No government can do everything it plans to do, not even one that has had the luxury of 13 years in power. But the omission by this government, until five weeks or so before the election, to offer any sort of answer to a problem that it posed in clear terms before the start of its first term is a failure of the first order. It reflects, in part, the intractable nature of the problem and the limited range of realistic options – each more politically unpalatable than the other. But it is also evidence of the dismally low priority given to the subject by politicians of all stripes. We are talking, of course, about care for the elderly, and specifically what has become known as "social care".
Yesterday's White Paper is welcome for one reason and one reason alone: it puts the argument about social care squarely on to the electoral agenda. While proposing a National Care Service that, like the NHS, would be free at the point of need, however, the Government has once again sought to duck the funding issue. It says it favours a combination of government money combined with a compulsory contribution from the individual. But it stops short of saying how or when the money would be collected, how to cater for those who cannot pay, and at what stage care would become free. The Government is also sticking to its promise to provide personal care at home for those most in need – a promise that is bound to raise expectations that will be very hard to meet.
This is the Government's second attempt to tackle care for the elderly. A Royal Commission on long-term care reported in 1999, but its recommendations were essentially rejected as too expensive. Last year's Green Paper proposed a £20,000 compulsory levy on individual estates, emotively dubbed a "death tax" by the Conservatives. This has now been dropped; or rather, the proposed charge is lower and a posthumous levy remains just one of several options.
In an ideal world, any government would surely prefer to avoid the question of social care in advance of an election. To an extent, though, this government's hand was forced. As the population ages, the problem looms ever larger, and Scotland's decision to fund all care, making no distinction between medical and social, prompted those elsewhere to ask why they were means-tested and, for the most part, had to pay. The other parties were also coming up with their own proposals: the Liberal Democrats first offered, then withdrew, free care on the Scottish model, while the Conservatives still argue – wishfully, we feel – that a voluntary one-off insurance payment would suffice. The hay the Conservatives then made with Labour's "death tax" made it urgent for ministers to find alternatives.
Public unhappiness, however, goes beyond awareness of the disparity with Scotland and fear of a "death tax". The present arrangements, in almost every respect, are unworthy of a first-world country with socialised medicine. It is not just that people resent selling their house – often their only major asset – to pay care-home fees. It is that the line between medical and social care is drawn differently by different councils, that services provided at home vary wildly between authorities, and that health area and local council boundaries rarely coincide, fostering a sense of powerlessness and confusion among families.
Add to the mix the lamentable standard of accommodation and care offered by many care homes, and there should be no mystery why "social care" has steadily risen up the political agenda. It should have been tackled long ago.
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