A debate on adult social care reform hosted by the Local Government Association (LGA) has posed a familiar question: who will pay for it?

The Smith Square debate is part of a series of events being held in tandem with the work of the Casey Commission. The discussion was led by a panel including former Labour health secretary Patricia Hewitt, chair of the Social Care Foundation and former Conservative first secretary of state Damian Green, senior policy adviser at The Health Foundation Richard Humphries, and associate director of Think Local Act Personal Dr Clenton Farquharson.

Hewitt, who is senior adviser at Cerina Health, Feebris Ltd and Performr.ai, began by observing: ‘We are spending too much on the NHS, particularly on hospitals and not enough on social care.'

Hewitt asked attendees to imagine a UK where the billions spent on the NHS instead went to social care.

Hewitt pointed to Japan as a more equitable and sustainable model, where people fund their elderly care through a mandatory insurance system with payments starting from the age of 40.

‘I think we then begin to be thinking about a very different kind of system, one that was much more integrated and one that was built around individuals' needs and lives,' she suggested.

She observed that 20-30% of hospital beds were taken by frail, elderly people who should not be there and would be better off at home or in a care home.

Noting that social care typically accounted for 60% of council budgets, Green said: ‘It's not sustainable for local authorities to continue on this path.'

He argued funding for social care should come from a national budget based on the local needs of individuals.

Hewitt, however, suggested social care funding should come from social insurance, commenting: ‘This is a classic for the insurance system.'

Noting she had not paid National Insurance since she was 60, even though she still worked, the 77-year-old said the current income tax system ‘profoundly and disgracefully discriminates against people of working age in favour of people like me.

‘It's completely insupportable that we go on privileging older people through the tax system in the way that we do in my view,' she said.

Hewitt pointed to Japan as a more equitable and sustainable model, where people fund their elderly care through a mandatory insurance system with payments starting from the age of 40.

She also highlighted inheritance tax as having the potential to offer a social insurance premium against the risk of catastrophic care costs.

Humphries noted how the intense focus on meeting NHS acute waiting times ‘soaked up all the attention and money'.

He urged the ringfencing of money for community NHS services to accelerate the shift from hospital spending.

Local government audience members argued too much profit made by private social care providers was going to private equity and hedge funds.

One attendee called for local authorities to be able to build care homes again to reduce dependence on the private sector.

There were further calls for the overhaul of the planning system to support the elderly population, arguing it was nonsensical for section 106 money to be used for private housing and not care homes.

All agreed the previous attempt at major reform led by the Dilnot Commission published in 2011, which proposed a cap on the lifetime costs of care and raising the means-tested threshold for assets, was rejected by government because it was too expensive.

Humphries said the Casey Commission represented a ‘golden opportunity' to deliver radical social care reform, adding it was essential its recommendations were accepted in full by the Government.

The panel expressed concerns, however, that the final Casey Commission report in 2028 is scheduled ahead of the next General Election.

They urged that the deadline of the report to be brought forward to prevent its recommendations being ditched for political expediency.

In addition, the panel agreed it was crucial that cross-party support was gained for the Commission to ensure its recommendations are enacted.

Hewitt concluded: ‘We've got an opportunity to actually get a package of reform proposals and then, in the run-up to the election, get the political commitment behind it.'

Green added: ‘Whatever comes out needs to have widespread support baked in before it is put to Parliament or the electorate. And the Casey Commission is the only game in town that might allow us to do that. So, I hope that ideas will continue to flow into it, and that eventually good ideas flow onto it as well.'