The government has acknowledged the historical neglect of social care, and is trying hard to make amends. Last month, the prime minister launched a major consultation on reform of the care system. Importantly, he promised a green paper before the next election. This is a brave move, as it will broach the classic big questions. Do we want a national or local service? Should it be universal or targeted? And what mix of public and private funds should be involved? By digging up these difficult issues, the green paper is a gamble for the government. If it also offers a fresh approach to public services, it could also be a real test of progressive politics.
The policy case for change is clear. We face a care crunch, with rising need for care posing major funding challenges. But if handled right, this could be a political opportunity for progressives to mark out new territory. For, like the credit crunch, the care crunch does not affect only the poorest.
Care is not a class issue. With over 9 million people already reporting disability across the spectrum and through life, in terms of numbers, care no longer has claim to a minority status. But with fewer than a million adults receiving care funded by their local council – less than did last year – care services can compare with their health counterparts and justly demand more attention. But the lesson from health is that services do not just need more public spending. Care needs a new kind of public service, and one that would better engage the public.
A striking verdict on the status of ‘the state’ came recently from the social care regulator, which reported that those adults with care needs who were not funded by the council had a worse service than those who were. Those outside the public system missed out on vital information and practitioner advice. Contrary to common conviction, public is better than private. A universal offer of information, advice and practitioner support over care is needed to help those funding part, or all, of their care themselves.
But the solution cannot just come from the state. Individual budgets give users control over their support, which enables them to direct and input into services whatever their resources. Budgets for carers could similarly better support families with caring responsibilities.
Communities also need to be more involved, in terms of collective voice in services, and an expanded role for both the voluntary sector and volunteering in supporting this new vision.
Pensions seem the obvious parallel to the question of how we fund care. But the care debate cannot be successfully conducted as a technocrat fix to an economic problem. Focused on outcomes, a new care system must give a clear new vision of independent adults, modern families and of a supporting state. It must also make clear how a progressive service is different to a residual one. In quantity, it must make better use of both public and private resources and fill the service gap for people who, as care minister Ivan Lewis put it, ‘are neither rich nor poor’. But in quality, too, it must engage and support all families and communities, and the range of services supporting adults, to a shared vision for independence and caring families.
The care issue could be about 9 million burdens to public service and spending. Or it could be about helping 9 million voters, workers, grandparents and consumers, plus their families and carers, to live independent, equal and included lives. A universal offer for care, with radical reform to personalise services through individual budgets and further empower local authorities and communities, would tell a new story about public services. It would reunite the health and care twins in a new shared prospect to boldly be put to the public, and show up the rifts in this apparent progressive peace.