Dementia Tax – Project Fear

Dementia has been a big part of my life. Over the years I have worked with people with dementia in some of our most deprived communities in south London – Brixton, Elephant and Castle, Peckham, Old Kent Road and the surrounding (often high-rise) estates.

I have therefore felt very torn by the party’s recent headlong charge for the populist line on the “dementia tax”. As a (naturally pretty tribal) Lib Dem of three decades standing I recognised a fantastic campaigning issue that might help claw back a few coastal “retirement” seats. However, I also knew that the inaccurate use of the term dementia tax (it is neither a tax nor is it about dementia) causes pain to many for whom this is not just a line in a press release but something real and near at hand.  People with dementia have a cognitive impairment but they are not stupid; they can and do take in political messages. Politicians need to think of the deep distress their negative campaigning can cause to many of our 850,000 fellow citizens who are living with this disease.

During the election the party launched a “Theresa May Estate Agent” website that quoted the  example of a “lady from Runcorn” who at the first symptoms of dementia had her home whipped away by the government. This achieves the triple whammy of being misleading about dementia, misleading about the current system and misleading about the (then) prospective system. If only we had moderated our language on this. For a start the dichotomy between “free” coronary care and “paid for” dementia care is false. Thanks to the voluntary sector (usually funded by health services or councils) many people with dementia get significant help and advice for free. If you are diagnosed with dementia early the stereotype of a tragic husk of a dementia victim slumped in a chair is completely untrue. There is no cure for or reversal of dementia but the NHS funds drugs which can have a plateauing effect on the symptoms of Alzheimer’s for many years. Lots of dementia care from MRI scans to memory clinics is completely free of charge.

Secondly, on the policy itself isn’t the much eulogised Dilnot proposal for care (with a cap of £35,000) itself a kind of “poll tax” where very rich people pay the same as those with fairly modest assets?  The original Conservative proposals meant that the richest would pay the most. Of course middle aged people like me want to hang on to the money gained by parents through the property bubble but who will pay the bill instead? And the bill is enormous – 1.7 billion (at 2011 prices) to implement Dilnot and 1 billion to bring social care salaries up to the living wage just for starters. The Prime Minister was right to say that social care is on the brink of collapse. Everyone talks about public sector pay but most care assistants and dementia activity co-ordinators are employed in the private sector and are earning the minimum wage or little more. Most would be better off (and have higher status) working in entry level retail jobs.

My house is valued at double the price I paid for it 15 years ago. If I were elderly would it not be rather ingenious to let the house remain in my name until my death but use that windfall gain in value to finance my social care when I died, still leaving the last 100k for my family?

The pitiful remains of Grenfell tower overshadow all political discourse at the moment. We should all feel uncomfortable that our election campaign focused so very little on social housing but so very much on safeguarding the inheritance of the propertied and the comfortably off.

* Ruth Bright has been a councillor in Southwark and Parliamentary Candidate for Hampshire East

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40 Comments

  • Tony Dawson 10th Jul '17 - 9:07am

    What utter balanced sense.

  • jayne Mansfield 10th Jul '17 - 9:09am

    @ Ruth,
    Thank you for your intelligent and knowledgable article.

  • Ruth, can I echo Jayne’s appreciation for your article on what is a very difficult and complicated subject.

    As a former Convenor (Chair) for Social Work (and as someone married to a Director of Adult Services) I winced at the crudeness of the ‘Dementia Tax’ campaign by the Lib Dems. As with some other issues, I felt there were some at the heart of the last campaign who had as much knowledge of this issue as a Rhino on heat. I’m afraid I’m also critical of the way certain of our former leading figures eviscerated local government during the Coalition years. The whole issue of quality control both in care and in finance needs to be looked at in the private sector.

    On a constructive level, what the party needs to do is to set up an expert panel to examine in detail the costs and viability of dealing with the needs of an ever ageing population. Jo Grimond, all those years ago, fostered links with expert advisers…. I hope Vince does the same.

    PS Vince looks and sounds a tad too young to be Leader………… but I must say he looks and sounds pretty good for a young fella.

  • David Becket 10th Jul '17 - 10:16am

    Thank you, you have highlighted an area where we should be having a reasoned discussion.

    Instead we had from the masterminds who produced a campaign that attracted 7% of the electorate a negative, inaccurate, mud slinging attack on Theresa May.

