The Times - UK (2020-07-28)

Dark dramas are more

cheering than romcoms

Libby Purves

Page 24

proposed the cap in 2011, said this

month that it should be £45,000.

Some Tories have suggested it could

be as high as £100,000, but that

would mean voters in some “red

wall” seats potentially having to sell

their homes.

Social care policy has been

politically toxic for successive leaders

and political parties. In the run up to

the 2010 election Gordon Brown was

accused of planning a “death tax”

and in 2017 Theresa May’s proposals

were branded a “dementia tax”. Any

radical reform that costs billions of

pounds will be controversial, but

Covid-19 and an ageing population

has now made it impossible to avoid.

Mr Johnson has promised to build

a “cross-party consensus” but will

not be able to win the support of

Labour and the Liberal Democrats

without significant increases to

funding and changes to the

immigration rules. A growing

number of senior Tories now know

that fundamental reform is required.

“This is a once in a generation thing,

it can’t be done in a black box with

the opposition parties shut out,” one

says. If the prime minister wants to

secure a legacy that can bring the

country together, after the divisions

of recent years, it is time to move

beyond ideology on social care.

Social care could be Johnson’s great legacy

If the prime minister U-turns on visa rules and bites the bullet on new taxes, he could succeed where others have failed

says an insider. “The government has

already shown it’s not afraid of

U-turns. Doing everything at once in

a Big Bang reform makes it easier

because it’s part of a package.”

That is not the only battle

looming. The prime minister is also

being urged to face down Tory

rightwingers and back a tax rise for

older workers to pay for their social

care. The proposal being discussed in

the Department for Health and

Social Care is for employees over 40

to pay about 1.5 per cent more in

National Insurance, with a similar

contribution from employers. There

would then be a lifetime cap on care

costs paid by individuals, with people

encouraged to take out insurance to

fund the bills up to this limit. No

decision has been made on the level

at which this should be set but

Sir Andrew Dilnot, who originally

Boris Johnson has a once-in-a-lifetime

chance to overhaul care for the elderly

for social care staff, despite their role

on the front line of the pandemic.

They were also omitted from the

separate three-year settlement

awarded to nurses and other NHS

employees in 2018. There is little

sense of career progression: after five

years, a care worker typically earns

only 15 pence more per hour than at

the start. The earnings gap between

the NHS and social care is growing.

A care assistant working in the

health service is paid 21 per cent

more than someone doing a similar

role in a social care setting and so it

is not surprising that many workers

are choosing to take NHS jobs

instead. One Whitehall source says:

“We need to sort out pay and

conditions to make social care an

attractive choice — at the moment

you can earn more, with less

emotional strain, working in a

supermarket. There needs to be

parity with the NHS.”

Creating a level playing field

involves money, of course, but

insiders acknowledge that it also

means looking again at the exclusion

of care workers from the fast-track

health and care visa that forms part

of the post-Brexit immigration

regime. Almost 20 per cent of care

workers have come to this country

from abroad (rising to 40 per cent in

London) and providers are already

warning of a catastrophe next year

when the new immigration system

comes into force. The Home Office

insists that social care providers

should pay enough to attract British

workers but the Treasury has not

given them the £1.8 billion a year

that it would cost to increase wages.

If there is to be true integration

between health and social care then

that must apply to immigration rules

as well as to budgets. “They’re going

to have to revisit the visa issue,

otherwise it’s not going to work,”

I

t is a year since Boris Johnson

promised to “fix the crisis in

social care once and for all” and

the “clear plan” he claimed to

have in place twelve months ago

is finally taking shape in Whitehall.

The coronavirus pandemic has

exposed the flaws in the system and

highlighted the need to better

integrate the NHS with social care.

There have been more than 25,000

excess deaths among care home

residents, and care workers have had

the highest death rates of any

occupational group. According to

Age UK, an estimated 1.5 million

people over the age of 65 — nearly

one in seven — are now struggling

without the help they need to carry

out everyday tasks.

One senior Tory says the “burning

platform of Covid-19” has turned a

medium-term priority into an urgent

one and proposals are now

developing “at pace” with a view to

an announcement in the autumn.

Rachel Wolf, the policy adviser who

co-wrote last year’s Conservative

manifesto, has been brought into the

Department of Health and Social

Care to oversee a “Big Bang”

blueprint for reform. The result is

likely to lead to a row with the Home

Office over immigration policy and a

showdown with Tory traditionalists

over tax rises, but it is one that the

prime minister must win.

The starting point for the review is

the quality of the social care system

rather than the funding mechanism

for delivering it. The aim is to

improve the care given to the elderly,

create greater stability and

encourage more providers into the

market at the same time as

reassuring people that they will be

looked after in old age without

having to sell their home. There will

be a further drive to co-ordinate

provision between the NHS and

social care, with Greater Manchester

— where resources are pooled and

GPs routinely visit care homes —

seen as a model for the rest of the

country. People are likely to be

given greater choice over the type

of care they receive through

personalised budgets.

Crucially, tackling the workforce

crisis in social care is now also seen

as a priority. Yesterday a report from

the charity Skills for Care said that

an extra 520,000 workers would be

needed by 2035 just to keep pace

with the rising number of elderly

people. There are more than 120,000

vacancies in the care sector and

almost a third of workers leave their

jobs every year. The high turnover

makes it much harder to deliver good

care, which depends on building up

relationships, and it also makes

homes more vulnerable to infection.

A study in May and June by the

Office for National Statistics found

higher levels of coronavirus in care

homes that used more agency staff

or did not offer sick pay.

Yet a quarter of care workers are

on zero-hours contracts and 90 per

cent are paid below the living wage.

Last week the chancellor announced

pay rises for doctors, teachers and

police officers but there was nothing

A quarter of care

home workers are on

zero hours contracts

Senior Tories accept

that fundamental

change is needed now

Comment

@rsylvestertimes

Rachel

Sylvester

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