75 years ago today, Britain was waking up to a big hangover. But the headaches didn’t last long and were soon replaced by a clear-headed collective certainty about the future.
Until recently, I had never fully understood why the country voted in the way it did in 1945. Now I understand more. Hard times make people look at the world through new eyes. We see more clearly what is wrong and what needs to change. We are reminded how inter-dependent we all are and how life has more meaning when we work with each other rather than just for ourselves.
The national mood in May 2020 is perhaps more in tune with those wartime years than at any time since. And, just as the country voted then for a new approach to health, I hope it will now demand an equally radical change to social care.
It is almost exactly 10 years since I published a White Paper calling for a properly-funded social care service provided on NHS terms. In the years since, I have continued to argue for that crucial reform but have repeatedly come up against two problems.
The first is the shallowness of modern Westminster politics and the cowardice of our political parties. I have sat in many a room in Westminster, including the Cabinet Room, discussing this issue with Labour colleagues. I lost count of the times I was told we couldn’t possibly ask people to pay more in tax for better care and properly-paid care workers. “What would the right-wing press make of it?” they would say. “Is that the same right-wing press,” I would reply, “that is constantly campaigning, rightly, about people losing their homes to pay for care?”.
But I was banging my head against a brick wall. Outside of those meetings, Labour strategists worked diligently to keep shunting the issue back into the long grass.
It was even worse with the other side. I have sat around tables with senior Tories in confidential cross-party talks, which they requested, and had my breath taken away as I watched them walk straight out of those rooms and straight into Conservative HQ to spill the beans for an election poster.
Politicians in both of the main parties have been doing this for decades. The Tories certainly shoulder more of the blame because they combined a failure to reform with years of deadly cuts. But, to be clear, Labour has abjectly failed on social care too.
Both parties now need to face a reckoning for that colossal political failure. They need to be honest enough to acknowledge their own part in leaving an unreformed and under-funded social care system in no position to face this crisis.
Why wasn’t there more of an outcry before all this? This brings me to the second problem. Unlike most other public services, only a small minority of the public are directly in contact with social care services at any one time. Many people go through life not thinking much about social care only to receive a major shock when they are forced to sell their parents’ home to pay for care which doesn’t even give mum or dad the dignity they deserved.
This perhaps explains why there has never been a major groundswell of public opinion for change. Perhaps that is now building. For the first time, the gaze of the entire country is fixed on a failing social care system. For the first time, people can see how inter-connected it is with the NHS but how little attention care homes receive compared to hospitals. And, finally, people in care homes – those in need of support and those providing it – are more visible than ever and the public can see what a terribly raw deal they get.
The Resolution Foundation revealed recently how 58 per cent of care workers in England do not receive the real Living Wage. What have we come to as a country when people who devote their lives to caring for other people’s relatives are not paid enough to live on?
So, what better way of marking the 75th anniversary of VE Day, and of showing our respect to wartime generation who voted to create the NHS we idolise today, than by striking a new collective resolution to create an NHS-style social care system in England coming out of this Covid crisis?
The unpalatable truth is that the awful pandemic we are living through does not make another one any less likely in the years ahead.
Another will almost certainly happen again and we need to be able to look ourselves in the mirror and say we did everything to protect future generations by leaving in place a capable social care system that will be much better equipped next time around. But this is about more than preparing for the next pandemic.
The way we treat disabled and older people who need care, and the way we reward people who devote their lives to providing it, says so much about what we are as a society. Today, social care in England does not embody British values of fairness but, instead, has more in common with US healthcare than the NHS.
Over the year, my thinking has evolved. Back in 2010, I proposed a National Care Service as the answer. The problem with that is that it would still maintain health and care as two separate systems when in fact they need to be one. So now I would favour social care being provided on NHS terms – tax-funded and provided on the basis of need, not ability to pay – as part of single, fully-integrated health and care system.
That is a reform for which the 21st century, the century of the ageing society, is crying out. As we all live longer, our needs become a blur of physical, mental and social. We need a single health and care system capable of providing whole-person care, in which the care home and the hospital are two ends of the care spectrum but equally important.
But then the question comes – how will we pay for it? That is exactly the same debate as the one that faced the country in 1945. Back then, people had bitter experience of seeing people struck down by accidents or illness facing the second injustice of financial ruin through medical fees. 75 years on, the same is true of social care in England today. The most unfortunate amongst us, for instance those who develop advanced dementia at an early age, face utterly ruinous costs stretching to hundreds of thousands of pounds.
So the same principle should apply. Rather than leaving people facing unlimited costs, surely it would be better to pay a defined amount from what they leave behind – let’s say 10 per cent – rather than face losing everything? They would then have the peace of mind of free, high-quality care integrated with the NHS and the certainly that they could plan to pass on 90 per cent of what they worked for.
Some papers will call it a death tax. But so what? Let them. It is a much fairer system than the indiscriminate dementia taxes (otherwise known as means-tested care charges) that we have now. But, while it is right to ask the current baby boomer older generation to make a partial contribution to their care through their assets, the funding of social care should in time be gradually merged into general taxation.
It is time to finish the job the wartime generation started in 1945. We won’t have a fair health and care system in this country until it is able to support people with dementia as well as it treats Covid-19 or cancer. I can’t think of a better day to resolve to make that a new national mission.
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