A lot has been hanging on the Wanless report. The message people wanted to hear from it was simple. If chronically underfunded social care was to get anything out of the government’s forthcoming comprehensive spending review, then the report must be unequivocal about the need for more money.
And it is. Wanless calls for a three-fold increase in spending on social care for older people; for funding to rise from 1.1 to 2 per cent of gross domestic product over the next 20 years. Cheers all round.
But like a game of Monopoly, just when you think you’ve passed go, new problems emerge. Why, people were asking just as Wanless was about to report, did the government set up its own major review of social care? Is it some kind of smokescreen? Is The Times right to read the care minister Liam Byrne’s response to the report as “non-committal”? (30 March) And at what level exactly will thresholds be set for access to support?
It may be tempting to focus on second level issues like these and get sucked into detailed debate about the competing merits of Wanless’s partnership, free social care and limited liability models. But this shouldn’t be allowed to divert us from two fundamental issues that Wanless and indeed any other proposals for social care for older people, must transcend. One relates to older people themselves and the other still concerns money and politics.
The Wanless report is about the care of older people. But older people are far from being a homogeneous group. While they may be united by ageist discrimination, they are also significantly divided by class and income. That is why the Daily Mail was able to come out in support of less well off older people, making Wanless its front-page headline and presenting it as a “scathing report” which “accused social workers of pushing vulnerable people into residential care in order to grab their homes” (30 March).
If the traditional system of social care for older people provided pretty poor basics for the poorest, is Wanless’s preferred partnership option anything more than making sure that older middle England and its offspring are kept on side? For while initially the proposals look like offering a universalist service, over the guaranteed minimum that all would receive (about two-thirds of the “ideal” care package), older people must make matched contributions to state payments.
Isn’t that a case of to those that have (and can therefore contribute) shall be given? The report says that those who can’t afford to contribute will receive benefits. But doesn’t this bring us back to means-testing? How does all this square with independent living ideals of people receiving all the support they need to live on more equal terms with others who aren’t affected by frailties or impairments?
Then there’s money. This report offers government a third opportunity at funding social care. The Royal Commission on Long Term Care and the first Wanless inquiry had their recommendations for increased social care funding rejected. Social care leaders will expect Byrne to use the new report to try to lever further funding from the Treasury. But how will this fit government spending plans at a time of broader economic uncertainties? The context is not encouraging.
There are two immediate courses of action to take, however, before social care allows itself to switch into “poor me” mode. First, there is nothing to stop us taking forward the positive proposals for prevention and individual control that Wanless endorses. Second, service users and their organisations must be more fully involved in the crucial next steps. Not least this must mean adding them to the membership of the new government review group.
All of us may not get what we want, but at least we will then be more likely to be heading in the right direction.
Peter Beresford is professor of social policy, Brunel University, and is involved with the mental health system survivormovement