One of the political messages which did get through in the July General Election – thanks to Ed Davey – was the vital importance, but also the chronic neglect, of carers. There are an estimated 1 in 5 of the population who care, unpaid, for sick or disabled loved ones: a vast invisible army without whom society would literally fall apart. Ed was able to use his own direct experience as a carer, and that of his upbringing, to highlight some of the problems – which are growing as the population ages and as fiscal pressures grow. 

Having got the issue on the agenda, what do we say and do about it? First, we need to sweep away some of the complexity and topical red herrings like the mooted, but now abandoned, ‘cap’ on social care costs.  A key starting point is the distinction between the 1.5 million care workers who are the professional backbone of adult social care (that is, care outside the NHS) and the estimated 10 million unpaid carers who are estimated to be the equivalent of 4 million paid care workers. The care workers are usually very badly paid, have minimal career progression and often have stressful working conditions which is why 10% of vacancies are unfilled and why recruitment depends very heavily on immigration from Asia and Africa. 

The unpaid carers are more numerous and less visible. Any conscientious MP or councillor will know however of the horror stories and heroics amongst carers: bereaved or abandoned children caring for other children to stay out of care homes; parents struggling to manage children with complex needs requiring 24-hour attention; elderly couples with waning powers and strength trying to help each other to manage a home and combat loneliness;  or the daughter (usually) of a frail or disabled parent trying to manage children, part-time job and mum.  Local councils provide some domiciliary support subject to means tests and -rising- thresholds of physical need which, itself, needs – scarce – social worker assessment. Almost 80% of carers receive no support. 

Carers’ needs are not just financial or physical. Caring imposes heavy emotional demands. My limited experience caring for my late wife when terminally ill was demanding enough and I was lucky to have a supportive family and friends and reasonable finances.  My wife was brave, lucid and engaged unlike the growing numbers of elderly, dementia sufferers who tax the emotional reserves of their carers. Many carers have had to give up careers and leisure, are isolated and lonely and worried stiff about money. The most useful support is often respite: time out for exercise, shopping, meeting people. But day respite care, let alone holidays, is patchy at best.

Helping carers usually involves money- for more, high quality, professional carers to support those struggling at home; more, better funded respite centres; more generous carers’ allowances; more generous eligibility tests for support. And that means more money channelled through cash strapped local government. Eyes inevitably roll at the mention of money. But support for carers is not a financial black hole; it keeps the frail elderly out of hospital and in the community; children out of care homes and specialist institutions. It keeps families together and the elderly from expensive institutional care. 

But for those of us who don’t subscribe to the tree theory of money there are difficult choices and trade-offs to be made. That is the context of the review of public spending being undertaken by the Labour government. The care sector – and local government, which is responsible for most of it – is facing austerity piled on austerity and is in competition for funds with the courts, prisons, defence, public sector workers and much else. Clearly taxes must rise but no one expects the tax increases to be remotely adequate to meet the current pressure on public services. It is important therefore to get priorities right.

In the case of social care, the language of priorities centres on the nature and extent of means testing. Social care differs fundamentally from NHS health care in that it is not free at the point of use.  Economies in public spending translate into bigger private contributions from those who are deemed to be able to pay. And that, in turn, quickly becomes an argument about ‘fairness’. Sufferers from Alzheimer’s or Parkinson’s (or, rather, their relatives) will complain that it is ‘unfair’ that they are paying for help with care, at home or in a care home, while cancer sufferers get their care free on the NHS. I suspect that those who have lost loved ones to cancer in the prime of life, do not take kindly to the idea that they are ‘lucky’ in relation to those who enjoy the luxury of advanced age but are asked to pay for some of their care.

There are genuine concerns that harsh means-tests penalise those who are on the threshold of pensioner poverty and who don’t claim what they are entitled to and need. That is part of the rationale for ‘free’ personal care (such as hairdressing and pedicure). The sums are not large but Scottish experience tells us that, in a financially constrained world, extending a free service to the (relatively) better off means more severe rationing for everyone else.

But the argument about ‘fairness’ merges into the bigger argument about what is a fair contribution from people who are income poor but asset rich: property owners. There has been a head of steam behind the campaign to put a cap on the amount which residents of care homes, especially, must pay for their expensive care. In a small number of cases residents must sell their home to pay the fees. The Dilnot Report, published a decade ago, advocated a cap (usually placed at around £80,000) with the state picking up any excess. The idea was endorsed by the Coalition, then Conservative, governments though the report was never implemented. 

Rachel Reeves, as one of her first acts, abandoned the capping policy.  There are inevitably some hard cases but, on balance, she was right to do so. The main source of grievance was from disinherited relatives (who had chosen not to become carers). But protecting inheritances can hardly be considered a social priority.  And those of us who are aging do have an option to part-insure for care costs. 

The Chancellor’s action is one step in what will be an increasingly achromous battle to shift the burden of tax and means-tested charges onto relatively wealthy, and older, property owners from asset-poor, younger working families.  Abandoning the care cap was one step along this road, together with the means testing of winter fuel payments (though the latter would have been less painful and less controversial if taxed rather than axed. 

Arguments about charging policy, affecting the family inheritance, should not however distract attention from the much bigger issues around social care provision. Professional caring is chronically under-resourced. And the invisible army of unpaid carers includes millions who are often desperate for support and respite in the work they do for their loved ones, and for the rest of us. They should be our priority.

* Sir Vince Cable is the former MP for Twickenham and was leader of the Liberal Democrats from 2017 until 2019. He also served in the Cabinet as Secretary of State for Business, Innovation and Skills from 2010 to 2015.