by Luke Bishop
THE old cliché goes ‘if it ain’t broke, don’t fix it’. But what if something crucially important for all our futures is broken, is acknowledged to be broken and yet we still refuse to do anything about it? Such is the case with adult social care in England, unfair and inconsistent even before the cuts, and now threatening to get very much worse.
Old age should be a blessing. It should be the time when you are rewarded for the hard work you have put into the previous 40 to 50 years. Of course, it can also be a time of steep physical and mental decline, and this should be acknowledged in the way we help the elderly by supporting their ability to care for themselves, whether it be by delivering a meal or helping them wash and bathe. What many face however is an old age fraught with uncertainty, loneliness, isolation and financial ruin.
The main problem about adult social care is that the way of funding and delivering it has not changed significantly since the 1970s. Over that time that time the Cold War has ended, industries privatised, successive governments have come and gone, the internet has changed the world and, most crucially, advances in medical science and healthcare have meant more of us are living for longer. Not one administration, however, has seen fit to change the way in which our vulnerable and elderly are cared for.
As you would expect from a system which hasn’t changed in a generation there are dreadful archaisms. The threshold by which people have to pay for all their care is currently £23,250 in assets – if they have more than this they receive no state support. Bearing in mind that these assets include owned property and pension funds, we are talking about rather modest amounts of money, meaning that only the very poorest of pensioners are exempt. There is also no upper limit for how much they would have to pay towards their care, which means their modest means, all that they had worked for and saved, would be drained off.
There is also little consistency as to what “state support” as provided by the local authority entails. Unlike education, health, or even bin collection, there is scandalously little in the way of statutory requirements when it comes to adult social care. One local authority could provide the bare minimum – a 15-minute session a day to help an elderly person have a quick wash. Another council might provide two hourly sessions (one in the morning, one in the evening) where you are helped with washing and dressing, cooked a meal, helped to go to the toilet and, maybe, you will even be sat down with for a while for a chat. Such blatant inconsistency would be scandalous in education or healthcare.
This system has groaned on for a quarter-of-a-century, but it is so imperative now because of the cuts. As adult social care is not well protected by statute, it remains the largest discretionary area for local authority budgets. In other words, if cuts are to be made, it’s far less of a headache to take it from this area than heavily safeguarded education. The consequences could be that the majority of councils will be providing a poor quality bare minimum.
There’s evidence that councils are even using more underhand methods to shirk their responsibilities by resetting eligibility criteria and refusing to give proper assessments of needs. Some have been successfully challenged, for example, last November two severely disabled adults won a court case against Isle of Wight council in which the Judge ruled the changes to adult social care were unlawful, but there are many less dramatic cases which are harder to challenge.
There could be real human consequences to such negligence. An elderly person who has been unable to secure help bathing might slip and break a hip and end up in hospital, perhaps never to return home or to be discharged out of hospital into a care home. They may have to sell their home and many of their possessions in order to afford the cost of care.
A very clear solution has been offered to this government from the Dilnot Commission, which suggests simple things such as raising the threshold by which people have to pay for care and introducing a cap. This would save many elderly people financial ruin at a time when they should be enjoying the fruits of their labour. It also suggests overall consistency, transparency and ease of use that the piecemeal current system starkly lacks. The costs of implementation are estimated to add £1.7 billion to the social care bill per year, but the long term savings would be inestimably more.
Despite being offered such a strong case and a practical plan for social care which was indeed commissioned by the current administration, the government line has been not particularly committed so far. It rather blandly ‘welcomed’ the proposals while having concerns over the hefty price tag which accompanied it. During Prime Minister’s Questions on January 11 David Cameron stated that “we must do something about the rising costs of domiciliary care, improve the quality of the care that people receive, and address the issue of people having to sell their homes and all their assets to pay for care”. But he added the crucial qualifier that a change in system must be one that the country “could afford”.
The powers of short-termism and political necessity have the ability to seriously scupper these sensible solutions and make them come to naught. In a time when the Conservatives seem ideologically attached to austerity despite the human cost, the price tag attached to change may be anathema to them. However, the long-term savings make the Dilnot proposals worthwhile, and if the government incorporates them into its upcoming social care bill the fact that it helped fix care for the elderly and disabled will be remembered long after the anger over cuts has subsided.
The Conservative MP John Redwood made throw-away comments to the Today programme about the Dilnot proposals being too concerned with protecting children’s inheritance. This is nonsense, it’s about protecting those whose shoulders we stand on, making sure their final years and decades are as comfortable as possible and not one of isolation and misery. The government needs to take on board the simple suggestions and fix a system that has been crying out for change for decades. At least they can’t say they’ve never been told.