Social care is bankrupting councils. Why are we not angry?

Why are we more content with the decline of social care than the same phenomenon in the NHS?

Consider the endless column inches devoted to the shock of long treatment waiting lists and the extra billions poured by this government, like so many others, into its endlessly glutted budgets. Meanwhile, excessive social care spending is pushing many councils to the brink of bankruptcy.

During the pandemic, we were urged to “protect the NHS” – while safeguards for care homes often seemed like an afterthought.

We are sleepwalking towards a version of the welfare state that treats bodily illness as a matter of high public priority and frailty, addiction and decline as something halfway between a family burden and a means test.

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This marginalization ignores how central social care is to other policy issues, the importance of which is not in doubt.

The state of adult social care has a massive impact on hospital flows, local government solvency, intergenerational justice and the rate of women’s unpaid work.

There is no equal valuation between these two parts of our public services, and this, more than any single political idea, is probably what drives the present vogue for a “National Care Service.”

But if this is to be anything more than a rebranding exercise, it will require a radically new approach to funding. This is the area where the drop matters most. The decline of the funding model helps explain the under-investment, workforce pressures and unmet needs that have become normalized throughout the system.

The current model is what happens when a decade-old settlement collides with contemporary demographics, a new demand profile and the diseases of old age that come with it. Social care for working-age adults was a relatively small part of spending; now it accounts for about half. And we lived shorter.

Tremendous advances in medical science, nutrition, and living standards have brought with them a simple reality: Most of us will one day need some care, some of us a great deal of it, and this is a normal and predictable part of the course of human life.

This makes later life care a classic case for the collective pooling of risk. In our new report, Beyond Carewe argue that England should ban working-age and later-life care together as if they raise the same ethical and fiscal questions.

For aftercare in particular, the case is for a new social security solution: one in which people contribute during their working lives to a truly pre-funded national pot, invested for growth to meet the costs of caring for their cohort in old age, with clearer entitlements and stronger protection against disruptive spending. No more council tax orders.

There is no longer default reliance on general taxation. And the transition should be supported by asking wealthier seniors to contribute more.

If we can make this debate a little more open, we will have done our job. If we fail to fix the system, the disappearance of dignity in later life will be a blot on all our copybooks.