Artillery Row

The rusty bucket

Six tests for the social care plan

Many Tory grandees, backbench MPs and party members are furious at plan to raise national insurance. They see it as a breach of manifesto promises, and inconsistent with Conservative principles such as low taxes, small government and competition. But Downing Street insists that there are NHS waiting lists to bring down, and social care to fix — another manifesto promise.

So, what tests should backbenchers set to ensure that the plan it will actually improve things and be consistent with Conservative principles and economic recovery? Here are six suggestions.

The evidence test
Will a tax rise actually reduce NHS waiting lists? Remember Gordon Brown’s rise in National Insurance, designed to boost the NHS budget? But without a reform plan, and facing union pressure, all that Brown managed to boost was GPs salaries, not patient care. We first need to know how quickly, month by month, the waiting lists would be cleared without any extra funding. Only then can we see if the extra cash has made a difference — or has gone straight into more bureaucracy.

Switzerland, France and other close neighbours have systems they are proud of too, and which produce better outcomes

And will a rise in tax really deliver better front-line social care? Will it stem the exit of care workers, 40,000 of whom don’t want the jab, and others who can find better-paid jobs at supermarket checkouts?

How would we measure any quality improvement? Will the extra money revitalise local-authority care homes — most of which are 25-plus years old, unfit for purpose and don’t even meet the legislative standards set 20 years ago? And for the care delivered in people’s own homes — fully half the public care costs — will local authorities be told to stop buying care on price and focus on quality instead. Will their carers be better qualified, and will they spend more useful time with their housebound clients?

The fairness test
Is a rise in National Insurance fair? Taking money from younger, poorer, working, northern renters in order that older, richer, retired southern homeowners can pass their mansions on to the children does not at first glance seem to promote the “levelling up” agenda. How can Downing Street show it does?

Will the money do anything for health inequalities? Or access to GPs? Will it help to pool the risk of the unlucky one in three who will need expensive social care with the fortunate others who don’t? 

The economics 101 test
Will the government’s plan help realign the demand for social care with its supply? Will it change the fact that people are living longer — not just elderly dementia patients but other adults with physical or learning disabilities too — and need more health and social care? Or that children do not live near their parents anymore, and that those baby-boomer children are themselves getting to the point when they need support rather than being able to deliver it?

Will the plan deliver better care at home so that families don’t have to consign their relatives to expensive care homes? Or other support so that families can look after elderly or disabled relatives themselves? 

The professional government test
Is the government’s plan better than all the other options? Indeed, have other options been seriously considered? Boris Johnson calls the NHS “The pride of the United Kingdom.” But Switzerland, France, the Netherlands and other close neighbours have systems they are proud of too, and which produce better outcomes. That is because they are a partnership between the state and individuals, not a state monopoly.

On social care, there are far better options than ours too. What about, say, the Australian system of providing basic care funding but expecting wealthier people to contribute more, backed up by tax-aided savings bonds for the basic “hotel” costs (catering, laundry and suchlike)? Or creating a private insurance market by the government picking up the “long tail” risks of the minority who need years or decades of expensive residential care? Or tax-assisted care savings plans. Has any of that been considered?

Quite simply, lower-tax economies grow faster, and with a post-Covid public debt like ours, we need to boost growth

The market principles test
Will the government’s plan open up the market to individual choice and competition, with new providers and new ideas? Dominic Cummings’s plan to nationalise the whole social care sector and turn it into an NHS monopoly plainly failed that test. But what is being done to build partnerships with private providers, in health and social care? What will the money do to break down the barriers between state and private sectors, so that patients can have a choice of treatment centres, with the public funding following their choices — not the choices of NHS bureaucrats?

With pension and insurance funds looking for safe investments because of the weak retail and office property markets? What will be done to bring them into providing new care homes for local-authority clients? Perhaps building them in the dozens rather than ones and twos, and providing a full care service to councils over, say, a 25-year contract? That would save councils the upfront cost of building their own.

And what is being done to welcome in the new generation of care providers who focus on first-rate recruitment and training, and use new technologies and IT to deliver quality care at home when human beings are in short supply? 

The fiscal responsibility test
Is the government’s plan consistent with the commitment to economic growth through fiscal responsibility? Tax is the biggest killer of entrepreneurship, and right now we need entrepreneurial businesses to revive and new ones to be created. Quite simply, lower-tax economies grow faster, and with a post-Covid public debt like ours, we need to boost growth, not taxes.

Churchill likened the attempt to tax yourself into prosperity to standing in bucket and trying to pull yourself up by the handle. Our social care system is a rust-bucket; you can throw money into it, but how much is simply going to fall out through the holes?

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