the oxymoron that is social care
Personified by Boris Johnson’s promise to “fix the crisis in social care once and for all”, every government in recent history has stated to do exactly that but all have universally failed. Why? However, noticeable by its surprising absence, Dishy-Rishi failed to pull a social-care-rabbit out of his magic-solutions-hat last week when he seemed to do so for every ailment and crisis the country currently suffers. Strange.
Social care covers a large range of service provided to the elderly, frail and disabled, from home visits to palliative end-of-life care. But with a rapidly ageing population, the political hot-potato is old-age care and more than three-quarters of us will need some form of social care in our lifetime. Unlike the NHS, and supposedly unbeknown to almost half-of-us, care is not free at the point of need. Those with cancer will have their treatment paid for by the state but those with dementia need to shell out themselves. Health costs are pooled across society; with care, though supported, the unlucky ones are hit with crippling bills.
Only people with assets worth less than #23,250 get state support in England and Northern Ireland – the threshold is #32,750 in Scotland and #50,000 in Wales. It was planned that the level would rise and a cap on care costs of #86,000 would be introduced from October this year but this has now been postponed a further two years. Provided you still live in it, the value of your own home isn’t included in the calculations, but if you have to move into residential care, it is then added. Research showed that in 2019, over 17,000 pensioners had to flog their homes to pay for their care.
In an attempt to solve the long-standing crisis of social care provision there have been over a dozen government papers, many of them cross-party, on reformation in the past two decades. In 2010, the then Labour health secretary outlined plans for a National Care Service funded from a #20,000 levy on the value of estates at death. The plan was branded a “death tax” and the election was lost. The following year the coalition government proposed a means-tested policy that no-one should have to contribute more than #35,000 towards the cost of their care over their lifetime, and no-more than #10,000/year in ‘accommodation’ costs. Ultimately, this was scuppered by exactly who would make-up the short-fall difference: both local and national authorities argued the other should. At the 2017 Tory Party Conference, Mother Theresa formally proposed that the value of a person’s home should be automatically included in the calculation of their assets. Dubbed the “dementia tax” it almost certainly contributed to her disastrous election campaign and prompted gorgeous Gideon Osborne to comment that “it’s much more straightforward politically to keep kicking this can down the road”. However, are there lessons to be learned from abroad?
Back in the 90s, Germany’s system was too in deep doo-dah. In response, it introduced a new funding model supported by both main political parties. The entire workforce puts 1.5% of their salaries into a social care fund and that sum is automatically matched by the employer and both are stopped at source. The result is an insurance-based system where a similar level of care is provided throughout the country and determined by need. Simples.
More comprehensive still is the model in Japan, home to one of the world’s most aged populations. It requires everyone over forty to pay into an additional national insurance fund but is further bolstered by the six million active users who then contribute a further 10% of the cost of their care at the point of use. Residential care homes cannot be run for profit and there is a societal focus on long-term prevention of ill-health. Both systems share one vital similarity, explained our current Chancellor, Jeremy Hunt, those countries “foresaw the demographic time bomb facing societies everywhere and grasped the nettle”. Ouch.
This nettle needs to be seized by the Labour Party and they need to reinforce the message that an effective and supportive national care service will cost money, serious money. The only question is how this is to be raised as equitably and progressively as possible. Relatively radical thinking has shown that workable models, not too dissimilar to our own NHS, can be developed and highlight that tax is what pays for decent levels of public service provision. Countries that have the best quality of life are, unsurprisingly, those whose governments take more tax and use it to help everyone, especially those in greatest need. With the election imminent, it would be a mistake for Labour to double-down on caution, we need a compelling vision and reason to vote for the future, and an effective social care policy should be part of their message.
