Read any report on social care provision in the UK and it will typically start like this:
‘Adult social care in England needs fixing – and has done for decades.’ – Health Foundation, 2019
In other words there is no meaningful crisis – ‘a time of intense difficulty or danger’. Just an ongoing gap between the expectations of interest groups and reality. It is in that exact regard like the ‘climate crisis’: a problem to be solved, not a crisis. The issues involved are multitudinous, complex and not easily addressed. There are worries about funding, levels, who pays and how. There are concerns about provision, whether public, private or third sector. There are the welfare questions: how do you provide for those who lack means to support themselves? What about working age adults who need full time care? Do means consider wealth as well as income? Does wealth include all assets, such as shares, or just housing? There are concerns about demographics: we have an aging population, but also one which is in better health in old age and working longer. There are health matters: when do you qualify for needing support? There are exogenous policy influences, such as the retirement age, the structure of healthcare, and restricting immigration. Endogenous policy trade-offs, price controls and caps might improve affordability, but drive quality providers out of the market. There are additional democratic constraints: 4 in 5 of the over 65s tend to vote in general elections, compared to just over half of the under 35s.
These complexities are boiled down to simplistic cross-party political slogans like ‘we will deliver free personal care for the elderly’, a self-evidently false prospectus for what amounts to a service that costs £700 to £1,300 a week in the public sector and up to 40% more in the private sector (Kings Fund / CMA). The latter is in part due to cross-subsidising artificially cheap public provision. That expense results in a second rhetorical fiction that somebody else will bear most of the cost. The lobbying power of the old creates a third myth that it’s unfair to make them pay. Even truisms like ‘we will all be elderly at some point’ are not true – around 15% of us die before we retire and those tend to be the less well off. A state run social care service means transfers from the working poor to asset-rich centenarians, nearly all of whom can either afford their own care or to pay for insurance without the state.
When Bastiat said ‘Government is the great fiction, through which everybody endeavours to live at the expense of everybody else’, he could not have envisaged how accurately that describes the institutional, pathological self-delusional lying that constitutes political debate on social care. This lying always seems to conclude that what is needed is more socialism.
Into this swamp enter the People’s Pinocchio, the Prime Minister, so prone to inconsistency, implausible statements, and U-turns that his former chief advisor compared his sense of purpose to a shopping trolley with a broken wheel. He has proposed breaking his 2019 manifesto pledge not to raise certain taxes, notably income tax and national insurance (NI). He will do this by inventing yet another income tax, a 1.25% health and social care ‘levy’ that unlike NI will also be paid by some of the over 65s, and a further 1.25% bump to Employer’s NI, so 2.5% overall. Most of this £14bn a year bump will go to the NHS, presumably to pay for over-priced facemasks and deep cleaning the contracts behind them. Social care in itself will get an average of £1.8bn a year (IFS), enough to restore funding levels to where they were in 2010.
It is then a dishonest crisis solution to something that isn’t a crisis, with something that isn’t a solution.
Cue much debate about how much damage this must inevitably do the reputation of the Conservative party for fiscal rectitude, competence and probity, at least one of which is a core value. This is potentially a ‘Nick Clegg’ moment, a reference to the Deputy PM author of a ‘no more broken promises’ election campaign, who ratted on his key election pledge – tuition fees, and proceeded to lose his seat, leadership and the reputation of his party. This is Johnson’s Breaking Bad climax, where the apparent mild-mannered anti-hero is reveals himself as a drug kingpin who masterminds the destruction of everything he loves to stay in control. You can well imagine Boris telling his Cabinet ‘Who do you think you are talking to right now… I am not in danger… I am the danger’.
I regret to say this is probably wishful thinking. Believe it or not, the Liberal Democrats used to have reputation for honesty and integrity, much like Tony Blair, before the whole illegal war, dodgy dossier, made up weapons of mass destruction stuff threw a scintilla of doubt onto the proposition that he was a ‘pretty straight sort of guy’. If that’s your brand, it does tend to matter what you put in your manifesto and whether you stick to it. If, conversely, your brand is that of a jovial game show host with twinkly eyes, seven or eight kids, and the ethics of an estate agent, then what has changed? Every single ‘Boris Johnson is a liar’ scandal has been met with the certainty of the commentariat that this time it will be different and he will be held to account. They have been wrong every single time. As for the Conservative Party, does it even have a brand to damage? It appears to be holding power on the very reasonable premise that all the alternatives are worse. If the party believes in anything at all it is surely only by accident. Its MPs are currently selected by Tory party bureaucrats not for their values, but for their vanilla appeal and pliability. That a heroic few survive with their integrity intact, despite the selection, election and governing process is truly remarkable.
The political calculation of this move is that the public expect to pay more tax due to COVID, and expect somebody to finally resolve the social care row, such that any soreness at the hole it will burn in their household finances will be marginal. Any problems, when it doesn’t work, are for a ‘future Boris’, likely a successor. Meanwhile, the Opposition can be relied upon to either say nothing or propose something infinitely more damaging. So far it is managing to do both with ongoing feuds between the current and former leadership factions. The Government then will likely escape from this self-inflicted policy crisis, and the Prime Minister will go back to pretending to be a real boy until such a time as the game of power stops being fun. Leaving all of us, but particularly the young, with the bills to pay. Does anyone care?