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By Harry Phibbs
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Most of us (76% apparently) will need to have some form of care and support when we are old. As we tend to live longer, the amount of the care needed will tend to increase – even with medical advances. Thus there is the awkward matter of how to pay for this growing cost – at a time when public finances are already hovering at the level that threatens national bankruptcy. Already 1.8 million of us are getting state funded social care – at a cost to local councils of £16 billion a year.

Today the Government have published their White Paper on social care for the elderly and disabled.

The well known dilemma is that if the rich are left to pick up their own costs, then their life savings can rapidly be eradicated. Those foolish enough to have savings of over £23,250 (for instance through becoming home owners) have to pay for care. Those with over £14,250 have to contribute. Those who have gone through life earning the same, but who have been profligate and not made any savings, are rewarded by having free care.

So that is unreasonable. But then the alternative that the state provides free care for everyone, rich and poor, is not terribly attractive – especially at a time when there isn't a huge appetite for massive public spending increases.

One proposal from the Government's White Paper is for those in need of care to be able to take out loans on their homes which are only repayable (including all the interest) on their death. This would be a way of avoiding people being forced to sell their homes in order to get care.

There is the complication of costs being shunted back and forth between local authorities and the NHS, and the White Paper proposes greater integration.

Andrew Dilnott, in an earlier independent report, has suggested a cap of £35,000 on the amount that we are charged for our own care when we grow old or become disabled. The idea would be that we would take out insurance to cover us up to that amount. The problem is that introducing it as proposed by Dilnott would have meant an increase in public spending of £4.2 billion a year by 2025. The Government proposes instead a voluntary scheme.

The White Paper includes an attack on localism.  It says the Government proposes:

Introducing a national minimum eligibility threshold to ensure greater national consistency in access to care and support, and ensuring that no-one’s care is interrupted if they move.

Why not abolish local government and achieve "greater national consistency" in a whole manner of services? There is a choice to be made by how much and in what ways the (sometimes poor) Council Taxpayer should pay for care for the (sometimes wealthy) elderly. Should that choice by resolved via local democracy or imposed across the country by the Health Secretary Andrew Lansley? How much detail will Whitehall end up meddling in over home care provision? How much will compiling the extra data cost?

The Deputy Prime Minister Nick Clegg has said:

Opponents of localism brandish the phrase "post code lottery" to dramatize differences in provision between areas.

But it is not a lottery when decisions about provision are made by people who can be held to democratic account. That is not a postcode lottery — it is a postcode democracy.

Does the Lib Dem Care Minister Paul Burstow agree?

It is not all bad news. The ultimate localism is personalisation. Providing the elderly with the choice and independence of personal care budgets was a good Conservative policy introduced by the Labour Government. In 2010, 312,911 individuals chose to have personal budgets. Last year it had increased 53% to 429,349. The White paper will give a legal right to a personal budget. It also seeks to develop "joined up" health and social care personal budgets.

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