112.Aware that previous attempts to reform social care had not come to fruition, we wanted to explore what was needed to ensure that the forthcoming Green Paper would lead to successful reform. We consider what might be required in this chapter.
113.We received strong representations from the sector that, after successive failed attempts over many years, reform was now critical and that it would stand most chance of success if the proposals were developed and supported by all political parties.
114.Within Parliament, there is also a clear appetite for a cross-party approach to reform. In November 2017, 90 Members wrote to the Prime Minister arguing that “only a cross-party approach could deliver a sustainable settlement for [social care] where conventional politics had failed to do so”. This followed a letter to the Prime Minister from the Chairs of the Public Accounts, Health and Social Care and Housing, Communities and Local Government Committees in January 2017, calling for a “political consensus” on funding social care.
115.A cross party approach is likely to be particularly valuable in identifying and gathering support for the sources of extra funding for social care. Sir Andrew Dilnot pointed out that the fact that a cap on care costs was already on the statute book, albeit not implemented, showed there was political consensus on “what the money should be spent on”. He continued:
Where there is not consensus is where the money should come from. That is what is always politically most toxic for Governments. The debate is much more now about where the money should come from than about what the money should be spent on. My advice for any institution trying to build consensus would be try to focus on that.
116.Indeed, previous attempts to identify sources of additional revenue for social care have become highly politicised. In 2010, plans by the then Labour Government to introduce a National Care Service paid for by a 10% levy on top of inheritance tax, were labelled a “death tax”. Then, in 2017, proposals in the Conservative manifesto to means test the Winter Fuel Allowance and scrap the triple lock on pensions in order to pay for the introduction of a more generous means test with a floor of £100,000 of savings and assets (including housing assets) attracted criticism from other political parties and in the media. And, before it was subsequently announced that there would be an absolute limit on the amount people would have to pay towards their care, the floor itself was labelled a “dementia tax”.
117.A cross-party approach is also more likely to ensure lasting reform, insulated from future political interference. This is particularly important in the case of complex, multiple-stranded reform likely to take longer than a single Parliament to implement. The members of the Citizens’ Assembly viewed future political interference as a particular risk. Their foremost principle underpinning reform was that the solution should be “long term”, “untouchable” and have “constitutional protection”. They identified one of their key messages as “Make sure there is cross-party consensus and social care stops being pushed about by party politics”.
118.Lastly, Germany’s experience of reforming social care funding through political consensus is instructive. In 1994, in response to increasing pressures on their publicly funded care system, they introduced a mandatory long-term care insurance scheme requiring contributions from employees and employers. As the then CLG Committee discovered on its visit to Berlin in December 2016, attracting cross-party political backing for the proposal was essential to its eventual implementation. This finding led to their recommendation in their March 2017 report on social care that political parties across the spectrum should be involved in the process of reaching a solution in England.
119.A cross-party approach on reforming social care funding is essential if we are to achieve final and lasting reform. There has been a failure in the past to make progress on reform, resulting from the use of unhelpful, party political terms like ‘death tax’ and ‘dementia tax’ which could have been curbed by a cross-party approach. This issue is unlikely ever to be fairly addressed in the midst of an election campaign. Furthermore, such an approach would also help to guard against partisan political interference after the reforms have been implemented.
120.As the discussion in previous chapters has demonstrated, long-term funding reform for social care is a challenging issue, particularly given that aspects of reform relating to revenue raising can become highly contentious. While a cross-party approach would help to alleviate this, the vehicle or mechanism through which it can be delivered is also extremely important.
121.The Institute for Government (IfG) identified the mechanisms that have previously been used to tackle “similarly knotty issues”, pointing to the Pensions Commission, the Parliamentary Commission on Banking Standards (PCBS) and the Committee on Climate Change. They said that inquiries or commissions could be “effective mechanisms for building and maintaining political consensus on controversial issues”. By way of illustration, the PCBS was created by Parliament, at the instigation of the Government, to examine professional standards and culture in the banking sector following the LIBOR scandal and conduct pre-legislative scrutiny of the Financial Services (Banking Reform) Bill. The PCBS is widely considered to have been a success, setting out proposals for radical reform of the industry.
122.The concept of parliamentary commission commanded support among the social care sector, unlike a Royal Commission which it was felt would take too long given the urgency of the need for reform and would repeat the research and analysis already undertaken by previous commissions. UNISON, however, was not convinced that a cross-party commission would work, saying that “narrow party interests [were] always likely to intrude on genuine attempts to foster cross-party consensus”.
123.A parliamentary commission is also the approach favoured by many parliamentarians and there would be a clear benefit to harnessing this momentum. In March 2018, over 100 MPs from across the political spectrum, including 21 select committee chairs, wrote to the Prime Minister urging her to set up a Parliamentary Commission on Health and Social Care. They pointed to the success of the PCBS and emphasised that such commission could build support for reforms in parliament, report in a timely fashion and take a “whole system” approach, considering funding for social care, health and public health in the round.
124.The IfG has identified the conditions which are helpful to the success of a commission. Nick Davies, Programme Director at the IfG, told us that, for the best chance of success, it should be commissioned by the Government and have “active buy in” from either the Prime Minister or the Chancellor, ideally both, and “reach out” and “bind in” the Opposition. In addition, it would need to be timely (reporting within nine months to a year), be properly resourced and be led by someone respected on both sides of the House and with a grasp of both the policy and politics involved. Lastly, and critically, it would need to engage successfully with the public (we consider the need for public engagement in the next section).
