Boris Johnson has created a ‘social care plan’ without any plan for social care

By Frances Ryan
Illustration by Matt Kenyon
Illustration by Matt Kenyon Illustration: Matt Kenyon/The Guardian

Two years after Boris Johnson promised a plan for social care, it can hardly be said that today’s announcement was “worth the wait”. As one Tory backbencher put it, “If the ‘big reveal’ of a decade of thinking is this, then some people want sacking.”

Unlike the NHS, social care – be it long-term support for elderly people in residential homes, or assistance to disabled people in their own homes – is not free at the point of use in England. Instead, it has been means-tested and provided by a patchwork of individuals, charities and private companies all overseen by local authorities.

The last decade has seen state funding recede by £8bn under austerity at the same time as demand has risen, with older people living longer and more working age adults living with disabilities. The result has been squeezed budgets, underappreciated staff, and a decrease in the standard of care. Some disabled or older people and their families have had to foot bills that can run into the hundreds of thousands, while others have been left to endure inhumane conditions because they have no care at all.

Currently, anyone with assets (usually a home) over £23,250 has to pay their care costs in full, but Johnson’s proposed changes will mean that anyone with assets below £20,000 will have their fees covered in full. Those with assets between £20,000 and £100,000 will be expected to contribute to their cost of care up to £86,000, but will be eligible for support on a sliding scale. In a deeply regressive move, these changes are to be funded by a 1.25 percentage point increase in national insurance contributions and tax dividends – putting the burden on young workers, but not wealthy pensioners. Further still, social care will continue to play second fiddle to the NHS: much of the initial funding will go to reducing the healthcare backlog.

These proposed changes will reduce the amount some people pay for care – and importantly for the Tory base, will mean preserving people’s inheritances. But the plans do little to address the systemic issues facing the sector. The problem with the government’s efforts is not simply the lack of adequate cash – it’s a lack of vision for how to use it. Johnson has managed to create a social care plan that essentially has no plan for social care.

The mass outsourcing of social care to the private sector in recent decades is in many ways the elephant in the room. There is no point increasing government funding if the money goes to lining the pockets of private equity magnates who own our care homes and services, rather than improving care workers’ wages or patients’ care packages.

Few could claim outsourcing brings good value or high standards. Last year, the Care Quality Commission found that one in six care providers in England were not meeting acceptable standards. It’s time for a conversation about bringing more services in-house and expanding social care co-ops run by communities – and at the very least, some accountability on profits and waste.

Then there is the issue of staff shortages. Recent debate over the sensible “no jab, no job” policy distracts from the real causes of the staffing crisis: more than 70% of care workers are currently paid less than the real living wage, and a quarter are on zero-hours contracts, meaning no sick pay for back-breaking work.

If Johnson is to fix care shortages, care staff must be brought into parity with their NHS colleagues, paid the living wage, and given the right to a staff contract. When a growing number of carers prefer to work in the conditions of an Amazon warehouse rather than care homes, something is seriously wrong.

Disabled care users have similarly been ignored in the new plan, despite half of all care budgets going on working age disabled people. Johnson’s pledge for a cap on care costs that protects a pensioner from selling their home is little use to a 30-year-old with a learning disability. Ministers must put an end to astronomical care charges in England that are seeing some working-age people living off little more than £3 a day.

Equally, younger disabled people should be given the right to – and funding for – independent living, which means support at home to live with dignity and fulfilment like anyone else. It is not enough for the government to offer “personal care”; after all, life is not just about having a shower, but also seeing friends and getting the kids to school.

No reform of social care can be complete without helping unpaid carers too, millions of whom will still be needed even in an improved system. Family carers (largely women) work around the clock and, at £67 a week benefit, receive less than the paltry sum given to jobseekers, while many get nothing due to harsh qualifying criteria. Carer’s allowance must be raised to lift carers out of poverty, and outside help given for their physical and mental health.

These plans are affordable – and fair – with the right long-term funding plan. Research by the TUC found increasing capital gains tax to the same level as income tax, and getting rid of exemptions, could raise up to £17bn a year for social care. Besides, cash spent on social needs is no less an investment than building roads; research by the Women’s Budget Group shows investing in care can create 2m well-paid jobs, as well as the savings that come from happier and healthier citizens.

No government should simply be out to “fix” social care – they must transform it. Progressives have rightly long been championing the creation of a “national care service” or a “national independent living service”, along the lines of the NHS: free at the point of use, universal coverage, with well paid and trained care staff at its heart. We shouldn’t apologise for demands for universal care on the grounds that it’s “too radical”. This is exactly what the scale of the crisis calls for – and we should be as proud of the principle as for the NHS.

Debates about care are not a chance for party political point-scoring. Their substance is real people’s lives – lives that have been blighted as they have waited years for the government to help them. Johnson had a chance to reform social care and finally deliver for millions of disabled and older people, family carers, and care workers. With this toothless plan, he has failed them all.

  • Frances Ryan is a Guardian columnist



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