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Will Labour have the guts to fight our unfair care system? Will Labour have the guts to fight our unfair care system?
(2 months later)
Are they dancing on their Zimmer frames in care home corridors? Not if the retired, or about to retire, have understood what's afoot. For seven of eight elderly people what the government plans means no change in the current unfair system for paying for social care. Some with modest savings may be saved a little money, while some of the wealthiest in nursing homes will be protected by the new payment cap. But few will live long enough to qualify.Are they dancing on their Zimmer frames in care home corridors? Not if the retired, or about to retire, have understood what's afoot. For seven of eight elderly people what the government plans means no change in the current unfair system for paying for social care. Some with modest savings may be saved a little money, while some of the wealthiest in nursing homes will be protected by the new payment cap. But few will live long enough to qualify.
"This overhaul of the way care is paid for gives people the certainty and peace of mind we all deserve," said Norman Lamb, the care minister. He must know it doesn't. The £72,000 cap on what anyone spends on care before the state picks up the rest of the bill turns out to be almost a fraud. If this was an ad, the Advertising Standards Authority might strike it out as mis-selling, since so few will ever clock up enough care costs to reach its protection – although they will still be paying large "hotel" costs (essentially food and accommodation), not counted as care."This overhaul of the way care is paid for gives people the certainty and peace of mind we all deserve," said Norman Lamb, the care minister. He must know it doesn't. The £72,000 cap on what anyone spends on care before the state picks up the rest of the bill turns out to be almost a fraud. If this was an ad, the Advertising Standards Authority might strike it out as mis-selling, since so few will ever clock up enough care costs to reach its protection – although they will still be paying large "hotel" costs (essentially food and accommodation), not counted as care.
Peace of mind? The system's means test is fiendishly complex to calculate. Certainty? The burden still falls unfairly, so those with less savings still pay a higher proportion. One definite improvement is the abolition of the postcode lottery, so that every council will offer care to all with "substantial" needs. But that is a high benchmark: to qualify for "substantial" someone would be, say, living alone with dementia and unable to shop, cook, remember pills or know if it's day or night. The plan was greeted sourly, as even government-friendly commentators rumbled how little would change.Peace of mind? The system's means test is fiendishly complex to calculate. Certainty? The burden still falls unfairly, so those with less savings still pay a higher proportion. One definite improvement is the abolition of the postcode lottery, so that every council will offer care to all with "substantial" needs. But that is a high benchmark: to qualify for "substantial" someone would be, say, living alone with dementia and unable to shop, cook, remember pills or know if it's day or night. The plan was greeted sourly, as even government-friendly commentators rumbled how little would change.
But here's the real problem: in an austerian age this plan addresses the least pressing aspect in the social care crisis. The Treasury will spend £1.3bn to protect the assets of those who no longer need them, saving the inheritance of middle-aged offspring. Not a penny more goes to improve abysmal social care standards. The famous "graph of doom" shows that on present trends by 2020, there will be no local authority money for anything except statutory child protection and rock-bottom care of the frailest. George Osborne pretended to give £2.3bn more to social care for 2015-16 but he cheated by double-counting: the same sum appears in both the NHS and the social care budgets.But here's the real problem: in an austerian age this plan addresses the least pressing aspect in the social care crisis. The Treasury will spend £1.3bn to protect the assets of those who no longer need them, saving the inheritance of middle-aged offspring. Not a penny more goes to improve abysmal social care standards. The famous "graph of doom" shows that on present trends by 2020, there will be no local authority money for anything except statutory child protection and rock-bottom care of the frailest. George Osborne pretended to give £2.3bn more to social care for 2015-16 but he cheated by double-counting: the same sum appears in both the NHS and the social care budgets.
Care homes are going to the wall, unable to survive on the low sums that local authorities pay. Delivered by the underpaid and under-trained, home "care" is often no more than a 15-minute visit. One care worker told me it can only be done in the time if you feed someone while they sit on the commode. In the two years between 2010 and 2012 as social care was cut, the number of over-90s rushed by ambulance to A&E rose by 66%, with 100,000 extra elderly people admitted to hospital. Facing that real social care crisis, you might think that preserving inheritances would be a low priority.Care homes are going to the wall, unable to survive on the low sums that local authorities pay. Delivered by the underpaid and under-trained, home "care" is often no more than a 15-minute visit. One care worker told me it can only be done in the time if you feed someone while they sit on the commode. In the two years between 2010 and 2012 as social care was cut, the number of over-90s rushed by ambulance to A&E rose by 66%, with 100,000 extra elderly people admitted to hospital. Facing that real social care crisis, you might think that preserving inheritances would be a low priority.
