Founded 1980
Chair:        
Secretary: 
Treasurer: 

Graham Smith
Jan Thompson
Graham Mumby-Croft


Paul Laxton
THE FUTURE OF SOCIAL CARE - THE GREAT QUESTION OF OUR AGE

I think I can safely say that if you are a person of a certain age, as we all are, is that the burning question of our age is not the exit from the EU, it is in fact social care. Those who voted Conservative could probably have done without their party's manifesto stumble over social care, but I would like to think that we were all glad that for once it reached the top of the political agenda. The downside was that on balance more heat than light was generated. The phrase "dementia tax" which was trumpeted by the Labour Party lowered the tone of the debate considerably, but fairness demands that I point out that the Labour had come up with proposals unfairly dubbed a "death tax" by their Conservative opponents during the previous parliament. It would help immensely if somehow this issued became depoliticised, but at times I think we are more likely to see flying pigs.

Contrary to what some journalists would have you believe, most social care is actually provided by families. The National Audit Office estimates that the value of informal social care for the elderly is around £34 billion. Local Authorities spend around £10 billion on social care for the elderly, the NHS another £3 billion, and recipients self-fund to the tune of around £7 billion. The cost of social care can only escalate with increased life expectancy, and with older people forming a growing percentage of the population, the ratio of workers to pensioners can only decline. This demographic time bomb is no secret, but the response of successive governments has been to file it in the "too difficult" tray. Many of our members will have already experienced the system, either with their parents or their spouses (or both). They will have watched helplessly as the relative declines and their resources decline with them. Anyone requiring residential social care will not receive any state support until their assets decline to £23,500, including the value of the family home, the sale of which can be forced unless there is a relative over 60 years of age living on the premises. There is the option to defer payments until after death, but this will mean a charge being placed on the family home and penal interest rates will accrue.

There is considerable anger amongst families that hard earned capital, which has already been taxed, can be confiscated in this way, particularly when other residents who had no savings and did not own a home, receive their care free. Another anomaly arises when care is provided in the recipient's own home via direct payments. In these cases the value of the home is not included in the calculation. It was this loophole that the Conservatives sought to close, and they paid for it in votes at the recent General Election. A further injustice arises in that self-funders are forced to pay a higher rate to cover the shortfall in income to the private care companies, caused by the Local Authorities being unable or unwilling to pay what the companies claim is the rate needed to cover their costs and make a profit. The contra-argument is that it is only right that the better-off contribute to their own care when there are so many competing demands on public expenditure. Secondly it is argued, why should children enjoy an inheritance they done have nothing to earn?

A different line of argument is that the care of the old should be a matter for the family, and that the neglect of our elderly by families is a national disgrace. I have already indicated that families do rather more than their critics would credit, but families are constrained in a number of ways: lack of room in their own home for an elderly relative, the demands of work, and the fact the families have been scattered far and wide by social mobility. It should also be stressed that advanced dementia is well beyond the coping ability of most untrained people.

This brings me to a critical point. Senile dementia is no less a disease than cancer, but the former will be treated as a means-tested social care case, and the latter offered free expensive treatment in the hope of remission. There is no tenable philosophical distinction between social care and health care, and therefore no logical justification for different funding approaches and different providers.

I am active in the West Yorkshire branch of the Civil Service Pensioners Alliance. Our group is firmly of the view that there needs to be radical reform of the system starting with the premise that the NHS must take primary responsibility for social care. We argue that for those whose needs are assessed as substantial or critical, social care should be free at the point of use, in the same way as NHS treatment, thus protecting the recipient's assets in their entirety. Those who choose to go to the private sector would free to do so in the same way as people access private hospital beds or independent school places. The big question obviously is how this would be funded. There are three main ways of funding this policy which can be used singly or in combination: from taxation, from clamping down on the £42 billion annual shortfall to the exchequer from tax avoidance, and realigning government priorities within the £650 billion or so per annum of taxpayers’ money it spends annually across the piece. It cannot be beyond the wit of government to slash tax dodging by at least one quarter. Voters could swiftly come up with ideas to realign priorities. According to whether you dress to the left or the right, Trident on the one hand and Overseas Aid on the other would be appealing targets. The income tax system works on the basis of the biggest burdens falling on broadest backs.

There are radical ideas out there which the government should at least consider. For example should people within twenty (or perhaps more) years of state pension age pay a higher rate of income tax, or alternatively a national insurance surcharge with the revenue hypothecated? These are ideas well worth considering and ones that would reinforce the concept of an intergenerational contract. However, government would need to ensure that middle aged people were not at the same time paying off student debt. An additional possibility is a levy on net estates above a nominal value, say £10,000. Any proposals will have winners and losers. If you use the tax and national insurance system, those fortunate enough to live to a ripe old age without needing care, will get nothing for their investment. However, you may ask, is the principal any different than insuring your car and your home? At least with social care your premium will not rise if you make a claim on the state. A levy on all estates protects the poorest in the same way as direct taxation. It also acknowledges the principal that property taxes which are a tax on capital, have a legitimate place in a fair revenue-raising system.

These are just some of the ideas that are around. They are much more radical than Dilnot and dispose of arguments about caps and floors. Unlike small change proposals such as means testing certain universal pensioner benefits, there is the scope to raise the kind of revenue needed to back up the money already allocated from taxation and bring about far-reaching reform. It will take time and money, but social care will need not only to be under the umbrella of the NHS, but provided almost entirely by the NHS. Back in 1979 64% of social care was provided by local authorities, that figure is now down to 6%. Outsourcing is a failed idea on which time should be called. Recipients of care suffer from poor standards and staff suffer from terms and conditions that have no place in a Britain that works for all. It is a national scandal that over 50% of staff in the social care industry are on zero hours contracts, and that some are not paid for the travelling time between patients. Will our political parties rise to the challenge? We shall see, but you can be assured that the various organisations that campaign on behalf of older people will continue to apply the pressure.

PAUL LAXTON

Issue 78 Spring 2018