In 1948 the nation rejoiced at the creation of the NHS and the promise of universal healthcare that, in the words of the leaflet dropped through every letterbox in the land, “will relieve your money worries at times of illness”.
In contrast the National Assistance Act of the same year that was to underpin the social care system for the next six decades opened with the words “an act to eliminate the existing poor law”.
Seventy years on, the enduring public popularity of the NHS ensures that its 70th birthday is seen rightly as a cause for national celebration – and what nicer way to celebrate than with a new spending settlement.
For the local authority social care system the contrast could not be starker. Like the NHS, councils are under siege from rising demand and costs. The new budget survey from the Association of Directors of Adult Social Services, based on responses from every council in England, paints a grim picture of fewer people getting care and support, a provider market that is becoming even more fragile, and plummeting confidence in councils’ ability to meet their statutory duties.
That adult social care now makes up almost 38% of total local council spend is simply unsustainable and has profound implications for the purpose and future of local government.
But unlike the NHS, no one is expecting that there will be a birthday cheque in the post for social care. Adding it to the secretary of state’s job title has not prevented the government from repeating the mistake of the 2010 spending review in adopting separate funding settlements for these interdependent services.
The prospect of the forthcoming green paper fulfilling the prime minister’s pledge last year to offer “the first ever proper plan to pay for – and provide – social care” represents the triumph of hope over experience. It seems more likely that the substantive funding issues will not be addressed until next year’s spending review.
A deeper reason why social care reform continues to languish in the shadows of history is that much of the recent debate is usually framed around social care as a financial burden or a threat to private wealth, without any vision of the good that social care can do. Many other countries have recognised that more investment in social care is important to wider policy goals.
Japan for example built support for major reform by emphasising the benefits to individuals, families and the economy. As the charity Skills for Care has shown, social care employs more than 1.5 million people and contributes more than £46bn to the national economy.
The financial health of care providers, and the organisations that commission them, has a vital bearing in our national economic prospects.
Richard Humphries, senior fellow – policy, The King’s Fund