The architect of the government’s delayed reforms to social care has told Sky News politicians need to “grow up” and tackle the crisis in the sector.

Amid a bitter election row over public spending, Sir Andrew Dilnot said he believed the two main parties were reluctant to discuss care reform for fear of being accused of plotting future tax hikes.

Sir Andrew – whose 2011 report laid out several key measures adopted by the government – described social care as the “biggest risk that isn’t managed” that the country faces.

He said: “Four out of five people are going to need social care before they die, we should grow up and face it.”

“I think politicians are reluctant to talk about it firstly because they’re worried about anything that means an increase in public spending and therefore possible taxation,” he added.

The implementation of a cap on care costs, unveiled by Boris Johnson, was delayed in 2022 until October next year.

The policy promised to limit the amount anyone in England will spend on personal care over their life to £86,000.

Speaking to Sky News on the campaign trail, Rishi Sunak said those charging reforms were still “on track”.

Labour has not explicitly committed to the cap in its manifesto, but a party source confirmed that it would also bring in the reforms as planned.

While the Liberal Democrats have made social care a key part of its policy offering, the sector has barely featured in the campaigns of the main two parties.

The cost of unpaid care

Rob Powell

Political correspondent

@robpowellnews

Norman Phillips is a carer for his wife Ros – who lives with multiple sclerosis and dementia.

Initially he was able to combine work with his caring responsibilities but as Ros’s condition worsened, he took early retirement.

“It was the stress and strain of trying to work… and saying look I’m terribly sorry, but I’ve got to turn around and go back to Stevenage because I can’t find anyone to look after Ros… that was tolerated for a while because I always got the work done… but then it went a bit pear shaped and… I collapsed in the street,” he said.

The couple found help hard to come by and after Norman suffered an injury, they were forced to sell their home to settle care-related debts.

“My kids learned a long time ago that their inheritance is gone… we don’t have any money left. We didn’t have any money left a while back,” Mr Phillips said.

Ros is now subject to an NHS continuing healthcare plan after Norman suffered a breakdown earlier this year and authorities decided he was unable to carry on caring for his wife.

This includes round the clock care for Ros – something Norman says wouldn’t have been needed if a lower level of help had been made available earlier.

He said: “They’ve got six million of us unpaid carers. If they… help us, we can help the system.

“But what’s happened to me, you know, is the system just kept backing away and backing away until I cracked.”

The idea of a cap was first suggested by the Dilnot Commission and put into legislation in 2014.

However its planned implementation in 2016 was delayed by the David Cameron government on cost grounds.

An attempt to reform the sector during the 2017 election was widely seen as the reason for Theresa May losing her Commons majority.

In his first speech as prime minister in 2019, Boris Johnson said he had a “clear plan” to “fix the crisis in social care once and for all”.

Reforms were announced in 2021 alongside an increase in National Insurance to fund the wider sector.

However this tax rise was reversed under Liz Truss before the broader changes were delayed under Rishi Sunak.

It means that many people requiring care are still potentially liable for costs that can stretch to thousands of pounds per month.

Sir Andrew said the lack of suitable social care was also having a “knock on effect” on the NHS as older people ended up stuck in hospitals.

“Lots of elective procedures rely on being able to have a bed and if you’ve got one older person… in hospital for twenty days more than is needed, that could easily mean ten hip replacements not being able to happen because there isn’t the bed space,” he said.

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Care bosses have also highlighted staffing shortages caused by low pay as another key problem in the sector while councils have called for more funding from the government.

Speaking to Sky News, Rishi Sunak said £8.5bn was put into the NHS and social care shortly after he became prime minister and that his government had focused on “improving the link between social care and hospitals… but also investing in the workforce”.

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A Labour source said “the social care chapter in our manifesto includes a commitment over the next decade to build a national care service, and first steps of a fair pay agreement for care workers”.

Shadow health secretary Wes Streeting also admitted that he wanted a “more ambitious” social policy but that it had to be “affordable” to be included in the manifesto.

