Emphasising the insurance principle is key to winning public support for tough choices on social care, says Peter Kellner
Here is the dream: most of us want a system of social care that is generous to older people who need it, but does not cost the public purse so much that taxpayers resent the amount they have to pay.
Can such a system be designed? Let me start with two initial observations. The first is that it is cheating to say we could find extra money without raising taxes if we, say, cancelled Trident or scrapped higher-rate pensions tax relief or cut the public sector deficit more slowly. The government could do these things anyway and use the money to cut our taxes. The only honest way to debate the issue is to acknowledge that, all else being equal, higher government spending on social care would require higher taxes.
My second initial observation is that voters can be irritatingly perverse. What they say they want in advance of change is not necessarily what they think afterwards. A YouGov survey earlier this year for Age UK found that 78 per cent of us think the government ‘could do more for older people in our society’. However, any minister who interpreted that result as a green light to raise taxes to satisfy the public’s apparent generosity would be taking a big risk.
That does not mean survey research tells us nothing useful. Here are some pointers from YouGov research:
Most of us worry about what will happen to us when we are older. Not surprisingly, those worries increase as we enter middle age. According to our Age UK poll, the proportions who say they are ‘very’ or ‘fairly’ worried are 43 per cent among the under-25s, 57 per cent for those aged 25-44 and 70 per cent for those aged 45-54.
As with other public services, there is a gulf that separates our perception of national standards and our direct, local experience. A YouGov survey last year for the Sun found that just 21 per cent of us describe as ‘good’ the quality of care for elderly people in the UK. But, in a separate poll last year for the Sunday Times, we found that 68 per cent of people with personal experience of an elderly relative in a home were ‘satisfied’ with the level of care they received.
Financial support for older people, such as the state pension, is more popular – or, at the very least, less unpopular – than welfare benefits paid to younger people. YouGov research for Prospect magazine detected widespread resentment against those benefits that are believed to go in large measure to ‘scroungers’, such as job seeker’s allowance and disability benefits.
We are currently going through difficult times. Millions of people are seeing prices rise while their wages are frozen. A decade ago, most people backed a rise in national insurance rates to pay for an improved NHS; but the economy was buoyant back then, and real wages were rising. Tax rises at any time in the next few years are likely to be far less popular, however worthy the cause.
What conclusions can be drawn from this? First, play up the insurance principle. Broadly speaking, public spending that is insurance-based is popular (such as the NHS and state pensions), while spending that is thought, fairly or unfairly, to be open to abuse is far less popular (such as ‘scrounger’ benefits). If people are to be asked to pay more, directly or indirectly, for a better system of social care, they need to be persuaded that they are buying not just a service but peace of mind.
Second, in today’s harsh climate, do not expect even the most persuasively argued case for collective insurance to justify big tax increases without provoking a voter and taxpayer backlash. Only limited increases in government spending will be politically possible. If more money is still needed, and it is, this must be found elsewhere.
Third, be open about what ‘elsewhere’ means. I doubt whether many people really understand the strategic options. Plainly there is resistance to forcing older people to sell their homes to help pay for their care. Yet, equally plainly, it would be wrong at a time when the overall budget is tight to deny poorer people the quality care they need in order to subsidise people who are asset-rich, even if they are cash-poor. An honest – and preferably cross-party – debate might gain acceptance for a way through this, such as the government taking a charge on the homes of people who go into care – up to, say, £50,000 or £100,000 – to be paid eventually out of their estate.
Fourth, make sure that the system that emerges offers both high quality and good value. The Southern Cross scandal appears, appallingly, to be just the tip of an iceberg. This is not an area where the private sector can be trusted to combine quality with cost-effectiveness. On the other hand, I doubt whether purely public sector provision would provide the efficiency, choice and innovation that are so badly needed.
In short, I see no easy choices. These are tough problems to crack, especially in these austere times. This makes it all the more important to face up to the scale and complexity of the task of reforming social care – and to face up to it now.
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Peter Kellner is president of YouGov