This chapter juxtaposes the legal definitions, characteristics and scope of application of the four types of limited rights dealt with in Part I. The purpose of this chapter is to reflect on how these rights relate to one another from a conceptual perspective. On the basis of this, the chapter subsequently seeks to answer the question of whether the results of the analysis of the four types of limited rights can also be applied to other limited rights that are not discussed in depth in this book. Attention is paid to the development of an overarching allocation framework and the role of the principle of equality.

This chapter concerns the pursuit of public interests involved in the award of financial grants by public authorities to natural individuals and organisations. The core aim of subsidising is to encourage certain activities being performed while public money is spent in an efficient and lawful way. In order to assess the use of competitive tendering when allocating financial grants, it is necessary to distinguish between grants awarded by EU institutions, in shared management (EU and domestic authorities together) and by domestic authorities. It turns out that the need to use a competitive procedure has been articulated more clearly at the EU level, whereas domestic allocations of financial grants are still subject to non-competitive allocation procedures (first come, first served, lottery) or even to direct award, lacking any call for competition, without proper justification.

This chapter addresses the question of how the realization of public interests by competitive tendering is affected by the preceding stage of limitation and the succeeding stage of execution of limited rights. For some types of limited rights, for example authorizations, the public interests involved seem primarily related to the need for limiting the number of these rights (instead of allocating them). By contrast, the award of public contracts focusses more naturally on the allocation stage of competitive tendering. Furthermore, the relationship between the allocation stage and the subsequent execution stage does not seem to be univocal. Whereas the sale of assets seems to depart from the assumption that public interests are satisfied once the assets are transferred, for other limited rights the execution stage seems almost as relevant for the promotion of public interests as the allocation stage itself. This chapter seeks to explain why different outcomes in the relationship between limitation, allocation and execution can be observed across different types of limited rights and to explore whether some common denominator can be identified with regard to this relationship.

Introduction

Health preservation strategies, to keep people well and independent for longer, are crucial to reduce the need for care and support. More people are surviving to their late 80s and beyond, but not surviving in good health. Around 27 per cent of those receiving social care across the life-span are over 85, and 11 per cent 75– 84. As mentioned in Chapter 3, the likely cost of health and care services is substantially affected by the age at which impairments of older age begin.

Fortunately the incidence of difficulties with activities of daily living (ADLs) among seniors has fallen between 2011 and 2021, from 31.3 per cent to 26 per cent. But this might not continue, since arthritis, diabetes and dementia5 are all rising rapidly. Healthy life expectancy at birth has been falling since 2006– 8, more for women than for men (Centre for Ageing Better, 2022). Those who were already 65 just before the COVID-19 pandemic could expect to live 9.8 to 9.9 more years disability-free, followed by 8.9 years with some disability. A key concern of public health services, in which the community can play an important role, is therefore extending healthy life expectancy and reducing prevalence of long-term conditions from middle age onwards.

People with early-stage or minor impairments could be helped a lot by preventive measures through the kind of support the community can give. If you have a painful arthritic knee, support with heavy shopping, or company for a gentle walk, may stop you getting worse. If you lack strength and energy for house jobs, help with fixing a loose handrail or tidying high cupboards may prevent a fall.

Chapter 2 has shown how the total volume of informal care has been sustained only by becoming more concentrated in fewer hands, causing much stress. This ‘intensification’ of care is due partly to unpaid carers replacing shrunken council services, but it is also rooted in several longer-term social and demographic factors.

This chapter deals with future trends in need, to highlight a growing gap that family care may not be able to meet. The need for care will rise by almost two-fifths up to 2040, and there are many reasons why informal care may not keep pace. These include the rapid relative growth of the oldest age groups, declining family size, labour market factors and the rising rate of disability among younger generations. Support of younger disabled people is in fact the most rapidly rising element in local authorities’ caseload. All these factors underline the case for expansion of formal care. They also pose the twin challenges of how to ease carer stress, while sustaining and expanding informal care to keep up with growing need. This means developing better support services and financial help to family carers. It also invokes the question of how to share informal care more widely, which is the subject of Chapters 5 and 6.

