The “deep reform” that social care needs (Editorial, 3 December) must break the cycle of short-term fixes and insufficient funding, which leaves the sector in a perpetual state of uncertainty – forever playing the role of Oliver Twist asking for more, yet lacking long-term security.
A better-funded version of the current system won’t suffice to address the profound demographic, societal and technological shifts shaping the future. Having helped steer the Care Act into law and set up the Dilnot commission, I know how challenging it is to get long‑term reform agreed upon.
Landing the cap on lifetime care costs proved nearly impossible during my time as a minister. A workable solution fell victim to a classic case of “making the best the enemy of the good”, with no consensus on what “best” meant. Efforts to secure sustainability were stymied by disagreement within the coalition government.
In hindsight, Andrew Dilnot should have had the flexibility to interpret his remit to achieve broader political buy-in. Despite his tireless efforts, the lack of a consensus left the issue stuck in the mud.
A new royal commission – or a similar process – must have the right remit. It need not start from scratch, given the reports and inquiries available. The focus should be on navigating trade-offs to achieve a workable cross-party settlement.
Any resolution must address three interconnected issues. First, adapting care models to meet the population’s changing needs over the next 10-30 years. Second, securing robust workforce plans while accounting for demographic pressures on labour markets domestically and globally. Third, balancing entitlements, burden-sharing, risk-pooling and taxpayer contributions equitably. Cross-party buy-in is essential to breaking the logjam. This cannot be a government-only solution. Moreover, the Treasury must support rather than obstruct the process – this is a can that can no longer be kicked down the road.
Paul Burstow
Chair, Social Care Institute for Excellence; minister of state for care 2010-12
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