    The T May Estate Agent ruse was a disgrace.
    Where was our solution to the problem?

    This was just one example of the worst campaign I have seen in over 25 years.

    The first thing Vince can do is to throw out of the HQ team those who still believe in negative campaigning.

  • David Evershed 10th Jul '17 - 10:50am

    What an informative, well argued and influential article.

    Vince Cable and Norman Lamb should take Ruth into their inner circle.

    HQ election campaign staff should be made to write it out 100 times before being replaced.

  • Laurence Cox 10th Jul '17 - 10:57am

    @Ruth

    Thanks for your article, which was badly needed. I was working in HQ as a volunteer during the campaign (in another area) and saw the internal launch of the ‘dementia tax’. It seems to me that during a stressful campaign there is even more of a danger of ‘groupthink’ taking over. It would be interesting to know if the people who thought it up actually ran it past Norman Lamb as both our Health Spokesperson and an experienced MP before going ahead with it.

  • In the heat of an Election Campaign its easy to lose sight of what we are fighting for. We should drop the use of the phrase “Dementia Tax” & get back to reasoned criticism & making some positive suggestions ourselves.

  • Jenny Barnes 10th Jul '17 - 11:45am

    Revise inheritance tax so that it’s paid by the recipient as income, rather than by the estate. Probably need to be spread over say 10 years. Do something about trust funds that keep control of wealth without it being exposed to tax. Use the money to replace the billions that have been removed from council funding, which is why social care is a problem.

  • As someone who helped care for my Father during his final few years battling this aweful disease I applaud this more sensible approach. For many the so callled Dementia tax would have quadrupled the amount of estate they got to leave. Personally I would like to see a percentage cap placed upon the amount the state would recover from a realised estate. In other words that state will take up to X% of your estate (perhaps 30%) to pay towards your care costs. The amount to be deducted prior to inheritance tax is calculated.

    Of course taking any amount of someone’s home is contentious and we really do need a cross party approach, although I doubt we’ll see one from Labour in this parliament just look at their response to the PM today.

    As an example, a family friend of my wife often talks about how his neighbour had the same income level as them but decided not to buy his council house. After struggling for years they finally ended their own mortgage (retiring a couple of years late) only to find their neighbour, also retired, now paid virtually zero rent. As both approach the twilight of their years our friend feels bitter that he will likely lose most of his house to pay for care. His parting shot to me was that he should have had better holidays and cars and retired two years sooner. It was hard to argue against that. We need to ensure that the policy doesn’t overly punish the moderately well off who are only that way through their own prudence..

  • Graham Evans 10th Jul '17 - 12:11pm

    @Jenny Barnes: Inheritance tax is 40% above the threshold. Unless you abolish the threshold there would be little difference to taxing it as income, so no savings. In fact if it were spread around several family members there might well be a loss of tax. The taxing of trust funds is a totally separate issue, and I doubt whether the sort of person wealthy enough to set up a trust fund is worried about the bill for social care. One of the problems with the current system of both social care and social benefit support is that it encourages dishonesty among people with modest savings, particularly if they are not home owners.

  • Graham Evans 10th Jul '17 - 12:18pm

    According to Guido Fawkes, admittedly not always the most reliable of sources, the term “dementia tax” was first used in an article by the Spectator’s Will Heaven, a former Tory speechwriter. “The Dementia Tax Backlash” was the front page splash of a headline in the “Mail on Sunday”. It was first tweeted by a chap called Phil Lewis, who appears to have nothing to do with the Labour Party. Does he have anything to do with the LDs.? Even the Tories have used the phrase “so-called dementia tax” in Google adverts targeting people searching for the issue.

  • John Critchley 10th Jul '17 - 12:45pm

    Thank you Ruth for your article. I thought I may be alone as I despaired at both the used of the word dementia and the idea that we could be against a better and fairer way forward on funding social care. Where to now for us on this?

  • Jocky McLean 10th Jul '17 - 1:32pm

    This is excellent.

