During this year’s party conference season, we held two events in partnership with Bright Blue, an independent think tank, whose ideas and thinking have had significant influence on public debate and government policy. Their areas of research focus on education and skills, employment, families and social policy as well as poverty and welfare.
Both events were chaired by Bright Blue Director, Ryan Shorthouse.
There were several key themes discussed at both fringe events. Here is a summary of the issues raised by panellists.
The Mayor of Greater Manchester said he was worried that the reform of social care is being delayed, when action is urgently required to deliver the care people need. He said the country must find a better way to respond to our ageing population: “we must stop saying the issue is too difficult.” He suggested that we don’t need another inquiry as the solution, stating that the issue of social care was “perfectly solvable with political will and maturity” and that an agreement between the two main parties can be sought as a political consensus already exists. The need for a cross-party consensus was called for by several of the panellists.
Andy Burnham also explained that in order to deal with some of the key challenges in health and care, the government will need to resolve the problem that “the NHS is still a 20th Century treatment model”. He called for a 21st Century model to explode silo working and address physical, and mental health as well as social care needs holistically.
Baroness Cavendish said that because of the complex nature of our health and care systems, and the needs and expectations of individuals, you cannot have a ‘one size fits all’ model. For example, reliance upon children as primary carers in later life will not work in every instance – many people do not have children, and for those that do, their children may not live close enough to take care of them.
Andy Burnham was positive about the potential for change to flow from city regions. He said that more change is liable to flow from a bottom-up approach and through devolution because the issue of care was becoming too complex for Westminster to handle alone. He made it clear that the Greater Manchester region would be submitting a proposal to the Chancellor with that in mind. The Greater Manchester pilot intends to demonstrate that the region is best-placed to means test a new local level model approach to health and social care because of the power it has been given through its region’s devolution deals.
The reforms suggested by Mr Burnham are intended to change the way the whole system works, and he wants to do this via what he referred to as a “Year of Care” approach. Simply stated, this would require the consolidation of social care, primary care and CCG funding, which would be paid to the local governing NHS organisation. He explained that this would give the NHS an incentive to employ its own staff in social care and result in higher quality care in people’s homes. He wants to make Manchester a pilot to demonstrate how to reform the way funding for health and social care is allocated throughout the country.
Andy Burnham said that the most vulnerable are paying the most for social care. To counteract this, his questioned whether 20% of people’s lifetime earnings could be saved on their behalf – ready to pay for their care at the point that they need it – in a pooled risk scheme akin to that which underpins the NHS. This, he said, would allow people to manage the rest of their savings as they wish and put older people in control of their care in later life.
Columnist Will Hutton said we need to revive insurance principles around social care. He stated that he was strongly behind the Dilnot adult social care reforms. He explained that, if it were developed, a new national care system would give people the confidence to confront old age. Will Hutton explored the idea of returning to the times of Social Insurance and Allied Services linked to the principles set out in the Beveridge Report. He also stated that access to the benefits of social care should be proportional to the contribution an individual makes in their lifetime to the labour market. Will Hutton said that the contribution principle goes with the grain of human nature and that the current system invites criticism of “care being gained and not won by people”.
Baroness Cavendish said that there are a number of cost-effective methods which merit exploration in more depth because, as we have seen, “funnelling the money around hasn’t worked – we haven’t made the savings we thought we would, so a new set of tactics might be in order”. David Sinclair added it is quite likely that we will have to use housing wealth to support the challenges of later life and the care needs that come with it. He also said that there can be serious economic consequences as a result of ageing – Japan being a case in point.
Jo Maugham QC said that the ideas around merging health and social care together could help consolidate the amount of money available to spend in one core budget, it would however, make things more difficult on the funding element. For him, the big question is not the amount of money the government spends, but more about whether it was being spent wisely and sustainably over the long-term. He also said that there is much more that the State can and ought to be doing in terms of getting involved in mediating when families are not in a position to pay or don’t have adequate capacity to balance care responsibilities.
