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What does tomorrow’s General Election hold for social care?

June 7, 2017

The election is approaching and we will all make our individual decisions on which way to vote based on a whole range of factors.

And it is certainly turning out to be a much more interesting campaign that most of us expected when the election was announced.

However some aspects of the manifestos will impact directly on what happens in our day job world.

Here I set out some of the key areas difference and similarity between the three main Party’s manifestos.

Let’s take social care first as it has certainly been in the news with the May “U-turn” on the contribution to costs cap.

The Conservative manifesto points out that under the current system, care costs deplete an individual’s assets, including in somecases the family home, down to £23,250 or even less.

They propose three connected measures. First, they will align the future basis for means-testing for domiciliary care with that for residential care.

This will mean that the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home.

Second, they will introduce a single capital floor, set at £100,000.

This will ensure that, no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home.

However the Manifesto contains no cap on the costs – they explicitly rejected the Dilnot cap.

Third, they will extend the current freedom to defer payments for residential care to those receiving care at home.

They do mention the proposed Green Paper but its remit is set as looking at improving the quality of care. If the Conservatives get in it will be interesting to see how far they move from what is set out in their manifesto.

Labour take a different tack. They will address the immediate funding crisis by increasing social care budgets by a further £8 billion over the lifetime of the next Parliament.

They will also move towards a National Care Service will be built alongside the NHS, with a shared requirement for single commissioning, partnership arrangements, pooled budgets and joint working arrangements.

They will place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.

They will seek consensus on a cross-party basis about how it should be funded, with options including wealth taxes, an employer care contribution or a new social care levy.

The Lib Dems also say they will implement a cap on the cost of social care.

Overall then we can see a consensus between these two Parties and if the Conservatives do get in with a small majority we might finally see the care costs cap coming into effect opening a space for new long term care product.

Moving on to health, each Party commits to increased spending for the NHS but there are some distinctive features in each Manifesto.

The Conservatives will abolish the cap on the number of doctors that can enter medical training in England.

Their aim is clearly to reduce the reliance on non-UK trained doctors. Whether this can be achieved without reducing skill levels remains to be seen.

All three parties mention NHS England’s Sustainability and Transformation Plans.

Part of the STP remit is to rationalise the number of hospitals and the Conservatives qualify what they will be allowed to do by stating that any plans must be clinically led and locally supported. Labour take a harder line.

They will halt and review them and ask local people to participate in the redrawing of plans with a focus on patient need rather than available finances.

The Lib Dems will establish a cross-party health and social care convention, bringing together stakeholders from all political parties, patients groups, the public and professionals from within the health and social care system to carry out a comprehensive review of the longer-term sustainability of the health and social care finances and workforce, and the practicalities of greater integration.

We have been before many times before and there appears to be no political will or consensus to support fundamental hospital rationalisation.

Somewhat surprisingly given they introduced it back in the Thatcher years, the Conservatives will review the operation of the internal market.

In addition they will take on the doctors again – this time a new contract for both GPs and hospital consultants. Good luck there.

Labour focus on guaranteeing and upholding the standards of service to patients, for example access to treatment within 18 weeks, taking one million people off NHS waiting lists by the end of the next Parliament and guaranteeing that patients can be seen in A&E within four hours.

The Lib Dems take a more direct approach on funding promising an immediate 1p rise on the basic, higher and additional rates of income tax which would be ring-fenced to be spent only on NHS and social care services.

In the longer term, and as a replacement for the 1p Income Tax rise, they will develop a dedicated health and care tax on the basis of wide consultation which will bring together spending on both services into a collective budget

Finally what about PMI. And insurance premium tax. Conservatives and Lib Dems don’t mention either. So we don’t know. Labour will fund free parking in NHS England for patients, staff and visitors – by increasing the tax on PMI premiums.

Either way the outlook for PMI in terms of supportive Government interventions does not look good whichever Party enters power.

Finally to welfare reform. The Conservatives are pretty brief on this. They recommit to getting 1 million more people with disabilities into employment over the next ten years and to give unemployed disabled claimants or those with a health condition personalised and tailored employment support.

They say they have no plans for further radical welfare reform and will continue the roll-out of Universal Credit

Both Labour and the Lib Dems will end some of the welfare cuts. For example they will both scrap the bedroom tax, reinstate Housing Benefit for under-21s and scrap cuts to work allowances in Universal Credit.

The Lib Dems commit to taking forward the recommendations of the House of Lords Select Committee on Financial Exclusion, in particular by expanding the FCA’s remit to include a statutory duty to promote financial inclusion as one of its key objectives.

No Party makes mention of income protection insurance. Not a huge surprise, but its omission is neither encouraging nor discouraging.

Written by Richard Walsh, SAMI Fellow and first published in Cover magazine, June 2017.

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