How we manage and fund care for elderly, frail or disabled people – and how we support those that care for them – will be one of the major policy issues in the next decade. Just as in the debate on pensions, we need to forge a consensus about where the balance of responsibility should lie between the state, individuals and families.
In his report for the King’s Fund, Sir Derek Wanless predicts a significant increase in levels of impairment and dependency over the next 20 years. If social care is not reformed and better funded, it will be individuals and families who have to step in and provide that care; this equates to a need for 50% more unpaid care by 2026.
If you happen to be one of those people who provides care for a partner, family member or friend, the impact on your life will be dramatic. Carers struggle to maintain a quality of life that most people take for granted. Their ability to work, enjoy good mental and physical health, and maintain social networks are all reduced as caring responsibilities increase. We are leaving too many people on benefits with no prospect of moving off them. We are asking people to risk their own health because of a lack of proper support.
The Audit Commission has suggested that carers are increasingly seen as a ‘free resource’, but evidence is building that the cost, although largely hidden, is mounting. The peak age for caring is 45-64, when many employees have gained valuable skills and are employed in senior positions; but one in five carers are forced to give up work, and many more are working in jobs below their potential because of a lack of support. It would be ludicrous to suggest that a mother with a two year old child should return to work without considering her childcare needs – yet someone caring for an adult is offered no support to find or pay for care. In theory every carer is entitled to an assessment of their needs by their local authority, but despite the fact that there are nearly a million people in England providing more than 50 hours care each week, only 194,000 carers received an assessment or review in 2004-05.
Last year’s health White Paper ‘Our health, our care, our say’ promised a review of the 1999 Prime Minister’s National Strategy for Carers. This review will be led by the Department of Health, but it is absolutely vital that the new prime minister takes a keen interest and insists on a radical and far-reaching report. With much evidence on the impact of caring already gathered for the Comprehensive Spending Review, the review should focus on identifying long-term solutions over a ten-year time scale. But short-term improvements are essential too.
First, we need substantial investment in social care to reverse the ‘fifteen minute slot’ approach to home care recently identified by the Commission for Social Care Inspection. Second, there needs to be reform of Jobcentre Plus so that it works with social service departments to target support at carers wishing to return to work. Finally, for carers already in work, tax credits and care vouchers (along the lines of existing childcare vouchers) should be introduced to make work pay, reduce poverty and improve productivity.
This is no small task-list for a new prime minister. Yet only by making these changes will he, or she, offer carers the chance to continue caring without sacrificing their own health, wealth and future prospects.