The silence of the bedpans

IN 2016, 6% of over-65s in Britain received publicly funded long-term care. By 2023 this proportion had fallen to 5%. That is not because Britons are getting healthier. Quite the opposite. Local councils, which fund social care only for those with the greatest need and the fewest assets, have faced real-terms cuts of 18% per person to their budgets since 2010. Less than half of the elderly who need care receive any support; overcrowded hospital wards in the National Health Service (NHS) end up taking much of the strain.

Some politicians have made efforts to fix the problem. The last prime minister but one, Boris Johnson, deserves rare credit for introducing a health and social-care levy to raise money for the ailing sector. He also pledged a cap on the costs of care that people bear for themselves—one in seven over-65s face bills of more than £100,000 ($126,700). But in this election, social care is conspicuous mainly by its absence.

The Conservative Party, having delayed the cap and scrapped the levy at the same time as they jettisoned Mr Johnson, would rather avoid the subject. Labour’s “Ming vase” strategy involves treading as cautiously as if carrying priceless porcelain across a slippery floor. The silence around social care is a good way to understand the shortcomings of the campaign as a whole.

Self-imposed fiscal constraints are one reason why the topic is being dodged. Both big parties pledge not to raise broad-based taxes; the Conservatives are committed to further cuts to national insurance, the payroll tax that Mr Johnson had wanted to raise. As a result neither party promises lots of extra spending on adult social care, even though the outgoing Tory government’s spending plans would probably mean further cuts for local councils and an ageing population will only increase demand for care.

Then there is the question of the social-care workforce, which is stretched thin. In 2023 the vacancy rate in adult social care was around 10%—two percentage points higher than in the NHS. But a fifth of social-care workers are foreign-born, and importing more of them is awkward for parties that want to appear tough on immigration. Labour is proposing a collective-bargaining agreement for workers in the sector, in part to make the pay more attractive to Britons. But jacking up wages without boosting funding is a recipe for trouble: the Tory government’s most recent rise in the national minimum wage is already increasing financial pressures on residential homes and home-care agencies.

Previous elections have also left scars. In 2010 Labour considered introducing a compulsory inheritance levy, whereby £20,000 would be taken from each estate after death to fund social care. The press promptly branded the policy a “death tax”. Seven years later Theresa May threw away a 20-point lead in the polls, in part because of a cobbled-together policy in which all but £100,000 of assets, including a person’s home, could be used to pay for care. That was christened a “dementia tax”. In both cases shoddy policymaking caused a lot of the problems, but the lesson that stuck was that social care is a banana skin.

Public ignorance about how the system works also enables the parties to paper over the subject. Since no one knows how long they will live or how great their needs will be, the current system is like “standing in a road with a lorry driving towards you and hoping you die before the lorry hits you”, says Andrew Dilnot, an economist who first proposed a cap on care costs way back in 2011. Most Britons do not realise—or do not care—how much financial risk they are running until they or a relative has to navigate the system.

These factors explain why the Conservatives and Labour have given social care only cursory attention. The Tory manifesto offers a paragraph with no new commitments, though it does repeat the promise to implement Mr Dilnot’s cap on care costs. Labour’s manifesto is similarly flimsy; Wes Streeting, the shadow health secretary, admitted on June 16th that it could have been “more ambitious”. Among other things it promises to crack down on poor-quality providers as part of a vaguely defined “National Care Service”. It is offering “a plan for a plan”, says Simon Bottery of The King’s Fund, a think-tank.

The Liberal Democrats, whose leader, Sir Ed Davey, is himself a carer for his disabled son, are the only party aside from the Greens to have offered a substantive plan. But the Lib Dems’ proposal for free personal care would require much more funding than the £2.7bn (0.1% of GDP) they have set aside; in Scotland, which has already implemented a similar policy, personal care appears to be being rationed. And smaller parties can in any case afford to be bolder.

The bigger parties have a different electoral calculus. On social care, as on other awkward issues related to the state of the public services or the damage done to the economy by Brexit, Labour and the Tories have both concluded that it is better to sweep problems under the carpet than risk confronting them. ■