Towards a new care settlement - part 2


I have written a series of posts:

about the care crisis, what it comprises, why it is worsening and why it is hard to remedy.  Today, in the last of the series, I suggest four sets of ideas which might together provide a platform for a long term care strategy.

As I said in my last post, we need our leaders to recognise that there is a care crisis, not simply a crisis for government and policy but for society, our norms, responsibilities, and expectations.  We need to set out an ambitious ten year plan to take us to a new care settlement in 2025 (roughly coinciding with the peak of the baby boom bulge in elders). In essence this is about guaranteeing more dignity and support for care recipients and carers but we also need to assert a core aim of policy as to make it easier and less disadvantageous for people (and this should not be taken to mean mainly women) to provide care to their own loved ones, rather than paying other people to do all or most of it.

We must use existing spending on older people to liberate funds for specific and guaranteed improvement in care.  The other aspects of my strategy are primarily about using resources more wisely and generating new commitment and effort to improve care, but nevertheless, any shift in direction will involve transitional and on-going new costs.  But these costs must not come from younger generations, which, as a number of people including David Willetts have argued, are already in many ways facing a much tougher situation than those who came before them.  So new funding for care should come from wealth testing some universal benefits for older people, from further reducing tax breaks on pensions and by going further than the Coalition’s initial step to increase inheritance tax levels.

We must – and this is hardly an original thought – achieve a better integration of health and social care and public health interventions.  Everyone from Andy Burnham to the recent House of Lords report argues for this which suggests the barrier is less principle and more implementation.  My solution – which may be simplistic – would simply be to transfer the budget for commissioning all health care for people over seventy and registered as disabled, apart from accident and emergency and elective surgery, to local authorities on the strict condition that, as commissioners, councils cannot also be service providers (for either health or social care).

We need a powerful publicly funded but independently governed agency/platform called something like ‘We Care’. The service would oversee my proposed ‘national care experience’ through which all young people between 14 and 19 are expected to undertake a good quality hundred hours care placement.  The service would oversee or incorporate Skills for Care and work to accelerate the development and take up of care apprenticeships particularly at level three and above. In time, all workers in the sector would be expected to be on, or have completed, a level three care apprenticeship or equivalent training package.  ‘We Care’ would also spread good practice and innovation and, particularly seek to take what works to scale (possibly through a strategic partnership with NESTA and the Big Lottery Fund). Particular emphasis would be placed on the way professional care services in the public, private and voluntary engage and develop volunteers. From the outset ‘We Care’ would have capacity to work with successful UK care providers to encourage them into international markets in what is a growing sector worldwide. ‘We Care’ would also advocate a wider policy and societal sensitivity to care needs, for example in the design of products, services and housing.

Because the care crisis is so huge and multi-faceted we need a strategy with all these elements; honest and brave leadership, new social norms, fair funding, fundamental service reconfiguration, institutional innovation, strategic co-ordination. In these sceptical, anti-statists, times there isn’t much appetite for grand plans but incrementalism simply won’t move us from an already unacceptable care situation which is only set to get worse.


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