I took part in an ‘Urgent Question’ debate in the Commons today, 23rd June, about the future for Adult Care.
Finding a way to fund support for both vulnerable adults through their lifetime and for older people in their final years, especially if they have increased physical infirmities and / or dementia, has been a subject of interest to me for this entire century: Especially so as a County Council Leader (2009 to 2013) and as Deputy Chairman and then Vice-President of the Local Government Association (2011 to present).
It is a subject of intense discussion and of urging the Government to act from the Select Committee of the Commons that I sit on – Housing, Communities and Local Government – and I am also Vice-Chairman of the All Party Parliamentary Group for Adult Social Care (chaired by former First Secretary of State, Rt Hon Damain Green MP) where similar calls for action emanate from.
Since the late 20th century numerous think tanks have identified that the funding mechanism for adult care, created in the late 1940s, and the lack of sufficient joined up work between the NHS, Councils and the private sector has led to adult care provision in England being less good than it is in comparable countries, such as Germany, Japan and the Netherlands.
Countries with the highest levels of satisfaction for adult care services tend to use insurance schemes (with ‘safety nets’ for those unable to pay), but for some reason, the Government (and indeed its predecessors) seem unable to fully grasp the opportunities that such schemes would provide.
I remain concerned by the lengthy delays in the production of a ‘solution’ for adult care; the Prime Minister had remarked that he had a prepared plan 700 days ago. I am also concerned that there is a temptation to lump adult care in with an already over-stretched NHS; when the private and voluntary sector and local government and housing providers need to be at the heart of provision. I am concerned that instead of insurance options there will merely be an unwelcome addition to already well above optimum tax levels to cover the undoubtedly significant costs of adult care in the years ahead.
I do not think it is a politically contentious statement to say that the Minister answering questions about Adult Care at the Despatch Box today was not giving much away about the direction of travel. I therefore - just about - cling to hope that a creative solution, using the power of the market but protecting those on low incomes, could still be forthcoming. My question had to be short, as there were so many speakers today and can be found here (https://fb.watch/6kadvTft8D/), but had time permitted, this is what I wanted to contribute:
The Report of the joint Health and HCLG Select Committees - of which I was part – left open the possibility of insurance type solutions for Adult Care funding, as successfully operated in many comparable countries to our own. This would have advantages in terms of finance, focus and structure.
Finance – As it would not just be a general or hypothecated increase to taxation which was already, pre-Covid, at the highest sustained percentage of GDP for 70 years.
Focus – In that those needing lifelong care for serious conditions could then be the focus of state funding, rather than those needing end of life care.
Structure – As insurance would avoid a purely NHS-defined land grab when we know that housing and choice are key to good adult care outcomes and that local government having a large scale role allows for that flexibility, choice and meaningful input from charities, business and local communities.
Can my Honourable Friend both confirm that insurance based solutions and an enhanced role for local government remain options for her and the other key decision makers when determining the way forward for Adult Care?