Unfortunately, your browser is too old to work on this website. Please upgrade your browser
Skip to main content

With the general election now less than 6 weeks away, it seems certain that the NHS will be a major issue in the campaign. But what about social care? Many groups are calling for investment and reform to fix the social care system – it’s one of the Health Foundation’s five priorities for the next government. What can we learn from past elections about how social care will fare on 4 July and beyond? 

On the face of it, a general election campaign ought to build momentum around important policy areas. In the coming weeks, political parties will nail their colours to the mast in election manifestos and set out their answers to the big questions facing the country. Much campaigning is conducted not on the national stage, but at a local level – which should provide opportunities for everyone to engage in these debates.

Reforming the threadbare system of support for older and disabled people and their carers is widely regarded as one of the most pressing public policy challenges of our time. Social care matters to millions of people around the UK who need care (or will do in the future). It matters to unpaid carers looking after loved ones, and it matters to those who work in social care. So, surely it ought to be a central issue in 2024 manifestos? But evidence from past general elections suggests we might not hear much about social care in this summer’s campaigns. Here’s my take on why that is – and what it means for everyone pushing for better social care.

Why might 2024 election campaigns stay silent on social care?

Public understanding of the social care system is low

Our public polling work with Ipsos shows a lack of understanding of what social care is, how it is delivered and who pays for it. In monthly Ipsos Issues surveys, people rarely mention social care when asked about the most important issues facing the country. This means specific manifesto commitments about social care risk being weaponised by political opponents (like the Conservatives’ infamous ‘death tax’ poster accusing Labour of considering a £20,000 inheritance tax rate to pay for social care, in the run-up to the 2010 election).

Then, ahead of the 2017 general election, the Conservatives boldly promised ‘the first ever proper plan to pay for – and provide – social care’. They went on to outline some very specific proposals: firstly, to include the value of people’s homes in means-testing for home care (bringing it into line with residential care), and secondly, to raise the upper means-test threshold for entitlement to public funding from £23,250 to £100,000. The latter was a substantial improvement, but this was lost on most people who simply did not know how stingy the existing means-testing thresholds were, or laboured under the misapprehension that social care was all free through the NHS. Plus, this good news was drowned out by the furore about the former proposal, rapidly dubbed a ‘dementia tax’, and aggravated by the previous lack of protection from catastrophic care costs. The debacle marked a decisive turning point in the election campaign which saw the Conservatives lose their parliamentary majority. Significantly, social care was identified, briefly, as a top ten issue in monthly opinion surveys, but for all the wrong reasons. 

Social care is a political football

A second problem for social care arises from the adversarial nature of election campaigns. Political parties compete for our votes by asserting the superiority of their policies compared with the deficiencies of everyone else’s, often finding fault even with sensible proposals that might otherwise attract wider support. But the social care system’s many problems demand long-term sustainable solutions, across consecutive parliaments, needing collaboration (if not consensus) across the main political parties. 

The ‘death tax’ row in 2010 caused cross-party talks to collapse immediately, engulfed by acrimony and accusations of sabotage. While it is important that election campaigns create space for debate about policy choices, the combative context is not conducive to constructive, evidence-based plans for the long-term improvement of social care.

Past elections demonstrate how social care can so easily become collateral damage in a party-political war of words, setting back the prospects for reform long after voting closes. Public backlash against contentious funding proposals can make social care seem like a toxic topic for politicians (one former minister described it as a ‘third rail’ issue: ‘you touch it politically and you get fried’). Consequently, they steer well clear, until the impact of policy neglect becomes so great that something has to be done... 

Social care reform gets kicked into the long grass

In his first speech as Prime Minister in 2019, Boris Johnson pledged to ‘fix social care once and for all’. But there were divisions at the highest levels of government about what to do and, according to the care minister at the time, Brexit was ‘taking centre stage’. Johnson’s supposedly ‘oven-ready’ plan for social care still hadn’t surfaced before COVID-19 hit the UK in early 2020. Inevitably, policymakers’ attention shifted to managing the consequences of the pandemic for the NHS and (more slowly) social care.

In 2021, social care reform plans finally emerged – focusing mostly on the 2019 manifesto commitment that no-one should have to sell their home to pay for care. But a year later, prospects for reform faded as the government pushed back the introduction of a cap on social care costs and changes to means-testing until October 2025. 

Difficult trade-offs for the next government 

Looking ahead to the election on 4 July, the social care policy positions of the major parties remain sketchy, but there are some clues about emerging thinking. The Liberal Democrats thus far appear to favour free personal care, a specific tax for health and care, more support for carers and better pay and conditions for care workers. 

It remains to be seen whether the Conservatives will go ahead with the funding reforms currently on hold. In their recent policy paper, they set out a wider reform agenda putting ‘people at the heart of care’ – we’ll soon see if this features in their 2024 manifesto.

Given Labour’s big lead in the opinion polls, there is intense curiosity about their policy positions. The flagship policy for social care looks set to be a National Care Service, drawing on the Fabian Society’s Support Guaranteed report. But Labour’s current focus is to reassure voters (and financial markets) of the party’s economic competence. The shadow cabinet is reportedly preparing a ‘bomb-proof’ manifesto to withstand any flak from political opponents, so it’s not likely to contain detailed first-term pledges on social care funding or legislation. Any future social care policies from Labour will probably prioritise workforce improvements (influenced by trade unions, and deputy leader Angela Rayner’s time as a care worker), as reflected in their most recent pledge to introduce fair pay agreements in social care as part of a new deal for working people.

The next government is likely to face some of the toughest choices the UK has ever encountered (aside from pandemics and major crises). The latest forecasts paint a grim picture of weak public finances, a stagnant economy and deteriorating public services. Room for manoeuvre with spending plans will be extremely limited, and social care is just one of many public services desperately needing new investment.

Opportunities for constructive debate

As the election campaign ramps up, what can political parties do to ensure that social care is properly debated in a way that improves, rather than damages, the prospects for improvement and reform?

I think there are four lessons to be learned from past elections:

  1. Advocates for reform should use the election campaign to acknowledge the value of good social care as an essential part of the UK’s social and economic infrastructure. Campaigners should raise public awareness that most of us will need – and/or provide – care at some point in our lives. Focusing on the importance of the care system for people’s wellbeing will help challenge the traditional negative framing of social care as a financial burden or a politically toxic threat to electability.
  2. Political parties should avoid fuelling public confusion and political point-scoring by making specific manifesto pledges about how social care should be paid for. Instead, they should set out a compelling vision for a modern social care system. Ambitious long-term plans should be balanced with realism and honesty about the big changes required, the timeline and the resources needed. 
  3. Given fiscal constraints, it’s time to explore the rich seam of existing policy ideas beyond simply more funding. Examples include a new public spending framework for preventative spending as the Health Foundation and Demos have proposed, or shifting care closer to home and drawing on the types of local innovation that could be applied more widely. 
  4. What politicians do after they have won the election matters more than what they said they would do before it. The Institute for Government has shown that the winning party will govern better if it spends time preparing for government and has policy plans in place before entering office. The quality of this preparation for social care reform will be just as important as (if not more important than) electioneering efforts, due to the sheer scale and depth of the challenge. Future prospects for reform will depend heavily on the winning party striking the right balance between campaigning to win power and preparing for government.

Reforming and investing in social care is rightly one of the Health Foundation’s five priorities for the next government. We’ll soon see if campaigners and policymakers alike will apply these important lessons from past elections in the run-up to 4 July.

Further reading

You might also like...

Kjell-bubble-diagramArtboard 101 copy

Get social

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more