Damian Green is Chair of the One Nation Caucus, a former First Secretary of State and is MP for Ashford.
After days of wailing about how the new money for social care was going to be raised, we can now face up to a question which matters immediately for millions of people. How will these proposals help the vulnerable people who actually receive social care?
The Government’s approach has been to recognise that sorting social care had become one of the big commitments that Boris Johnson had made. This means that he could not afford to kick the can down the road for the rest of the Parliament.
At the same time, the effect of the pandemic on the NHS has meant another huge demand on the taxpayer to put the health service on an even keel. Following the eternal advice that you should never let a crisis go to waste, the new Health and Care Levy can be sold as a way of “solving” short term pressures on the NHS, while also raising enough money to start repairing the social care system.
At the same time (reverting for a second to the weekend’s arguments) the transparent need to bail out the NHS gives the Prime Minister the chance to be almost disarmingly upfront about what he is doing.
He admitted in the Commons that he was breaking a manifesto commitment, but his very effective plea in mitigation was that no one had a global pandemic in their manifesto in 2019. This honesty will I suspect mean that the measures pass through the House relatively comfortably.
So there is one big cheer for the Government actually producing a way of raising the money, even though I would argue, as I have on this site, that it would be better to use a mixed system on the pension model, where the state funds a decent minimum care offering, and ensures the creation of a mass insurance market so that anyone with income and/or assets can pay for insurance which will provide them with peace of mind in old age.
The use of the Dilnot-style cap meaning that no one will be asked to pay more than £86,000 in care costs means that actuaries can calculate premiums, so such an insurance market would be viable. I think this would be a more Conservative solution, so my one cheer is struggling to turn into two or three.
Accepting that the Government has chosen instead to go down the taxation route, my main concern now is that the promised switch over time, where the NHS spending from the Levy is tapered down while the money going into the care system increases, will never happen. There is always a good case to be made for extra NHS spending, and there are officials within the NHS whose whole career entails making that case.
I may be unduly cynical, but I cannot envisage the circumstances in which those at the top of the NHS will agree to shaving some of their own spending so that a higher proportion of the Levy can be diverted into care.
Therefore my real fear is that in a few years’ time there will not be a visible enough improvement in the care system to justify the claim that this persistent nettle has been effectively grasped. The practical changes that are needed are obvious. We need tens of thousands of extra care workers. We need to ensure that we have the capacity to enable people to receive care in their own homes, so that they have a better quality of life for longer and minimise the huge costs of residential care. We need to build and adapt homes differently, so that people can live for longer without needing 24-hour support. We need more care places, and we need to improve the quality of care.
The Levy will raise £12 billion a year. In truth, if you wanted to address those care issues comprehensively you could use all that money. Of course the NHS has legitimate and urgent demands as well.
But those of us who follow this complex issue closely will look at three questions in the coming years. Is the talk of “integrating” health and social care actually turning into something real on the ground? Is the new integrated system actually giving a voice to social care providers which is strong as the voice of the NHS? Is access to the social care system less opaque and frightening than it has been in the past?
As the dust settles on the announcement, and the political caravan moves on, some of us will continue to pay attention. More importantly, millions of people who have not thought much about the care system will come into contact with it for the first time. The test of the Government’s policy will be if those millions do not fear the effects of engaging with the care system, but find it a proper national asset, enabling older people or those with disabilities to live in a way that reflects credit on a generous and civilised society. It is a stiff test.