The government promised to publish a Green Paper on funding adult social care last
autumn, but in the end, it did not materialise, instead, saying that it would be published
alongside its NHS Long Term Plan. Well, on Monday this week, the NHS Long Term Plan
was published, but the Green Paper on adult social care was nowhere to be seen. There has
been no word from the government on when it will be released.
To recap, the Green Paper idea was hatched in the wake of the Tories disastrous manifesto
commitment at the 2017 general election, which pledged to fund adult social care by
requiring users of the service to pay for care with equity held within their homes, should they
own one. The policy idea was said to be the brainchild of Nick Timothy, one of the prime
minister’s special advisers, and apparently not even discussed in Cabinet beforehand.
It was a bit of a back of a fag packet plan, which when I first heard about it I thought was a
very un-Tory like policy, and very risky to just spring on the electorate at a general election. It
almost certainly cost the Tories votes and contributed to the government losing its majority in
Parliament. It was quickly dubbed the ‘dementia tax’ and Tory MPs reported that it ‘went
down like a bucket of sick’ on doorsteps during the election campaign. Timothy was duly
sacked as an adviser.
There is broad agreement among politicians and health care professionals that this issue
does need to be sorted out. In the meantime, the government has found £410 million to give
to local authorities (in England) for adult and children’s social care and allowed them to
raise council tax by up to 6%, to get them through the coming year. This is just a sticking
plaster on a deep wound, but the Green Paper idea allows the government to kick this
particular can down the road, as they have done with many other issues.
Why there needs to be any more delay on this pressing issue is a mystery, government
Green Papers are only consultation documents after all. Quicker off the mark has been the
Local Government Association (LGA), who published their own ‘green paper’ in July last
year and the consultation closed on 26 September. The results have been analysed, and the
LGA has now published the findings. Over 540 people and interest groups submitted
responses, with more than 15,500 people looking at the LGA website about the green paper.
The consultation responses indicated that people like decisions about adult social care being
taken locally, by local authorities, so that local factors are taken into account, but worried
that this would lead to variations in the service across England. Many thought that the
service should be provided locally but guidelines should be decided nationally. Most people
thought that funding should be provided nationally, rather than covered by council tax.
The LGA estimates that by 2024-25 providing a good standard of care to all adults who need
it, will cost around £5 billion per year, and with an increasingly aged population costs will rise
even further after that. Most responses to the consultation made the point that more money
needs to be allocated to adult social care.
At the moment people who receive care are obliged to contribute towards the cost if they
have income and assets over £23,250, which 80% of respondents thought was too low an
amount. Just over half thought that this amount should be raised to £100,000, but that extra
funding from the government should also be provided.
The most popular option for respondents for raising this central funding was an increase in
National Insurance contributions (56%) from employees and employers, with a rise in
income tax (49%) the second most popular choice. 56% of people also said they would
support paying extra for specific social insurance to cover the costs of care, which could be
done through either National Insurance or some ring-fenced income tax.
I think that it is very unlikely that higher earners will have to cover most of the costs by
raising the top rate of income tax, because the Tories just don’t do that sort thing, even if the
fairness of this is obvious to most people.
Whatever scheme is eventually devised to pay for adult social care, the problem needs
addressing urgently, so the government should just get on with releasing the Green Paper,
to take this long overdue decision, and stop stalling.