125.Although not cross-party, the 2002–6 Pensions Commission was cited in evidence as another successful example of a commission building consensus around a charged political issue to achieve effective outcomes. It is particularly noteworthy for its independence from the Government, effective chairing, rigorous approach and analysis, and in-depth and skilful engagement with major sector stakeholders and the public.
126.The concept of a cross-party parliamentary commission currently has the support of more than 100 MPs from all English political parties. As a proven mechanism for building and maintaining political consensus on difficult issues, and following other unsuccessful attempts at reform, we strongly recommend that a parliamentary commission offers the best way to make desperately needed progress on this issue. We note the key elements of the Pensions Commission which led to its success—independence, timeliness, engagement with key stakeholders and the public, and transparency.
127.Using the principles set out in this report as a basis for proceeding, a parliamentary commission should look at the specific proposals we are making, together with the recommendations made in the Green Paper, in order to determine the mechanisms which will provide a long-term funding solution for social care. To ensure the systems are properly joined up and a ‘whole systems’ approach to funding reform is taken into account, the parliamentary commission should also look at how the funding for social care relates to funding for health and public health.
128.Alongside political consensus, public engagement in the reform process—with the general public, as well as people who receive social care and other stakeholders—will be critical to its success. Crucially, engaging service users and other interested parties will improve the quality of the proposals and ensure that they meet people’s needs and are workable. We commissioned a Citizens’ Assembly for precisely these reasons, keen to ensure that our inquiry and its eventual conclusions and recommendations were informed by the views of the public.
129.Building understanding of social care is an essential element of successful public engagement. As identified earlier, not only is the public reluctant to consider social care, they have a poor understanding of the current system, the challenges it faces and how it is paid for. Indeed, many people anticipate that their social care will be free, believing they will have paid for it via taxation throughout their lives. This lack of knowledge can be a barrier to securing the public’s support for proposals which stand to affect them financially. Caroline Abrahams of Age UK explained:
Politically, having to say to people, “Well, you know that thing you thought was free, here is the bad news: you are going to have to pay something towards it. But here is the good news: it is not quite as much as you might otherwise would,” is a tremendously hard argument to get across.
The failure to build public understanding ahead of attempts at reform in 2010 and 2017 may have contributed to the poor reception which they received. Indeed, the Alzheimer’s Society said that the dementia tax debate revealed that the public had “little understanding of how the system works”. We heard that provision by the Government of accessible, easily understandable and clear information alongside the reform process would help.
130.The evidence we received did not generally consider how to engage the public on social care reform; indeed, the IfG said that the particular methods used would depend on the role of the body conducting it. However, organisations submitting evidence had often conducted their own public engagement—using online surveys, focus groups, workshops and interviews—showing that there are a range of possible approaches and methods. Our Citizens’ Assembly also provides a possible model for further public engagement, combining building understanding with an exploration of the issues and decision-making. Assembly members were taken through a process of learning, deliberating and decision-making which enabled them to tackle difficult questions about where funding for social care should come from. They identified the benefits of this process themselves, agreeing on the message:
Don’t underestimate the public—once they know they will be willing to pay. The lesson from these two weekends is that when everyone is informed consensus develops.
Elsewhere we heard that, once given the opportunity to engage, people begin to feel strongly and passionately about the issue of social care reform.
131.Engaging the public in the reform process will be critical to its success. The Government should commit to a public engagement process, which builds the public’s understanding of social care and the challenges it faces and explain why reform is needed. This is an essential step in gaining public support for proposals which are going to ask them to pay more in order to improve the system. This must be supplemented by the publication of clear and comprehensible costings of different funding options, which are communicated in a clear, impartial, and jargon-free way to the general public.
132.Engaging with people receiving social care, carers, relatives and care workers, and others with a stake in the outcome of the reforms, throughout the reform process is also critical. This will help to ensure an outcome that meets people’s needs, receives their backing and, ultimately, has the best chance of success. A Parliamentary Commission, although primarily focused on the funding mechanisms, could also play a role in engaging the public and stakeholders.
210 The King’s Fund (); The Local Government Association (); ADASS (); County Councils Network ()
211 , BBC News (18 November 2017)
212 (6 January 2017)
213 . See also ADASS ()
215 ADASS (), The King’s Fund ()
216 HCLG Committee, , Ninth Report of Session 2016–17, HC 1103 (March 2017)
217 Institute for Government ()
218 The King’s Fund ()
219 A royal commission is an ad hoc advisory committee appointed by the government (in the name of the Crown) for a specific investigatory and/or advisory purpose. They usually take several years to report.
220 UNISON (), ADASS ()
221 The King’s Fund ()
222 UNISON ()
223 , March 2018
226 Institute for Government,
227 Institute for Government ()
228 Institute for Government ()
229 Leonard Cheshire Disability ()
230 The 47 Assembly members were representative of the English population and a proportion had experience of the social care system, either directly or through a relative or friend.
234 The King’s Fund ()
235 Care and Support Alliance (). See also Demos ()
236 Institute for Government ()
Published: 27 June 2018