Women have the greatest responsibility for informal care, which compounds their existing disadvantage in the labour market. Mothers are the most frequent carers of disabled adult sons and daughters, although among retired couples, men are slightly more likely to give care to women than vice versa.

This collection of interview material and public presentations about the role of carers serves to illustrate some of the issues elsewhere in the book. Three accounts of ‘well networked’ individuals show both the importance and limitations of friendship networks, especially for those with insufficient support from relatives, plus some unmet needs for more flexible care services and digital support, and some battles with the National Health Service. Burçu's speech highlights the special difficulties of someone called upon to become a carer at a very young age, perhaps not untypical in London's many migrant communities. Jo and others in the YouTube video made by End Social Care Disgrace show the extraordinary load faced by some older carers of disabled daughters or sons.

The author's previous research in 2011– 12 (Gray, 2015) illustrates two important dimensions of community solidarity:

• • the potential for mutual aid between seniors where people of mixed levels of dependency, some ‘younger old’ as well as ‘older old’, live in close proximity and are brought together in a ‘closed’ community with some shared social activities, as in many retirement housing schemes;

• • the important role of younger volunteers to help mobility-impaired seniors go out and maintain contacts with clubs and activities they used to have.

Names are pseudonyms, except for Jo and Burçu, who were happy to be identified.

Hyacinth is an example of how complex life can be at 87. She chose to move to a ‘housing with care’ block which has beautiful flats, but in her view the ‘care’ aspect is never what she really wants. Staff make 15-minute visits to empty bins, sometimes wash dishes, change sheets or tidy up.

This appendix presents an illustrative selection of measures to increase overall UK tax revenue. Some which are often advocated to fund particular programmes are omitted, like taxes on fossil fuel companies (often linked to environmental measures) or reduction of overall company tax concessions to fund better benefits. The total yield from them all would be around £60 billion to £80 billion, about 5.6 per cent to 7.5 per cent of total government spending. This compares to the budget for the NHS in 2022/3 (£212 billion), for education (£106 billion), social protection, which includes care, pensions and other cash benefits (£319 billion), defence (£56 billion), transport and ‘public order and safety’ (£44 billion each), housing (£18 billion) and environmental protection (£14 billion). It is being argued that the NHS needs an extra £40 billion, investments in renewable energy and home insulation around £28 billion, restoring central government grants to local government to the real-terms level of 2009/10 about £18.5 billion, restoration of the real value of cash benefits to households to its level of 2012, £21.2 billion (Rowlands, 2023), plus possibly additional sums for tax cuts on lower incomes.

Increasing revenue is not the only possibility. Many are the arguments about how large government borrowing should be allowed to grow, or which public expenditures should be cut. Subsidies to fossil fuel companies are frequently opposed by environmental campaigners; others question the need for nuclear weapon upgrades or advocate rent control as an alternative to much of the spending on housing benefits, to mention just some examples.

Table B1 shows how many seniors in each age band had difficulty with various tasks, and what proportion received some help with them. The first four columns are based on the English Longitudinal Study of Ageing (ELSA) data for 2018– 19 (Banks et al, 2024), the others from the HSE (NatCen Social Research, 2023). ELSA asks if someone had a difficulty and then whether anyone helped with that task. But it does not indicate how serious the need for help was. So column E of Table B1 draws on the HSE, which does ask whether someone can do a task by themselves with difficulty, or only with help, or not at all, although its sample is much smaller. From the HSE, one can see what proportion of those with a difficulty couldn't manage without help and how many actually had help. The difference is the proportion with unmet need.

Column D shows that two of the biggest needs are help with bathing and with stairs. They are ones that might be addressed at least partly by home adaptations or housing design. The other major needs (help with going out, shopping and housework) are things that formal care services rarely provide. Extending also to gardening, these are the biggest unmet needs (column E) and are suitable for friends, neighbours and volunteers to take on.

ELSA data analysed by the author for Wave 9 (2018– 19; Banks et al, 2024) also offer a breakdown of the types of informal helper who support the different tasks. Results for the most common types of difficulty are shown in Table B2.

