Those who wish social care provision in this country to be logical, face rather a daunting problem. Jacob Rees-Mogg, interviewed for this site last week, said:
“It is odd that if you’ve got Alzheimer’s it’s not paid for, but if you’ve got cancer it is paid for”.
Indeed so. If the principle of the NHS is that healthcare should be universal and free at the point of use, then why not also social care?
On the other hand, if means-testing is accepted for welfare payments, why not for social care? John Redwood argued in a Centre for Policy Studies paper a few years ago:
“Families who would like to inherit the old family home or their elderly relative’s property argue that it is unfair for the state to pay for the residential or care home costs of those who saved nothing during their lives and did not buy a home, whilst expecting the richer pensioners who did make provision to pay their own bills. Their argument is a specific case of a more general argument against means-testing – it “rewards” the unsuccessful, the profligate, the lazy, the unlucky and the disadvantaged at the expense of the hard working and the prudent.
“It is, surely, morally right to expect the taxpayer to fund decent food, care and accommodation for the disadvantaged and the disabled who may have not been able to get a better paid job, or afford the home or put money away in savings. This may also entail the state paying for some of those who could have provided for themselves but chose not to. The latter is the price of being able to do the former: for everyone who has blown money on round the world cruises or fast cars who ends up penniless, there are many more deserving cases of people who were never able to earn good money in their working years.”
The full basic State Pension is currently £137.60 per week. I’m due to start being paid that benefit after my 67th birthday on January 11th 2033. If I keep toiling away for ConservativeHome I may well be too rich to be eligible for anything on top of that modest provision from the taxpayer by then. But what if I become idle and extravagant with “world cruises or fast cars”? And then, scheduled rather cunningly, I become completely skint by 2033? I could fill my boots with Pensions Credit (currently an extra £177.10 a week). Plus my rent could be paid by Housing Benefit (which still exists for pensioners making new claims rather then being absorbed under Universal Credit.) Also Council Tax Support. Should we push up the basic state pension to, say £300, and scrap the Pensions Credit and Housing Benefit perverse incentives for the wastrels? There seems to be no clamour for any such reform.
The Government proposals strike me as misguided as they incentivise pensioners who are paying for good quality care which they have control over to switch to a deficient service paid for by their local authority. (They might be pressurised by their greedy offspring to make this switch.) Even if this increase in public spending was justified, it is complete nonsense to see that it is “impossible” to find savings in the trillion pounds of overall state spending. Even if it was impossible to fund such economies, we are so heavily burdened with tax already that any hike in rates may well be counterproductive in terms of revenues. Still, I accept that the issue of who should pick up the cost for social care is, as Sherlock Holmes put it, “a three-pipe problem”. Lord Lilley’s case for a genuine insurance scheme struck me as compelling.
What seems to be missing from the debate is how to reduce the number of us (half a million at present) who need residential social care – that fate which typically manages to combine being miserably dreary with staggeringly expensive. Of course, with an ageing population there is a sense of “running to stand still” with such endeavours. All the more reason to make every possible effort to avoid institutional care wherever possible.
Here are some relatively straightforward starting points.
First. End Stamp Duty on “downsizing”.
For some, there is great sentimental value in staying where they are. For others, the upheaval of moving is discouraging. But cost is also a factor. Charging Stamp Duty for those who downsize makes no sense. From October, the threshold will revert to £125,000 – the rate ranges from two per cent to 12 per cent of the purchase price. Given our astonishingly high property prices, that means that even those wanting to buy something more modest then they currently have would face a hefty bill. So inertia is encouraged with no transactions and no tax revenue. It also restricts the supply of family homes. Coping with a large home might well be challenging for an octogenarian. Repairs accumulate. Heating is expensive. Moving to a smaller home, perhaps nearer to relatives would have advantages. Less likely to fall. Less loneliness. Better family care. The need for a care home could, at least, be delayed. But the Chancellor of the Exchequer stands in the way.
Second. Lift planning obstacles to retirement homes.
For some simply moving to a smaller home might not be enough. While remaining property owners they might also want an arrangement where they have some assistance – and buy a flat or bungalow or cottage that is a “retirement property”. These are collections of properties where there is some assistance with security and maintenance. There are some developers (such as McCarthy Stone) seeking to meet this demand for those over 55 or 60 who are basically still able to cope with independent living with some back up. But there is a shortage – the Australians and Amercians have far more. Planning applications for such properties are treated like other private housing as it is unsubsidised. Then it is subjected to the financial penalties of Section 106 demands and the Community Infrastructure Levy. The social benefits of these developments should be recognised and such burdens lifted.
A Demos report concluded that:
“Specialist housing for older people delays and often prevents the need for residential care. Since for each year a person postpones moving into residential care the state would save on average £28,080 the cost savings can be substantial. Both the University of Reading and IPC calculated net cost savings to the NHS of hundreds of millions of pounds in building more retirement housing.”
So far as social housing is concerned the priority should be new sheltered housing. It should be well managed and architecturally beautiful. Where council-owned sheltered housing blocks are badly run then charitable trusts, if able to offer a better service, should take over the management. It makes no sense for an elderly person to be alone in a four-bedroom council home just because there is no alternative of attractive sheltered housing available.
Third. Require better value for money from Public Health budgets
Local authorities have Public Health budgets of £3.7 billion. Plenty has been written about wasteful spending during the pandemic. But I had already highlighted on this site that this was nothing new.
But the money could be spent effectively. Providing a vaccination against shingles is an example. Sometimes victims from this unpleasant illness have to go into hospital. More frequntly they remain at home but are unable to look after themselves and thus need social care.
Fourth. Boost local innovation
We often think of Council Adult Social Care as just being for the elderly – but a significant part of the service is also for adults with learning difficulties. Many councils have made substantial progress in improving the lives of disabled residents by taking part in the Shared Lives scheme. This offers an alternative for those currently in supported living or institutional care. It is of them being placed in a family environment in someone’s home. It can also provide respite for parents with grown up sons or daughters who they are caring for. But progress is uneven. Some councils are failing to take the opportunity to provide a better service for the disabled at a lower cost for the Council Taxpayer.
Then we have technological improvements. We can look to what other countries are achieving. Also innovation that has succeeded in parts of our own country that other areas have yet to embrace. The private sector has a role to play. Bath and North East Somerset Council and the NHS have used Virgin Care to provide integrated community care – which has delivered good results.
This is localism in practice and is already working to some extent. But the Government should nudge it along. At present, the Adult Social Care precept on the Council Tax just bails out failure. It could be replaced by an Innovation Fund.
Fifth. Bring back the Big Society
One heartening aspect of the pandemic was the enthusiasm for helping out elderly and vulnerable neighbours. Faith groups and voluntary organisations will always be better suited at applying compassion than inflexible public sector bureaucracies. The state should not seek to usurp this role but it should look at how it can help it to flourish – in commissioning services rather than trying to doing everything directly. Also in simply getting out of the way – in lifting regulatory budrens.
We are twice as likely as the Italians to end up in care homes. Four times as likely as the Poles. Eight times as likely as the Ukranians. We are constantly told it is “inevitable” that evermore of us can expect that fate. But why should we accept outcomes that are so much worse than other countries? Why should the only argument be about who pays for this grim destiny?
“Do not go gentle into that good night.
Rage, rage against the dying of the light.”