Social care

Secondly, as I say, I’ve looked through the Wanless Social Care Review, Securing Good Care for Older People: Taking a long-term view.

Basic points are as follows: Social care is a growth industry, with funding to maintain outcomes increasing by 139% from 2002 to 2026 alone. The aging demography of the UK is well known, and the problem is compounded by the fact that a significant proportion of informal care is delivered by the elderly themselves (one in six people over 65 delivers informal social care).

Wanless’ remit is to improve outcomes as much as possible and as efficiently as possible against a benchmark which boils down to one year of substantially improved care at 20000 pounds’ worth of expenditure per head. The three models that Wanless sets out are: partnership, (two-thirds of the benchmark cost is met by the state, then individuals make contributions which are matched 1:1 up the benchmark limit, beyond which contributions are not matched. Means-tested Benefits for those unable to contribute), free personal care, (state meets whole benchmark, no personal contribution) and limited liability (hybrid, means tested provision for the first 3 or 4 years, thereafter free).

Regardless of the philosophical arguments around free provision, it seems to me that in his summary, Wanless finds evidence over and again in support of a Partnership-based funding model for social care in the future, though in his conclusion he equivocates a little and dilutes the strong case that he has built. Wanless uses a range of economic criteria to reach this conclusion (p.xxxiii or the summary).

There is a strong localist case to be made for partnership allocation of funding, based primarly upon the complexity of the means-testing, which (under partnership would not include housing value) and on the differing allocations to be made: factors include housing, domestic support, personal care, nursing care. Because means-testing would take into account other benefits administered, the case for a locally-administered partnership funding model for social care is the same as every other argument for localist solutions (ie, that the principle of subsidiarity is inarguable), only, because of the complexity of the assessments to be made, more so.

At this point, it is instructive to look at the figures involved. Under Wanless’ suggestions (and I am taking his baseline most conservative estimate that delivers zero improvements in outcomes, but which simply restructures funding models), by 2026 costs are projected to be 24bn. With improvements in service delivery, that figure jumps to 31.3bn. This is against the background of current figures of 10.1bn.

It is worth putting these numbers into some context: Alan Johnson has just conceded that Individual budgets are going to go ahead, and to do this has released 520m. For local government to have any kind of angle in future social care provision, let’s say that it would need administration over only 50% of funding: this means that central government would have needed to sign a social care concordat handing over 5.05bn to local authorities four years ago. Alan Johnson’s commitment in December is one tenth of this.

My point is that to agitate for a localist delivery of social care is not a politically realistic thing to do. We might be able to get funding from, say, XXX, were we to write a report calling for complete local control of social care, but who would take seriously a report demanding the 12bn handover necessary to meet social care costs in 2008, dwarfing by 24 times Alan Johnson’s grand gesture? On the other hand, whilst I don’t doubt that we could put together a report which strongly advocating the partnership model and its localist implementation, I don’t think that, given the practical obstacles, a report like that would get funded. After all, we know that partnership-funded care is best because it’s there in the Wanless report already.

The problems in my argument are that the King’s Fund might have had its own agenda in putting these figures together and so there might be inaccuracies, and that the report itself dates from 2006 and so might be out of date.

The point of all this is that I was wondering whether you could set down for me a brief abstract of the angle that you think that we could viably take in such a report. If you could send me one then we’d be able to build on it start putting together a position and a proposal from there.