Centenarians, care and cuts

A quarter of British babies born this year are expected to reach 100. In England and Wales 10,000 of us are already centenarians. What does this mean for the future of social care in this country at a time when budgets are being cut?

Many years ago, JRF launched an Inquiry into the Costs of Continuing Care (1996), having clocked that funding would have to increase dramatically to provide care for a growing ageing population. We proposed a social insurance model at the time, along the lines used effectively in many other countries.

The Adult Social Care White Paper in March set out the previous government's vision for a National Care Service : a 'comprehensive' funding option.

A social insurance model is one option the new Commission for Funding Care and Support will consider alongside plenty of other evidence and ideas. Policy Exchange's recent report – Careless – recommends the King's Fund partnership model, a social insurance model, or a hybrid model combining the best elements of each. Trade-offs will have to be made. General taxation is probably easiest to understand (and widely preferred by service users and some of the general public). But it is not the fairest across generations and there is little political will to even consider general taxation in the current climate of public spending cuts. A care levy offers a very interesting alternative, potentially providing intergenerational fairness and transparency by people contributing via existing taxes like inheritance tax and national insurance.

In Careless, Policy Exchange advocates merging social care budgets into health budgets. This could prove to be more assimilation than integration, of course. Concerns have already been voiced from the social care sector about GPs commissioning social care (which could work brilliantly if your local GP understands and values social care). In advocating the merger of health and social care budgets, Policy Exchange – as with Reform – also remind us the NHS hasn't been free at the point of access for a long time. Voluntary health insurance, top-ups and co-payments already operate in the NHS. (Of course, if you are over 65 you are exempt from many of these.) It is time, they suggest to rethink the future and funding of the NHS – and to do so without starting from the premise that NHS funding, or any other funding stream, should be singled out for protection and ring-fencing at any cost, as the coalition government is doing.

Crucially, though, the nettle none of us has truly grasped is how to align a new funding settlement for care with what people themselves need, want and value. We must start with people's lives, not services.

This necessitates thinking beyond health and social care integration. None of us think of our lives in terms of neat service domains. What about transport, leisure, culture, welfare, housing? (Can someone reassure me that the excellent HAPPI report published last year on Housing our Ageing Population has not been brushed aside?) What about the wider roles of carers, families and communities?

At a time of austerity and cuts, we need a new vision and funding settlement for care and support that is both socially and financially sustainable for all our futures. Central to all of this are people’s needs, wishes and values in later life.