Reflections on ADASS Summer seminar and the session I co-presented: ‘How to deliver good adult social care - despite Covid’
The Conservative manifesto has plenty to say about social care. Whatever you think of the specific policy ideas, we would like to emphasise that we are delighted that the wicked issue of social care funding has been tackled in the manifesto. It would have been easy to duck – pointing to the £2bn given in the budget and the already promised Green Paper.
It shouldn’t be missed that the manifesto makes a number of promises about the forthcoming Green Paper, including that it will:
- Address system-wide issues to improve quality of care and reduce variation
- Reduce loneliness and promote technological solutions to prolong independent living
- Invest in dementia research
- Implement a new statutory right to carer’s leave.
However, most of the headlines will be captured by the changes to social care funding. The manifesto promises three interlinked changes. They are:
- To include the value of your home in financial assessment for home care (as it is for residential care)
- To introduce a single “capital floor” of £100k (so no-one has to bite in to their last £100k of assets for social care)
- To make it easier to defer payment until after you die (so no-one has to sell their house in their lifetime to pay for care)
These are quite technical changes to get across, and unusual for a manifesto. We have already had a number of discussions with experts working out who are the winners and losers. Who voters perceive to be winners and losers on something so complex will be interesting to see.
In all of the debate about winners and losers, we would like to ask a slightly different question. Our diagnosis is that one of the main issues with health and care is that no-one has the right incentives in place to make the right decisions; this includes local government’s incentives to help keep people out of hospital, hospitals’ incentives to keep people well, and older people’s incentives to save for their own care. We would therefore like to pose the question: how do these proposals change incentives? Like calculating winners and losers, this is a complex picture that will emerge as the detail becomes clear. In particular, how these proposals change incentives for those ‘just about managing’ is complex to work out, but crucial.
There is one immediate change in incentives to highlight – ironically, for a Conservative government, these changes will decrease the incentive to own your own home – a key group of losers will be those who own a home but have few savings.
One last group it is worth highlighting are what could be called the “Dilnot losers”. This manifesto marks the official ditching of the Dilnot care cap that has been killed off in stages. It was committed to as part of the Care Act, then made a part 2 of the Care Act, then put off to 2020. Now finally announced (by omission) as dead. Andrew Dilnot pointed out that 1 in 10 people have to pay over £100k for their care. The fraction of those who will spend big on care, still be rich enough to benefit from the £100k capital floor, but not rich enough not to suffer are the big losers. The calculation must be that not enough of us will be, or think we will be, in that category to change our voting incentives.