An important consideration is changing people’s behaviour – pension tax relief isn’t necessarily the best way to go about it. Jo Maugham explained that we need to incentive people to save more for their future, but what pension tax relief does is allow richer individuals to save more and the poorest in society to save next to nothing. We need to help the poorer in later life, he argued, not make it more difficult for them – if people are less self-sufficient and don’t have the money or assets to pay for care, this will inevitably lead them to sought out state help and become more reliant upon the state.
Demos Chief Executive Claudia Wood suggested that we must do more to encourage a cultural shift in respect of social care. She explained that the majority of workplaces tend to assume people work Monday to Friday, from 9am to 5pm. While our jobs and what we do is evolving, our office culture is not, and it means that we are not able to balance care alongside work. The labour market is not keeping up with demographic trends.
Will Hutton stated that the age of people in work continues to rise, and demands on care services will largely be paid for by the increased participation of an older workforce in the labour market.
Baroness Cavendish said that as a nation, we haven’t been speaking about this topic enough – acknowledging this issue and shift can only be a good thing for social care going forward. From personal experience, she said she wished that she’d been told at a much earlier age about the need to plan for the future: “the lottery of life is very acute for the elderly – but we don’t know what social care really is before either you or a loved one is in need of it”.
David Sinclair said there are a number of things we ought to look at in making changes – including, the economy; inequalities; making communities work better for all generations; dismissal of and discrimination towards older people. In particular, he underlined that we need to be more innovative than we have been in recent years.
David Sinclair also made the point that not everything is ‘doom and gloom’ – age in and of itself no longer means being poor for most people. We have seen fewer winter deaths over the past several years and more people are saving for their later years. Heart attacks and strokes are not the prolific killers they once were – it is now more about dementia and other diseases that come with ageing. Whilst trying to go about change and making outcomes better in the future, the success of policies from successive governments ought to be celebrated too.
Jo Maugham reiterated that intergenerational fairness is increasingly important – reflecting that it’s now part of mainstream political debate. In particular, he said that it was striking that for the first time in our history, an older generation is earning more and better off financially than a younger generation. He added, however, that there is a misconception about the causes of intergenerational unfairness. The triple lock on pensions, for example, cost £6bn more than it would have done to increase pensions in line with earnings – that is also how much it would cost to abolish university tuition fees.
Will Hutton said that advances in technology and life sciences could help people care for themselves now. He said that “you, yourself can become much more capable of self-diagnosis”; become more pro-active and take steps to stay well for longer.
During the debate, the panel also discussed the importance of social care provision as part of the Government’s industrial strategy. Claudia Wood responded by saying that political parties could be bolder on this and that successive governments have not been straight with the public about social care. Dean James said that placing social care within the broader context of the industrial strategy would be beneficial to the sector, as steps could be taken to produce a more formal career ladder for carers and to ensure that care has the same opportunities open to other health professionals.
At the beginning of September, Future Care Capital published Securing the Future: planning health and care for every generation. This paper was launched to coincide with the party conference season to help raise awareness about the key challenges that our expert contributors expect to face health and care service commissioners and providers in five, ten and fifteen years’ time. Amongst other things, the paper underlines our belief that we should be “celebrating the fact we are living longer”, rather than focusing on the narrative of how we are going to pay for it.
In 22 years’ time 17.5 million of the population will be over 65. We need a long-term plan if we are to provide the high-quality care we both want and deserve later in life. There is also a huge disparity between socio-economic classes in later life. For example, if you are a 65-year-old woman living in a more deprived area of Britain, you will have 3.3 years of disability-free retirement on average. By contrast, if you are a 65-year-old woman living in a rich area, the average is 17.5 years.
In terms of health policy more generally, when the sustainability of the NHS was reviewed by the House of Lords, Peers said that health policy is suffering from short termism. Future Care Capital’s report ‘Securing the Future’ offers a potential solution in recommending a new settlement between the state and individuals in the form of a Care Covenant underpinned by Future Care Guarantees. You can read the report here.
The party conference season afforded us a good opportunity to hear, debate and challenge current thinking about how we might all work together to better respond to those health and care challenges we will face in later life as our society continues to age. It was clear from our fringe events that politicians in the Westminster bubble urgently need to acknowledge the situation we face and agree a plan if we are to move beyond the current ‘crisis’ and take substantive steps towards the delivery of health and care services that successive generations will need.