Jeremy Hunt shouldn't waste his chance to properly reform social care

There is growing support outside government for older people to pay more towards health, care and welfare, which will between them need £24bn extra by 2030 and £63bn by 2040

(AFP/Getty)

When Jeremy Hunt turned down other cabinet jobs and pleaded with Theresa May to let him stay at the Department of Health in her January mini-reshuffle, his title as health secretary was expanded to include social care.

So far, in public at least, there has been little to show for this welcome move to bring a more joined-up approach to the overlapping health and social care systems. Behind the scenes, Hunt has been beavering away on a green paper due in the next two months. There is a lot riding on it for both him and the government.

Despite that, we shouldn’t hold our breath. In a report published today, the Commons Public Accounts Committee warns that the consultative green paper should not be an excuse for yet more discussion when the social care crisis is so well documented. It wants a long-term funding settlement this year, warning that further emergency cash injections are “the road to nowhere”. Meg Hillier, the committee’s chair, said: “The sector is scraping by and without an explicit, long-term plan backed by government it could soon be on its knees.” Astonishingly, the MPs’ report warns that social services and the NHS are bidding against each other at local level for beds in care homes – another illustration of the need for a merged national health and care service.

There is growing support outside government for older people to pay more towards health, care and welfare, which will between them need £24bn extra by 2030 and £63bn by 2040, according to the Resolution Foundation. In an impressive report on Tuesday, its commission on closing the wealth gap between the generations proposed a new property tax to replace council tax to raise £2bn for social care, and that people past retirement age should pay national insurance on their earnings to raise £2.3bn for the NHS. If that happened, the inevitable tax rises would not add to the burden on already squeezed millennials, but would rightly fall on the baby boomers just as they become the heaviest users of the health and care systems.

David Willetts, the Tory peer who chairs the foundation, said politicians had to adjust to the “new world” of upward pressures on spending in a fair way, and it was right for older people to make a contribution. “This is the future of politics and it cannot be avoided,” he said.

In an ideal world, the main political parties would agree that tax rises rather than spending cuts are the only way to meet demographic pressures, and try to reach a consensus on at least some of them. Sadly, real life is not like that. The Tories, having foolishly ignored the economy at last year’s election, will go hard for Labour’s tax and borrowing plans next time. In turn, Labour will outbid whatever the Tories do on NHS and care funding.

The government has reacted coolly to the commission’s flagship proposal for a £10,000 “citizens’ inheritance” to 25-year-olds, which could be used to buy a home, get qualifications, fund a pension or start a business, and would be financed by replacing inheritance tax with a fairer lifetime receipts tax. But ministers are said to be weighing up imposing national insurance on pensioners in work as a way to raise money for health and social care.

Inevitably, May is wary of anything that would risk a rerun of her ill-fated “dementia tax” in the Tory manifesto she launched a year ago next week. She shouldn’t be. Her social care proposals were hastily cobbled together and several cabinet ministers did not even see them until they were en route to the manifesto’s launch. Hunt’s green paper offers ministers the chance to look at the issue from all angles, and time to “roll the pitch”, as David Cameron used to call it, rather than announce a controversial policy without preparing the ground. It is also more sensible to do this well away from the heat of an election battle. The inter-generational commission offers plenty of arguments as well as specific proposals, such as an individual’s care bills being limited to a quarter of their assets (such a cap was the fatal omission in May’s blueprint).

Hunt should introduce a white paper or at least a green one with specific proposals that do not require yet further consultation. He should include the commission’s ideas for health and care funding.

May might be tempted to mark the 70^th anniversary of the NHS’s founding in July as a platform to announce a long-term funding plan, while again leaving social care in the “too difficult” box. That would be absurd, and a golden opportunity missed.