Good ideas on sheltered housing – but no idea on cost

Yet it is a document that could affect millions of the most vulnerable in our society and have a profound impact on housing for older and disabled people.

The government’s green paper setting out its vision for social care in England may be genuinely green – in the sense that it asks plenty of consultation questions. But its aspirations are high and it spells out a very different direction for this huge – £14.4bn in public money alone – and often forgotten area of public service.

The latest estimates of the level of need make for sombre reading. The group most likely to need care are those over 85 – their numbers will increase from just over 1 million in 2000 to a staggering 4 million by 2051.

This huge number is less likely to have access to family support and more likely to come from a minority-ethnic community.

So where will this ever more grey nation want to live as the infirmities of old age start to bite? The government believes, and almost certainly it is right, that most will want to stay in their own homes. Step forward, then, extra-care housing, adaptations of all shapes and sizes and the extensive use of new technology to enable those previously destined for institutions to remain in their own homes or at least to have “their own front door” in a new setting.

The government is even consulting on the idea that older people should have the right to request not to live in a residential or nursing care home, although interestingly there is no suggestion of a corresponding right to request such a service.

The paper is good at identifying weaknesses in care provision: a tendency to provide one-size-to-fit-all, to patronise and disempower those who have to use them, and an inability to engage with needs until they become severe. But there will need to be greater thought given to the solutions.

First, the challenge must be to reinvigorate residential and nursing home care, not dismiss it. The future is certain to include something that is not a million miles away from what we currently call care homes and it is likely these places will continue to have to look after the most vulnerable. They need to be modernised, not marginalised.

The future is certain to include care homes and these places will continue to care for the most vulnerable. They must be modernised, not marginalised

Second, while the government is surely right to insist that new forms of social care should be developed and that the nature of housing support is key, its insistence that this can be done without further extra funding must at least be questioned.

The current proposals are based on the belief that more preventative interventions will save money by preserving independence.

That is fine so far as it goes. The problem is that all past experience suggests that you cannot go “upstream” from services that concentrate on those in greatest need to those who may be prevented from deteriorating, without extra investment.

In short you cannot abandon today’s demands to prevent tomorrow’s.

In truth the government does not know what its vision would cost and its insistence that it can all be done within existing planned expenditure is based on little more than the practical politics of the moment.

The King’s Fund inquiry into long-term social care for older people, due to report in spring 2006, should give numbers to the aspirations. If we are to have a serious debate about where older and disabled people should live, if we are to meet their needs and wants, we have to be realistic about the costs as well as the benefits. To raise expectations, spout the rhetoric of choice and rights – and fail to deliver would be nothing short of cruel.

The government has also attempted to shut down the debate over who pays for care – rejecting out of hand the Scottish model of free personal care. That may indeed be the right approach, but until we know what the costs are it is surely too early for any of the political parties to reach that conclusion.