Social care reform: What are the sticking points?

This morning different government departments can't even seem to agree on whether the prime minister, the chancellor and the health secretary are going to sit down with each other to talk about social care on Tuesday.

But again there's a flurry of interest in what might, or might not be done to improve the creaking system that cares for the most elderly and people with high care needs in our society.

The short answer to that question is likely not that much in the foreseeable future.

Before the pandemic the prime minister, health secretary and the then Chancellor, Sajid Javid, had more or less agreed a shape for reform, as we reported on last year.

What hadn't been decided however was how to pay for it, whether a new tax would be required, or an increase in existing taxes.

Many months later, when the flaws of some parts of the care system have been there for all to see, there's renewed pressure from people working in the sector for politicians to grind out a solution.

Remember too that the prime minister has again and again promised that he'll sort out it.

And a meeting between him, the chancellor and the health secretary was expected to take place on Tuesday.

Whether that meeting will actually take place or not is, right now, clear as mud, although it's obvious that conversations have been taking place at senior levels of government in recent weeks.

After months of discussions the shape of the likely reform is still more or less what it was last year, and the year before that, and the year before that, and the year before that.

Essentially, ministers are looking at a version of the Dilnot reforms you can read about here, that were first put forward nearly ten years ago.

Legislation has already been passed to enact these changes so many insiders would agree that it's the most straightforward way to go, and a hunt for better solutions has not come up with anything that has so far found consensus.

What is the sticking point then? It's not unreasonable to ask. The PM's promised to fix it. There is a plan on the table. It seems even after years there's no better solution being suggested?

After a year of record breaking borrowing and emergency spending, I'm told the Treasury has made it clear to the prime minister that the only way he can keep his vow to sort out social care, is if he breaks a different commitment made in the general election, and raises tax.

Even the skinniest form of the Dilnot reforms would require an enormous amount of money that, given generational changes would increase over time.

And there's anxiety too that it would not live up to Boris Johnson's political goal, that no one would have to sell their house to pay for care, as the reforms would cover care costs, but not 'hotel costs', food and accommodation.

Nothing is final, and there are various models floating around, but I'm told the numbers being looked at right now are a cap on care costs of somewhere between £80,000 and £100,000, after inflation, not far off the £75,000 that was being proposed in 2013.

But the potential bill would require more than a penny extra on income tax.

There have even been discussions about whether or not the tax could be specific, 'hypothecated' to use the jargon.

That's something that normally brings the Treasury out in hives, but I'm told a form of 'loose hypothecation', has been under consideration.

In other words, an increase to income tax branded as a hike with a particular purpose.

There is no doubting the need for the sector to improve.

The structure is creaking, under funding after cash pressure on councils is obvious too.

But some in government are concerned at what could happen, arguing that a sudden announcement of tax increases on working people could backfire, arguing that a proposal like that needs time to be developed, for ministers to build up the case.

There is a concern too that the prime minister could decide to move, announce the big reform, seeking approving headlines, announce the increase in tax to pay for it, but then meet a wall of backbench resistance, drop the tax hike, but keep the reform, leaving the public purse with a huge new extra cost and no means of finding the cash.

The policy choice over how to fix the system seems pretty much to have been made already.

It might seem frustrating that after all of this time, the changes are likely to be those that were mooted years ago.

But the political decision, however, on how to pay for fixing the social care system in England has not.

It's the prime minister who will make that choice, and that's not something that can predictably be put in anyone's diary.

No one in government wants to comment on any of the possible details officially. Downing Street is even being tight lipped about when any discussions could take place.