From Rishi Sunak, we saw the good, the bad and the ugly during the latest TV election showdown with other party leaders – and a tough and unforgiving audience.

The good came when he broke his silence on the Tory betting scandal early on in his half-hour session of questions, declaring he was “incredibly angry” and vowing that any law breakers would be “booted out” of his party.

The bad followed when he struggled to defend his own policy on national service for 18-year-olds and was tetchy with an audience member who asked about Brexit.

And the ugly came at the end when the audience angrily shouted “shame!” when he launched into Reform UK-style rhetoric about the European Convention on Human Rights and attacked what he called a “foreign court”.

That sort of talk may play well with right-wing MPs and activists, but it bombed here and will have alienated those voters thinking of switching to Labour or the Liberal Democrats.

So Mr Sunak started well, got bogged down in detail in the middle and then ended badly, though he eventually did manage to land some blows on Labour on tax – as he has continued to do so throughout the election campaign.

The two takeaways from the PM’s part of this election programme will be his threat to expel betting wrongdoers and his misjudging the audience on the ECHR.

But not surprisingly, that wasn’t good enough for opposition MPs.

Immediately after the programme, Labour’s Jonathan Ashworth told Sky News Mr Sunak still has not taken any action against Tory candidates Craig Williams and Laura Saunders, who are being investigated by the Gambling Commission.

He should have suspended them immediately, as Sir Keir Starmer has demanded, Mr Ashworth said.

But despite the shouts of “shame!” from the audience on the ECHR near the end, Mr Sunak will feel that with the Tories losing votes to Nigel Farage he had to throw the Tory right and would-be Reform UK voters some red meat.

Those Tory MPs who love to hate the ECHR will no doubt have approved of Mr Sunak’s attack as far as it went – and no doubt accuse the BBC of selecting a “lefty” audience.

Before Mr Sunak, Sir Keir stumbled once again, as he did in his interview with Beth Rigby in last week’s Sky News Battle for No 10 programme in Grimsby, when asked about his support for Jeremy Corbyn.

Host Fiona Bruce repeatedly challenged Sir Keir on why he said Mr Corbyn would make a great prime minister in 2019, but the Labour leader kept dodging the question and looked shifty.

Eventually, Sir Keir said, rather lamely, that Mr Corbyn would have made a better prime minister than Boris Johnson.

Tories will no doubt taunt him on that claim for the rest of the campaign.

Sir Keir’s other tricky moments came when he was quizzed about his dispute with Labour MP Rosie Duffield on trans issues.

“I agree with Tony Blair,” he said. But he shunned the Canterbury MP and couldn’t bring himself to mention her name.

That was disrespectful. The Labour leader seems to have a problem with Ms Duffield. It makes him sound intolerant, which his critics would say is fair criticism.

The surprise here was a solid performance from the SNP leader John Swinney. He is less confrontational than the party’s Westminster leader Stephen Flynn.

He has a funereal style of delivery that has previously seen him compared to an undertaker.

He could also be compared to a Church of Scotland priest reading from the prayer book, to be fair.

But he’s an old pro and a details man, as he demonstrated when answering tricky questions about the SNP performance on the NHS in Scotland and was courteous with members of the audience, even when the questions were tough.

It all began with Sir Ed Davey, who was immediately greeted with the question: “Aren’t you going to bankrupt the country?”

“No,” he replied.

Well, it would have been a shock if he’d said yes.

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The second questioner was applauded after he accused Sir Ed of breaking promises in coalition government, citing the Lib Dems’ U-turn on tuition fees.

He was also ridiculed by a member of the audience over his “horseplay” in the campaign, the stunts such as splashing around on Lake Windemere and riding on a rollercoaster at Thorpe Park in Surrey.

And inevitably, he was asked if he was proud of his record as Post Office minister during the Horizon scandal.

The questions were tough, but he dealt with them calmly. His style was that of a fireside chat.

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With four party leaders competing this was a game of four quarters.

And this tough and unforgiving audience gave the leaders no quarter.