will happen? A lesser known quote from Niels Bohr says that, ‘Every great and deep difficulty bears in itself its own solution.’

But then he’d not encountered social care funding reform.

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