Indignation fatigue makes it hard to keep track of the many public service failures, so social care has fallen from the public eye since Covid – though it goes on getting worse. Its failings block more hospital beds with elderly patients who can’t be released because there’s nowhere for them to go. More people needing care find rising barriers of ever-higher criteria, leaving them with none. Quality is so appalling in some places that councils in England have spent £7.5bn since 2019 paying for care rated as “inadequate” by the regulator. All this is laid out graphically in a report, Support Guaranteed, published today by the Fabian Society.
Labour’s shadow health secretary Wes Streeting and the trade union Unison commissioned the report to lay out a roadmap to a new National Care Service. This is the right time for Labour to explore radical policies, planning how to implement them, as centre-left thinktanks did in the run-up to 1997. It doesn’t commit the party to a policy, but it does the research and the thinking, ensuring it is ready for power. The report shows what good care should look like, the order and priorities for improvement and how to do it – when funding permits.
The first, most urgent step is the one Keir Starmer recommitted to in his speech this week to the GMB conference, promising care workers would be the first to get a fair pay agreement, which Labour will roll out across all sectors: this will “set a new floor, a higher floor” for wages. The failure to recruit and retain care workers is so acute there are 165,000 vacancies, a number that is growing by the month. The report’s co-author Andrew Harrop told me that many leave for higher pay as healthcare assistants in the NHS, with a chance for an upward career path – so this report recommends a gradual alignment of employment terms between the two services. But consider this: the Health Foundation says it will cost an extra £6bn by 2030 to keep social care in its present sorry state, just to stand still without improvement.
Beyond a fair pay agreement, for which councils need to be funded, Labour has yet to commit to spending on care, or any other desperately needed service. It has said it will double the number of people trained as doctors and nurses, using money from abolishing non-dom tax breaks, but no commitments have been made yet about everyday NHS funds, nor about schools (beyond the bonus from charging VAT on private schools), or councils or further education colleges or early years teaching and childcare – let alone prisons, probation, courts, or everything else in a state of dire decrepitude and decline.
Labour is right to resist the pressure to effectively produce a budget for an election that is perhaps 18 months away. It will wait to make most of its spending commitments until it has seen figures in the Tories’ March budget. There will be an avalanche of attacks, such as this week’s accusing Labour’s spending “plans” of requiring a 3p income tax rise.
The attack is absurd as the items listed were not policy, but it was enough to prompt Starmer and his shadow chancellor Rachel Reeves to “read the riot act” at a Commons meeting this week, with a letter to the shadow cabinet warning “there will be no unfunded spending commitments – if something is not signed off, it is not policy”. The next election will be fought on Labour’s idea of fiscal responsibility: “It is important that everyone appreciates the high level of scrutiny we are under. The test of being trusted with the public finances is not optional – it is essential.” Time and again Labour will be accused of profligacy, the shades of Jeremy Corbyn’s last-minute free broadband for all at the last election acting as a flashing warning of how easily a pleasing promise turns into a signal of wild spending. After Liz Truss, the test got harder, unfairly, as she borrowed to splurge on tax cuts for the well-off, while Labour has pledged to borrow only for green growth investment.
The Fabian report’s 10-year plan is inspiring, but until we see what money gets allocated in the manifesto, it’s just a roadmap on a drawing board. It gives the recommendation from the Dilnot commission for capping costs at £86,000 quite a low priority, as improving care for those who get little or none is more pressing than spending money on easing the means test for the better off. (You could relax the means test and instead tax old people more, with pensioners paying national insurance on their income.) The serious crisis is not just about elderly people, but a lack of support for the fast-rising numbers of disabled adults aged 18 to 64 needing support, due to more babies surviving with disabilities.
The choices that Labour faces will be almost unbearable, the expectations near-impossible – Starmer and Reeves will need to be ruthless. Great questions must be confronted, such as how you share out spending on old people and young people. Political pressure and power is always with older voters, with most clamour for the needs of the NHS and social care, largely for elderly people. Children are the silent voices, which is why spending on them, their early years, schooling, benefits, care and mental wellbeing has fallen back severely in the past decade. As the cliche goes, they are the future, and so we wait to see who will be the winners in the great shadow cabinet spending tug of war.
Polly Toynbee is a Guardian columnist