Poll after poll shows that most people are clueless about care, assuming it's free like the NHS, until they discover otherwise. You pay after a means test on your income, plus £1 for every £250 on any property. All you keep is £23.50 a week for pocket money. Age UK reveals the opaque cost of a care home: councils bulk-buy places at low rates, so care homes compensate by charging higher rates to self-funders (the better off) to subsidise council-funded residents in the same care home for the same care. To stop this, the new system will require councils to find places at their "usual rate" for self-funders too. That means care homes losing an average £120 a week cross-subsidy – so either more will shut or fees will go up, squeezing council budgets harder. The new plan is a weak answer to the wrong problem.Poll after poll shows that most people are clueless about care, assuming it's free like the NHS, until they discover otherwise. You pay after a means test on your income, plus £1 for every £250 on any property. All you keep is £23.50 a week for pocket money. Age UK reveals the opaque cost of a care home: councils bulk-buy places at low rates, so care homes compensate by charging higher rates to self-funders (the better off) to subsidise council-funded residents in the same care home for the same care. To stop this, the new system will require councils to find places at their "usual rate" for self-funders too. That means care homes losing an average £120 a week cross-subsidy – so either more will shut or fees will go up, squeezing council budgets harder. The new plan is a weak answer to the wrong problem.
Labour promises the total integration of health and social care budgets locally. But that can't be done when one system is free and the other paid for, bundling people from hospital to care home on separate budgets, when staying in an NHS bed is in the financial interest of patients and their families. Can Labour devise a universal care system as free as the NHS; and what's the least objectionable way to get people to pay for it?Labour promises the total integration of health and social care budgets locally. But that can't be done when one system is free and the other paid for, bundling people from hospital to care home on separate budgets, when staying in an NHS bed is in the financial interest of patients and their families. Can Labour devise a universal care system as free as the NHS; and what's the least objectionable way to get people to pay for it?
Under consideration is a 10% levy on everyone's assets at retirement paid upfront or deferred to after death, with interest. That offers certainty: everyone keeps 90% of their property and gets a legal right to free care. A levy brings new money not just to improve the quality of care, but to restore free care for those with "moderate" as well as "substantial" needs. In the great lottery of life, this pools the risk so those who drop dead and never need a day's care share the cost of those who live for years in a nursing home. A universal sharing of risk is the spirit of the NHS.Under consideration is a 10% levy on everyone's assets at retirement paid upfront or deferred to after death, with interest. That offers certainty: everyone keeps 90% of their property and gets a legal right to free care. A levy brings new money not just to improve the quality of care, but to restore free care for those with "moderate" as well as "substantial" needs. In the great lottery of life, this pools the risk so those who drop dead and never need a day's care share the cost of those who live for years in a nursing home. A universal sharing of risk is the spirit of the NHS.
The nervous in Labour's ranks remember Tory gravestone posters at the last election, warning of Labour's "death tax" over a similar plan for a levy for a national care service. But doorstep evidence suggests it was a popular policy, drowned out by myriad other reasons for not voting Labour. When asked, people prefer a fixed hypothecated tax to a random risk of losing large sums – a risk the high £72,000 cap has done too little to remove. No doubt the "death tax" attack would be mounted again – but Labour would be better armed this time. By 2015 there will be no hiding an NHS and social care system under extreme stress, in urgent need of funds. Where better to get it than from the property-rich of the older generation? Fairness and shared risk versus the arbitrary bad luck of life will frame much of the coming election battleground.The nervous in Labour's ranks remember Tory gravestone posters at the last election, warning of Labour's "death tax" over a similar plan for a levy for a national care service. But doorstep evidence suggests it was a popular policy, drowned out by myriad other reasons for not voting Labour. When asked, people prefer a fixed hypothecated tax to a random risk of losing large sums – a risk the high £72,000 cap has done too little to remove. No doubt the "death tax" attack would be mounted again – but Labour would be better armed this time. By 2015 there will be no hiding an NHS and social care system under extreme stress, in urgent need of funds. Where better to get it than from the property-rich of the older generation? Fairness and shared risk versus the arbitrary bad luck of life will frame much of the coming election battleground.
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