How this book came to be written

What promoted this work on social care? I began with a qualitative study of people engaged in befriending schemes both as volunteers and ‘befriended’ and with volunteers running older people's social clubs in a London borough (Gray, 2006). Then came a more statistical investigation of what creates ‘social capital’ for older people (Gray, 2009). From 2011, I turned to the lives of people in retirement housing, to the question of how social activities and tenants’ groups could give residents a sense of neighbourliness leading to mutual aid, and a collective voice about their housing conditions and services (Gray, 2015; Gray and Worlledge, 2018). I also became involved in local campaigns to preserve the health service and improve social care in the London borough where I live. Helping to run a pensioners’ group with both social and advocacy/campaigning roles offered many insights into the daily lives of seniors struggling with self-care and the care of relatives, illustrated within this book. I experienced the harsh realities of helping to arrange care for my partner's parents in the United States, which presented a severe challenge to their children living thousands of miles away. This is perhaps not untypical for many London residents whose children or parents live abroad. I witnessed among my personal contacts the trials of seniors facing the COVID-19 pandemic on both sides of the Atlantic, impeded during lockdowns from contact with relatives, and with many normal facilities for support and socialising unavailable.

Introduction

The overall conclusion of this book is that expanding informal support from beyond the family is crucial to helping both family carers and seniors, especially those without close relatives to hand. Informal support must engage the wider community to keep up with rising needs. The need for better and cheaper formal services needs to be pushed forward in tandem; paid carers are needed especially for personal care. Formal and informal care are complements; there is limited substitutability between personal care from formal services or close relatives and support from non-kin. Both need to expand. Community engagement with informal care can drive forward a consciousness of the importance of better formal services and political pressure to raise their priority in national budgets.

Advocates of free tax-funded care argue that it ensures equality by health status as well as income. A gradual transition to free universal care could be achieved in stages; the suggestions of Chapter 4 are summarised in what follows. But abolishing charges would consume far less money than the vital requirements of helping more people with more hours, and paying care workers adequately. Plans for the future of formal care services need to consider that much higher care workers’ pay is needed to sustain an adequate workforce, and to recognise the trade-offs between different objectives; making care more affordable, increasing hours offered per client, the number of clients reached or the needs threshold, the quality of care services, and the extent of support given to intensive family carers.

Introduction

Chapter 4 has shown how challenging it would be to meet all of the care shortage by expanding formal care. The vast bulk of care hours comes from the unpaid sector, so it needs to expand at least as fast as the population in need. Hopefully it can help to dampen the rising trend of need for formal care, by supporting people at an early stage of their difficulties and helping them to stay in good health – and obviously happier – for longer. There is a need to widen the circle of support, especially for isolated seniors and family carers. This chapter shows how friends and neighbours can help with that part of ‘moderate needs’ which involves instrumental activities of daily living rather than activities of daily living, things like going out, shopping, housework and advice on digital communications. These are often unsupported in the current care shortage.

Previous chapters presented a quantitative perspective; how many people are needed for tasks measured in hours. We need this to define the scale of the care deficit, but it is important not to obscure the qualitative perspective of care as a social activity and a relationship. This chapter first examines the qualitative and ethical basis for a vision of ‘widening the caring circle’, outlining the central values of solidarity – ‘relational care’, ‘politics of compassion’, the ‘commons of care’, mutual support and co-production – which form foundational concepts for engaging the community to address the care deficit.

Introduction

The demand for free personal care, modelled on the Scottish policy, has become popular further south in recent years. As noted in Chapter 1, many organisations want a national social care service, to be free at the point of use, and funded nationally like the NHS, rather than locally. People are asking, if Scotland can make care free, why not England? It would cost much more than the very limited care reforms once planned for autumn 2025, then abandoned in the tight fiscal regime of July 2024. But as this chapter will show, the amounts of money required to pay care workers adequately and meet unmet needs are substantially larger than the cost of abolishing user charges. Care reform requires bold steps to raise more public funds. The clamour of so many organisations for free social care is a popular and worthy long-term objective which has also been adopted by the Welsh government for the long term (Welsh Government, 2023). However, one needs to be realistic about what can be achieved quickly, and to consider how to prioritise different care reforms.

Any increase in care subsidies cannot depend on the regressive, geographically uneven and inadequate yields of council tax. The most urgent requirement, even before reducing charges, is a major injection of funds from national sources to avoid further cuts.