Instead the Chancellor outlined awful economic projections from the Office of Budget Responsibility and told us his plan: not to redouble austerity but to redirect it. The government will borrow and spend, but – crucially - only on infrastructure. He will grow the economy by boosting technology and productivity. Until that happens (and even assuming that it does), there will be no extra money for a host of essential public services.
That feels like a familiar place for social care, which has for years argued it is underfunded. Yet this is not politics as normal. This time, it is worse because there really is no likely relief in sight, for three main reasons:
- Election forecasts. In previous years, there was always a realistic hope that a change of government might lead to a policy rethink. This time the Labour opposition is so far behind in the opinion polls that any sensible strategy has to assume they will be out of power for at least another eight years. Labour's position in the polls is a particular disappointment because it has shown some of the best thinking about social care and has some of the most knowledgeable people. And if nothing else, a more competitive Opposition might force the government to up its game. Yet nearly three quarter of adults think Labour will be out of power until not 2020 but 2025. Perhaps that will change but you wouldn't want to bet the farm on it. (For those who think that the opinion polls have been spectacularly wrong recently, remember in which direction they have been wrong. There was no hidden mass of leftish, liberal votes waiting to surprise the pollsters. Quite the opposite).
So a change of government seems a long way off. But even if it happened, we would be unwise to bank on it to ‘save’ social care. That’s because of two other factors: the economic situation that any government, including Labour, is likely to face and the reality that social care always struggles to be funded in competition with the ‘big beasts’ of the NHS.
- Brexit and the economy. Previously we could always expect (or at least reasonably hope) that economic growth would generate more cash for the government and that some of this would find its way to social care. But Brexit means all bets on immediate economic success are off. The only people being optimistic are those who wanted us to leave the EU. You would love them to be right (at least, you would be foolish not to) but trading our way to economic success looks at best to be a long-term plan. Even if you think leaving the EU will eventually help the UK prosper, in the short to medium term it seems likely that uncertainty will put a heavy drag on the economy.
- The NHS advantage. Finally, we are gradually coming to realise that social care always does badly in comparison to health, and in particular acute health services. So even if points 1 or 2 above prove to be wrong, there is not going to be a magic pot of money available for social workers and care assistants. Or even if the crisis in health and social care reaches such an extent that the current government is forced to act, it is unlikely to be enough for the social care system that we want or even need. If STPs start to generate huge public discontent next year, where do you think any saving money will go: A&E services or care homes?
Against that unprecedently bad outlook (at least in the 35 or so years I have been adult enough to take notice), what should we do? We could of course cross our fingers behind our backs and continue to make sensible, rational cases for more money. It has been suggested to me that this has eventually worked for the disability sector in the last few years. I don’t buy this. A few important but relatively minor concessions by the government in recent months do not count as success. If they did, there would be no need for I, Daniel Blake.
The alternative is to start thinking about far more radical change to delivery of social care and support for older people generally. I do not pretend to have a solution but I think it might be time to dust down our copies of the 2014 Barker Commission report. Among its many, often controversial, proposals, it made the almost-heretical statement that “some way of raising extra revenue, or releasing revenue, will be needed if England wants health and social care that is fit for the 21st century”. It suggested a number of funding options including tax and NI increases, additional money from existing NHS charges and restriction of some universal benefits to the least affluent pensioners. There was, as Independent Age said at the time, something in it for everyone to disagree with. It made far too many people uncomfortable, in the voluntary sector and beyond, and it sank largely without trace.
Yet it is now surely time to see which bits we are prepared to contemplate, as part of a cross-party look at the future of health and care funding.
Plan A - simply making the rational case for more money - is not working.
Plan B should stand, at least in part, for ‘Barker’.