Guest blog by Caroline Abrahams

The 10th anniversary of the publication of the Dilnot Commission’s report is almost upon us, a good point at which to reflect on what has changed as regards social care – and what hasn’t, and on what needs to change now.

To a depressing extent we are in roughly the same place as regards social care as we were a decade ago, only worse. The social care system was not viewed as particularly effective then but is struggling even more now in the face of rising demand from increasing numbers of older and disabled people, and budgets that have failed to keep pace. For those lucky enough to be receiving a service the quality of care on offer is often pretty patchy. There are chronically high levels of vacancies in the workforce, and of churn, neither conducive to decent care, given the reliance on building strong relationships. Providers come and go and recently we have seen the emergence of ‘care deserts’ – places where care cannot be purchased for love or money because there is no one wanting to do the job.

I should add that this description is of England: while we have stood still the other constituent nations of the UK have forged ahead in a variety of ways in reforming their social care systems, leaving older people here as second-class citizens.

Andrew Dilnot was commissioned by the Coalition Government to look at how to protect the public from the risk of sky-high care bills, if they needed care for a long time. This was a problem then and remains so now, but it’s by no means the only one bedevilling social care. However, we can’t blame Sir Andrew (as he has since become) for not looking at a wider range of reforms in his report – he did what he was asked to do. He and his colleagues also made an explicit assumption in their work that social care would be properly funded: the Commission’s recommendations need to be read with this in mind.

Now, ten years on, although the paving clauses for implementing the cap on catastrophic care costs which Sir Andrew recommended are in statute, they are still to be actioned – the Coalition Government and its Conservative successors having decided that bringing them to life would be too politically difficult and/or pricey. It is believed that the Treasury has repeatedly ‘blocked’ reforms of all kinds to social care because of these reasons, the latter especially.

Is all this about to change and will Sir Andrew finally see his scheme brought into practice? Quite possibly, if you believe what the Prime Minister has said. He is thought to favour the idea of the cap, as the centrepiece of the reforms he promised to introduce in order to “fix social care once and for all”. That pledge was made, you may recall, on the steps of 10 Downing Street, following his triumph at the 2019 General Election.

Two years have passed since then with very little to show for it, but this may be in large part because of the pandemic, a seismic event in all our lives which in and of itself may also have strengthened the case for reforming social care. Some 40,000 care home residents and several hundred care staff have died before their time from COVID-19 so far, a shockingly high death toll when compared to the number of deaths overall (c.128,000). It is generally agreed that had social care been better resourced in terms of funding and staff when the virus came roaring in then some of these lives might have been saved. Sadly, we can’t bring those people back but at least we can ensure a similar tragedy cannot happen again.

That’s why there is now some cautious optimism that this Government may finally do what others have ducked and act to reform and refinance social care. However, it is hard to see how the Prime Minister could say he is fulfilling his promise by only introducing a cap on catastrophic care costs. Thinking about all the horrors we have seen affecting care homes during the pandemic, no one would logically conclude that the ‘answer’ is merely to provide some financial help to those people who buy their own care and need it for a long time. A more realistic solution for the fragility and erratic quality of social care would be to invest significantly more money in councils’ care budgets, plus action to professionalise and strengthen the workforce – as well as a ‘Dilnot cap’, if that’s what the Prime Minister wants.

This is certainly what my organisation Age UK is calling for, alongside our friends in the Care and Support Alliance – comprising 75 disability, carer and older people’s charities. It’s also what Sir Andrew Dilnot says is needed, in the context we find ourselves in now compared to a decade ago.

If the Government agreed to a three-pronged package of this kind then it would go a long way towards keeping the Prime Minister’s promise. It would probably cost an extra £10 billion a year – a big sum in anyone’s terms, but small when compared to what we spend on the NHS and on what we’ve spent managing the pandemic to date.

Will it happen? I hope so – but we may have to wait until the Autumn Spending Review to find out.