  • Graham Evans 10th Jul '17 - 1:37pm

    The overwhelming majority of old people need little or no social care, relatively few need to go into a nursing home, and even fewer need comprehensive dementia care. This is a classic case where there is a need for insurance. Like house insurance, the chances of your having to take advantage of the insurance are low, but the consequences of of your needing to do so, or of your house burning down, are severe. However unlike house insurance, which most house owners take out, social care insurance is not commercially viable because so few people take it up. It is very much a chicken and egg situation. This is why the state needs to step in to provide a form of quasi insurance. It could of course introduce compulsory social care insurance for everyone, as was once the objective of National Insurance. However the distinction between national insurance contributions and tax has been so blurred down the decades that national insurance has become discredited. State sponsored social care insurance might well be tarred with the same brush. The reason to set a cap on paying for social care is to get around this problem. The so-called death tax of £20K once suggested by Labour would have achieved the same end, though whether it would have raised enough money is questionable. The key difference between insurance and tax is that tax is normally related to income, whereas the insurance premium is related to risk. While poor people are more likely to ultimately require social care, I am not suggesting that they should pay higher premiums, but by the same token the people with modest wealth should not be obliged to see the most of it lost because of a stroke of fate.

  • Lorenzo Cherin 10th Jul '17 - 2:00pm

    Ruth is a measured , sensible contributor, here , no exception.

    We need more people involved in policy and the party who are effected by and experienced in the matter concerned.

    I believe that the party was trying to have it’s cake and eat it. I do not like the idea of ever higher inheritance taxes on average bequests, so the so called tax, and objections to it , fits with my stance.

    There are many who are in favour of higher inheritance taxes , on average bequests , who were up in arms about this policy.

    My view is that we need what is principled and popular wherever possible, not the same as populist.

    If this party could learn this, it would do better.

  • @Lorenzo Cherin
    ‘My view is that we need what is principled and popular wherever possible, not the same as populist.’

    I am really struggling to understand the principles here. How do we define what necessitates a social service and under what circumstances the state is best positioned to be the provider?
    To predicate a revenue stream on a house price inflation that we would hopefully legislate to bear down on would seem to be somewhat flawed. So it comes down to a tax on accumulated wealth. Hence that could be interpreted as a tax on a life style choice to accumulate rather than consume. Likewise would we ask for a contribution to terminal cancer care.
    It’s the same with tuition fees. Graduates benefit from education so they should pay. Well school leavers at 16 are more likely to benefit from job seekers allowance, so should they pay?
    Maybe we can have a stab at defining these principles and hence have a chance of policies that will stand up to scrutiny.

  • Nye Bevan – one of the great founders of the welfare state – once said, “The great secret about the National Insurance fund is that there ain’t no fund.”

    Elderly care should come from general taxation. Anything else is a mirage or a fraud. Any tinkering is full of anomalies. To fund out of property values at death ignores the many millions who have no such asset – and if this government lasts much longer that number will continue to rise. The trouble these days is that many politicians run scared of raising taxes because they have bought into the Daily Mail agenda.

    And can we please get away from the horrible name of a ‘dementia tax’. There are a thousand and one reasons why the very old need support of one sort or another. To call it a dementia tax ought to get Liberals reaching out for the prejudice and ignorance button.

    It’s all a question of what sort of society you want.

  • David Evershed 10th Jul '17 - 4:03pm

    Graham Evans

    You can’t take it with you.

    So if any insurance is to be paid to protect inheritances, it should be paid by those who are due to inherit, who would need assurance they will not be cut out of the will.

    So overall, insurance is probably not a very practical solution.

  • Ruth,

    Though your article clearly shows how much thought you have put into this, I do believe that it misinterprets what the campaign on this topic was trying to highlight. The Tories proposed a measure that would, if it were to be enacted put additional burden and worry on people in need of care, be that with dementia or otherwise, exactly at the point that they would have enough to worry about. Of course the proposed tax (something taken by the state to pay for something) was not solely about dementia sufferers and maybe here more thought could have been taken. Anyway, the point was, and is, that we propose to fund social care through income tax, thus addressing and removing the worries about funding for those needing social care, or indeed their careers. In the ideal world we will end up with a hypothecated tax that is ring fenced in a general insurance fund solely for the NHS and Social care.

