The moral strength of a society can be judged by how it treats its most vulnerable citizens.
In most respects Britain does well on that measure, as reflected by the NHS, education and the benefits system, where essential needs are met collectively by the state.
But there is one glaring omission: namely, social care. Despite its vital role in providing support to those who need help, particularly older people, this was never part of the great post-war welfare settlement.
That neglect has continued, with the result that social care remains badly underfunded and inconsistently delivered.
For its users and their relatives, it is often a source of anxiety rather than comfort, because of its inadequate standards and hefty bills.
Indeed, its entire funding structure, full of contradictions and injustices, is the cause of profound resentment, epitomised by the anger of families who have to sell their homes to meet crippling care charges.
Sir Andrew Dilnot said social care has been neglected and remains badly underfunded and inconsistently delivered (pictured: residents at Highcliffe Residential Home in Chorley)
Ramshackle
The Daily Mail recently calculated that 17,000 older people have to sell their properties every year in order to fund care — the equivalent of 325 sales a week and a rise of 45 per cent since 2000.
Despite growing indignation, successive governments have failed to reform the ramshackle, cash-starved system.
In recent decades, the case for radical change has been advanced in a continual stream of reports, studies and investigations, as well as two Royal Commissions, one set up in 1998 under Sir Stewart Sutherland, the Scottish academic and public servant, and another in 2011 under my own chairmanship.
But time after time, the politicians have failed to grasp the nettle. On this issue, they have been distinguished only by their paralysis.
Even Boris Johnson has failed to act so far, despite his pledge on the steps of Downing Street on the day he became Prime Minister, when he declared: ‘My job is to protect you and your parents and your grandparents from having to sell your home to pay the costs of your care.’
The inertia will be highlighted today at Westminster. For all the Government’s boasts about its dynamic legislative programme, there’s a risk that there will be only the briefest mention of social care in the Queen’s Speech, based on a promise to bring forward a plan later in the year, though without any specifics.
Yet the case for reform is becoming ever more urgent. As life expectancy lengthens and the population ages, the demand for social care is growing rapidly.
Moreover, the Covid crisis shone a harsh spotlight on the residential care sector, exposing poor levels of provision, lack of basic resources and a beleaguered workforce.
The scandal of the high early death toll in care homes, combined with the limited supplies of protective gear and testing equipment, should act as a clarion call for wholesale improvements. It is obvious that we cannot go on as we are.
So what needs to happen now? The first step must be to increase dramatically the overall level of funding for the sector, so it is no longer the poor relation of the NHS.
It is a remarkable fact that, despite the surge in demand, cash support for social care has actually fallen in real terms over recent years, thanks to severe cuts in local authority budgets.
That institutional poverty is reflected in the low wages of the 1.5 million workforce, which in turn leads to a high staff turnover, poor training and a lack of continuity of care.
Every year, around a third of employees leave their jobs.
Boris Johnson (pictured) has failed to act, despite his pledge when he became Prime Minister, when he said his job is to protect people from selling their homes ‘to pay for care costs’
Underfunding also means that the Treasury regularly has to provide emergency injections of cash for local councils because of the dire shortfalls.
But this makeshift, ill-managed approach amounts to putting a sticking plaster on a festering wound. It would be much better to put the whole system on a firmer, healthier, long-term basis – if necessary through an increase in national taxation or insurance.
Some free-market purists might argue against such an expanded role for the state. After all, the Government does not hand out food or homes. Why shouldn’t we be required to make our own provision for our old age, or use our assets?
The problem is that when it comes to social care, the burdens do not fall evenly. Today, roughly one quarter of older people will not need care at all; and for the remaining three-quarters, the costs can vary from the light to the catastrophic, wiping out their savings even if they are affluent.
Only recently, I heard from someone I know that her husband has been diagnosed with dementia. They face a terrible enough struggle with the illness; to also inflict on them care costs which could last decades just seems wrong.
If someone needs care for 30 years — which is conceivable nowadays, given ever greater longevity — the bill, based on an annual rate of £33,000, could come to £1 million.
Danger
There is, justifiably, a sense of gross unfairness at how, through ill-luck, a family can see all their assets destroyed while others escape. This does not happen in other areas of life because of the concept of pooled risk.
No one builds up their savings so that they can afford to buy a new car if they crash the old one. Instead they buy car insurance, pooling the risk with other motorists.
The same is true, in a sense, with healthcare, where we all pool the risk of costly medical treatment by paying our taxes and national insurance to back the NHS.
But this does not happen with social care, because private companies refuse to provide insurance to cover long-term costs, on the grounds that there is too much uncertainty and risk.
So we are left with today’s unfair, means-tested system where anyone with assets over £14,250 has to meet some of their costs. And above the level of £23,250 – hardly a significant sum given today’s property values – care bills have to be met in full, which means even the family home can be in danger.
People who have worked hard all their lives not only have to live in the shadow of penury in their final years, but are denied the opportunity to leave much to their families.
The dire situation could be likened to someone standing in the middle of the road, watching a lorry speed towards them and hoping they die before they are hit.
But there is a way out, and this brings me to the second plank of reform.
The Daily Mail recently calculated 17,000 older people have to sell their properties every year to fund care – the equivalent of 325 sales a week and a rise of 45% since 2000 (stock image)
Cruel
In our Commission report of almost a decade ago, we suggested that the cruel sale of family homes could be stopped by the introduction of a lifetime cap on social care costs of £35,000, with modest inflation, that cap could be set today at £45,000. Anything above that sum, the families can keep.
That would immediately take away a lot of the misery, fear and bitterness. In addition, the means-tested threshold of £23,500, above which all bills have to be paid in full, should be gradually tapered to a more generous level of £100,000.
That would be a progressive step, allowing households, especially in the North and the Midlands, to retain more of their modest assets.
Boris Johnson often talks of levelling up the economy. This would be a tangible demonstration of his policy. The proposed new caps and thresholds would have to be underwritten by increases in taxation.
But ministers should bite the bullet. This is the only fair way forward — a classic example of pooling risks for the greater good.
Winston Churchill, who as the president of the Board of Trade in the Edwardian era was one of the pioneers of the early welfare state, said that ‘social insurance brings the magic of averages to the rescue of millions’.
More than a century later, his words can guide the urgently needed reform of social care. To do nothing can no longer be an option.
Sir Andrew Dilnot was chairman of 2011’s Dilnot Commission into Social Care Funding.