There comes a point when delay itself becomes a decision. Reports that fundamental reform of social care under the Labour Government will now have to wait until after the next general election should concern every family in this country, regardless of their politics. This is not about party political point-scoring. Successive governments have struggled with social care and successive governments have failed to resolve some of its most fundamental problems. But that history cannot become an excuse for continuing to pass the problem from one Parliament to the next. The Government itself said only in July that it wanted to end “decades of political drift” on social care, acknowledging that too many older and disabled people are being let down and that millions of unpaid carers are carrying an enormous burden. It also accelerated Baroness Louise Casey’s work towards a National Care Service. So if the emerging reality is that the fundamental reform people have been promised will not arrive before another general election, we need to ask a very serious question –how much longer are the people actually living with the consequences expected to wait?
For more than a decade at Care Campaign for the Vulnerable, I have listened to families describe what happens when the system does not work as it should. Behind every discussion about reform, commissions, funding and long-term strategies are real people trying to care for somebody they love. They are navigating dementia, frailty, disability, safeguarding concerns, NHS Continuing Healthcare, hospital discharge, funding decisions and care placements, often at one of the most difficult moments their family will ever experience. They cannot place those circumstances on hold until after another election.
A general election may feel relatively close in Westminster. It can feel like a lifetime to somebody living with dementia. Several years may represent a substantial part of the remaining life of an older person already requiring care. It can mean thousands more mornings for a husband caring for his wife, or a daughter juggling employment and children while trying to keep a parent safe. It means more years in which care workers and providers are expected to manage increasingly complex needs while the wider system waits for its promised transformation.
That is why I believe we need to challenge the language of “long-term reform”. Of course reform must be sustainable. Of course decisions about funding, workforce, prevention, integration with the NHS and responsibility between individuals and the state are enormously difficult. Baroness Casey’s Commission exists precisely because these questions require serious consideration, and its work is currently engaging the public in what care should provide and who should pay for it. But complexity cannot become paralysis. There is an enormous difference between saying that the final destination will take years to reach and saying that meaningful change must therefore wait for years.
What concerns me most is how accustomed Britain has become to waiting for social care reform. We have normalised the language of crisis. Another review. Another commission. Another consultation. Another set of recommendations. Another government promising that this time social care will finally be addressed. Somewhere along the way, we have stopped asking the most basic question: what is the human cost of waiting?
Social care is also still treated too often as though it is separate from the NHS. It isn’t. When social care cannot respond, hospitals feel it. When somebody cannot be discharged safely because appropriate support is unavailable, hospital capacity feels it. The Government itself has acknowledged that failures in social care contribute to people remaining in hospital after they are medically fit to leave and add pressure elsewhere in the NHS. If we genuinely want to protect the NHS, social care cannot continually be treated as tomorrow’s problem.
Families themselves have also quietly become part of the infrastructure keeping the system functioning. They chase assessments, read care plans, question medication, attend meetings, monitor deterioration, challenge decisions, organise appointments and fill gaps. Many become extraordinarily knowledgeable, not because they ever wanted to become experts in social care, but because loving somebody vulnerable gave them no alternative. Imagine for one moment what would happen if every unpaid family carer simply stopped tomorrow morning. We would very quickly understand how much of our care system is being held together inside ordinary people’s homes.
And while national reform is debated, there is much that could be changing now. We can improve transparency and accountability. We can invest in the skills and status of the care workforce. We can use technology more intelligently to prevent falls, recognise deterioration and support independence. We can improve communication between providers and families. We can make safety, dignity and choice the foundations of care rather than competing priorities. We can confront the bewildering divide between health and social care that leaves families trying to understand why one person’s complex needs are funded by the NHS while another person’s apparently similar needs become their family’s financial responsibility.
There is extraordinary innovation already happening across social care. CCFTV sees it through our work with families, care providers, professionals and technology innovators. There are outstanding care workers and providers trying to change things. There are technologies capable of identifying risks earlier and supporting people to remain independent for longer. There are people throughout the sector who know exactly where some of the problems are and have practical ideas for solving them. The tragedy would be to allow the pursuit of one enormous future reform to prevent us implementing hundreds of achievable improvements now.
And this is where I believe government should be challenged. If the complete transformation of social care cannot happen before the next general election, then tell the public what will.
Give us a timetable. Give us measurable commitments. Tell families what will be different in 12 months, 24 months and 36 months. Tell care workers what will change for them. Tell providers what certainty they can expect. Tell unpaid carers what support will actually reach them. Tell people living with dementia, disability and complex needs what improvements they will experience during this Parliament.
Because accountability cannot simply be another promise that the next system will be better.
Social care ultimately asks something profound about us as a country. It asks what value we place upon a human being when they become dependent upon others. Most of us will encounter that question eventually. It may be our mother, our father, our husband, our wife, our child or ourselves. When that day comes, nobody will care which government commissioned which report or which party originally proposed which funding model. They will want somebody to answer the telephone. They will want appropriate care to exist. They will want the person they love to be safe. And they will want them treated with dignity.
That is why today’s reports should matter far beyond Westminster.
We have spent decades asking how we are going to fix social care. Perhaps it is time to ask a more uncomfortable question of how many more people will grow old, become ill, care for someone they love, reach breaking point or die while Britain is still discussing how to fix it?
People understand that genuine reform takes time. What they should no longer be expected to accept is a political system in which waiting becomes the reform.
