Social Care Crisis | No plan, no clue

This is Boris as a newly elected PM 18 months ago telling the world that he had a plan to fix the crisis engulfing residential and domiciliary care for older people.

Since then we have had no plan, and now there is an announcement in this weeks Queens speech that  “Proposals on reforms to social care will be brought forward.” Given the legislative timetable we can expect some a Bill sometime in 2022 at the soonest.

That’s it. From telling the world he had a plan to proposing legislation will be at least 3 years. Generally Governments try and do the difficult stuff in the first couple of years of a Parliament, rather than in the run up to an election. There is a very serious chance that reform of social care could be put back until after 2024.

This was the thinest Queens Speech since John Major announced the Cones Hotline. Nothing of any meaning on levelling up, protecting renters affected by the cladding scandal, or employment rights post Brexit. Nothing at all on how the Government will deliver the “sunlit uplands” that Brexit was meant to deliver.

While the Government dithers social care is in a total crisis.

There is a massive unhappiness about the cost of residential care, and the way that individuals often have to use the capital built up in their homes to pay for care. This is a huge perception of unfairness – some people are allowed to pass on that wealth to their children, others have to use it to pay for care. As it gets harder and harder for young people to afford to buy a house inherited wealth passed on from generations becomes more emotive.

At the heart of the problem is demographics. The UK has the largest ever cohort of older people being supported by the taxes of a relatively small number of workers. Covid and Brexit have brought about the largest ever contraction in the UK workforce as 100,000s of EU workers have left. This cohort of older people dominate politics, hence the Government is committed to keeping house prices high but does nothing to keep wages high. Politics is all about retirement not employment. Government can’t politically do anything that affects the financial status of older voters, but it can’t afford to keep the current levels of spending without higher taxes.

The Government is caught between raising taxes, or increasing the amount that people have to contribute out the equity in their homes, neither of which are popular, particularly as most proposals are regressive – they benefit richer voters the most.

Theresa May produced proposals to reform Social Care, which increased the Governments contribution to social care by billions, capped individuals lifetime contribution at £35,000, with asset protection of £100,000. however this was seized upon by Labour as the Dementia Tax and cost her huge numbers of votes. In the end it was abandoned. Boris Johnson promised a new, better plan, but as yet no sign of it.

Individual funding however is only one half of the problem. There are even bigger problems with the supply of care home places.

Building a care home (or converting an older building) is expensive, and keeping it up to Care Quality Commission standards costs even more. This means that the whole sector is highly indebted. Even now with interest rates at an all time low capital costs are the largest cause of care home bankruptcies.

But once you have bought and equipped a care home you have to staff it. Wages in the care sector are low, and historically the sector has relied on workers coming from abroad, particularly Eastern Europe. Brexit and Covid have made the UK a much less attractive place for foreign workers – horror stories circulate about EU citizens coming to the UK for job interviews being held in detention centres and then deported. Care Homes need minimum staffing to meet CQC standards, but can’t recruit from a shrinking workforce.

The combination of an imminent staffing crisis and high levels of debt make the while sector incredibly vulnerable.

Johnson is taking a huge risk by delaying a decision on reform of sector funding and there is a serious chance that a crisis will come along that takes matters out of his hands. Boris is a needy character, who craves popularity and hates taking difficult decisions, and this is a policy area where every possible choice is unpopular.

It is hard to tell whether he is simply putting off a tough decision, or if he hopes that a crisis will come along which will allow him to tell people he had no choice but to do difficult things.

And there is one other problem with social care policy. Frankly, its boring. If you don’t have an elderly relative needing care it is something that you just can’t be bothered getting your head around. People are too busy with whatever culture war distraction is taking up attention – statues, the National Trust.

The one group who do care about it are older voters who own their own homes. Who just happen to be the Governments core constituency. He can’t afford to upset them, but he doesn’t have a plan that he can afford that keeps them happy.

A classic wicked problem. I am afraid that we have several years of dither and delay ahead of us- a Government with a 80 seat majority, that is still too weak to make tough decisions.

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