THE NEED TO RE-THINK
A more rational and affordable care system will involve disrupting the market. But the result of that disruption, through methods such as insurance and government cost sharing, or pension-fund financing of care home provision, will be greater supply, greater sustainability and greater fairness.
Public sector reforms are part of this: for example (as mentioned), NHS-funded Continuing Care creates perverse incentives and unfairness. Funding rules, too, produce other perverse incentives. If you go into a care home and your spouse is no longer with you, your residence is counted under means testing rules; but if care is delivered at your residence, it is not. Or again, (in another rule introduced by the Cameron government) the home is not included in means testing for care at home, while it is if care is to be provided in a care home. These examples (and others) distort local authorities’ decision making.
The debate on social care has centred on how much more of it we can afford, either as individuals or as taxpayers. Sadly, that debate is pointless when the money we spend goes into a system that is largely dysfunctional. But with fresh thinking, it is possible to improve the quality of social care provision, to find ways of making it more affordable, and to rebalance service delivery more rationally between care at home and care in a care home.
In conclusion, an arbitrary boost to care budgets, and minor changes to the existing system will do little good and will not help long term sustainability. What we need are new partnerships in new markets that embrace fundamental change across the board, improved transparency and better integrated health and social care.