Yes, we need better funding for social care – but first we should decide what kind of service we actually want

The government is talking at last about increasing funding for social care, having talked about a solution for two years and having cut funding to councils by nearly half over a decade. On Tuesday, it announced that an estimated £12bn can be raised by increasing national insurance contributions by 1.25 per cent.

As a GP, I know how vital a flourishing social-care sector can be. We all want security and support when we need it. We welcome the debate on a plan for social care and how to pay for it.

However, before we talk about finances, we need to agree what we want to pay for – what kind of social care do we want?

Social care has been failing both the people it serves and its staff. Twenty-six per cent fewer people are supported than in 2010 while demand soars. People face isolation, indignity, maltreatment, neglect, barriers to inclusion and independent living.

Care is marketised and privatised. Many small providers have folded; care homes are increasingly managed by unstable corporates and hedge funds that often deliver poor care in large institutional settings – while extracting massive profits offshore.

Disabled and elderly people who need social care and support face high charges, leaving thousands in poverty. Care and support doesn’t reflect users’ needs or wishes. Staff wages, training and conditions are at rock bottom – turnover exceeds 30 per cent. Eight million unpaid and overworked family carers, including children and elderly relatives, provide vital support.

Solutions have been both inadequate and absent of the voices of those directly involved – the service users and workforce. What is often missing is any acknowledgement that the system denies certain citizens their human rights.

The country needs a radical redefinition of social care. We want a national care and supported-living service to provide care, independent and supported living – adopting into English law articles from the UN convention on rights of disabled people that establish choice and control, dignity and respect at the centre of person-centred planning. It is essential that all are supported to live the life that they choose. Social care should make that possible. It often doesn’t now and, sadly, rarely did so even when funding was more comprehensive.

We want a service defined and designed by those who use it, publicly funded, free at the point of use and not for profit. We need care and support staff or personal assistants who have appropriate training, qualifications, career structure, pay and conditions to nurture the skills required to provide support services worthy of a decent society.

The service must meet the needs of informal carers. All this must be informed by a taskforce on independent living led by diverse, user-controlled groups.

Social care and support is an investment which already makes an important contribution to local economies. Adult social care contributes at least three times its cost to local authority budgets. How much better that would be with more investment!

As the TUC says, it is plainly wrong that the government’s social care plans will mean a low-paid social care worker paying extra to fund the social care system while there will be no change for the private equity magnate who profits from asset-stripping care homes.

Social care needs to be funded equitably. Options include equalising the tax rate on capital gains tax and income tax; reducing the capital gains tax annual allowance; reintroducing an investment income surcharge; cutting the massive subsidy on the pension contributions of some of the wealthiest in society. Funds for social care are available without hitting the least well-off, the young, the employed and small employers – which is what the government plans instead.

Similar to the circumstances that led to the creation of the NHS in the 1940s, we need an Aneurin Bevan moment for social care. This is the time.

Dr Brian Fisher is a GP and a member of NACSILS, The Campaign for a National Care, Support and Independent Living Service, part of campaigning organisation Keep Our NHS Public.