Who cares? The coming debate over social care.

Author:Churchill, Neil

To many voters, it has become hard to spot the key policy differences between Labour and Conservatives. In recent weeks, we have heard David Cameron pledge to match government spending plans for the NHS, champion patients, reduce poverty and improve rape convictions. It is Labour's achievement to have defined the centre ground so powerfully, but the party's offer now looks indistinctive, and the government's autumn horribilis shows that management competence is not a simple election-winning strategy.

Yet there is one electoral battleground which remains largely uncontested and where there is potential for clear water between the parties on principle and not just competence. This is the battleground for older voters and the rising political issue of adult social care, which are the essentials of everyday living many of us take for granted--help getting out of bed, going to the toilet or taking a bath. The challenge was laid out by Sir Derek Wanless in a report for the King's Fund (Wanless, 2006) which showed that Britain faces a growing crisis in providing and paying for care needed by thousands of people now and in the future. His message was stark: we are failing to meet the needs of today's older people and the situation will be exacerbated by the fact that many more people in our ageing population will live to need care services.

This is not the first report to point out the challenge: Labour set up a Royal Commission shortly after coming into office ten years ago but rejected its recommendations (Royal Commission on Long Term Care, 1999). But this time looks different. Wanless pinpointed not only the extent of today's significant unmet need but also the drivers of future need: growing longevity means there will be a doubling of people with dementia and pressures on choice and quality will arise from the higher expectations of the baby boomer generation now reaching retirement. In his report, Wanless concluded that a new partnership between individual and state was needed based on fundamental reforms, his call has been ably championed by Ivan Lewis, the care minister and a new Green Paper has been promised but no timetable has been set.

Since his report, Wanless and other commentators have expressed cautious optimism that reforms will be in the offing. But this optimism masks the fact that real and difficult choices will still need to be made. This was thrown into stark relief by Gordon Brown's New Year message. Although 2008 will sow the seeds for a long-term programme of government, he said, it will also be a year of economic belt-tightening and mounting pressure on public and individual finances. That makes it even more important that there be strong political leadership to frame the debate before the media and eventually the public are disappointed by what is on offer.

Gordon Brown has already recognised that social care presents a substantial policy challenge. In part, this is recognition of the fact that what services there are have been increasingly restricted, across the country, to people with the most severe needs. For some, services once available have been withdrawn in the face of funding pressures, even if the individual's needs have not changed. Although social care has not been politicised to the same extent as the NHS, failings of care have started to get publicity, and there have been a stream of stories about neglect, disinterest and abuse. Given that this affects some of the most vulnerable people in society, it is not surprising that the Prime Minister and Health Secretary Alan Johnson have expressed themselves determined to act.

The spring of 2008 will however be crucial in...

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