  • Peter Hayes 10th Jul '17 - 4:53pm

    There is also the problem of people who sell their home to pay for sheltered accommodation but then have to move into dementia care. The money they can currently ‘keep’ is just over 20k. My parents sold their mobile home for a 6 figure amount but after a few years in a sheltered home without needing nursing cover my father had a stroke and went into a not for profit home with care. A year after he died I was called to a hospital discharge meeting for my mother where they assumed we would find a new home with 24×7 nursing cover at at her expense, she died 3 weeks later in hospital but presumably Cheshire and the NHS considered that a cost free end of a bed blocking. Bitter just a bit, I did inherit a bit of what was left and made a donation to Methodist homes who had done so well for them and my father in his later years.

  • Joseph Bourke 10th Jul '17 - 5:17pm

    I depart somewhat from the conclusion
    “We should all feel uncomfortable…safeguarding the inheritance of the propertied and the comfortably off.”

    Classifying homeowners as the propertied and the comfortably off will solve nothing.

    Henry George’s economic philosophy argued that all people should own the product of their labour, but that things found in nature, particularly land, belongs equally to all humanity.

    It is in the interest of society to aid families in caring for the elderly at home wherever possible. This is best achieved by incorporating social care provision within the NHS (i.e. a society wide insurance scheme) and funding domiciliary care with a Land Value Tax. Long-term local authority nursing home care could be funded largely from local authority rental of vacated properties with family top ups for private nursing home care..

    Land Value Tax would replace inheritance tax on land entirely and would be assessed at income tax rates on land rental values over and above a tax free band equivalent to the local area housing allowance (on top of the existing income tax allowance) All homeowners with properties situated on higher value land and with income in excess of the personal tax allowance would contribute.

    Qualifying asset rich and income poor householders (the poor widow) could defer LVT until the land was sold or transferred on death. The deferred LVT cap would be the value of land in excess of the imputed land value in the local areas housing allowance. By this means the protected estate that could be passed on in any event would be the lowest one third by market value of homes in the area i.e. only the top two thirds of properties (where lower income had necessitated a deferral of LVT) would be subject to recovery of a deferred LVT at death.

    In this way we all contribute to funding social care costs and not just those unfortunate enough to endure a long period of ill health and infirmity prior to death. At the same time family homes can be passed on to children/grandchildren who will in turn pay the Land Value Tax if they occupy them.

  • Ruth Bright 10th Jul '17 - 5:47pm

    Many thanks you all for your comments (and to Caron who rather wisely rejected my first
    version of the piece).

    Peter Hayes personal experience certainly reminds us of what is at stake here.

    I accept Andy Hinton’s point that the criticism of the “dementia tax” policy and the marketing of the criticism of the policy are two separate things. There seems to be quite a consensus that the “May estate agent” campaign was dubious the say the least. However it is important to state that much of the stuff churned out by the press office morning, noon and night during the election was really excellent.

    It is perfectly reasonable for P.J. to point out that using the property bubble to feed social care might be a one off and we would have to reach for other solutions. But May’ s solution was not immoral or nasty which is how we portrayed it during the campaign.

    Paul DB I am sure we would both be ideologically very comfortable with an NHSS with all health and social care free at the point of delivery. I would also favour dental care, optical care and chiropody being brought fully back into the NHS. The bill, however, would be astronomical and the 6 billion proposed in the manifesto (as I think Hywel and others have pointed out on LDV before) would not even get close.

  • I live close to a care home for mentally/physically handicapped children and adults many of whom need 24 hour care…Expecting families to ‘mortgage’ their homes to finance such came would be an anathema to most people. Yet for those needing care in their old age that is what the ‘Dementia Tax’ (nasty name for a nasty idea) does….Stating that their home will not be sold in their lifetime is a poor substitute…

    ALL care should be paid either from general taxation or from an national inheritance tax..(as has been said it is only a small proportion of the over 65s who need such care*)… Spread over the whole population such an essential service would result in a small rise…
    *Statistics from Office for National Statistics from 2001 to 2011 show that despite an 11 per cent rise in the number of people aged 65 and over, the number of people living in care homes was almost unchanged at just over 3%….

  • Ruth Bright 10th Jul '17 - 6:32pm

    Respectfully expats we are not talking about the same thing. (Part) of an inheritance is being forfeited by the next generation that is all.

    As for a universal system free at the point of delivery of course it will not be as expensive if you:
    a. omit domiciliary care from your costings and only include residential
    b. factor in only the current “on the cheap” system where staff are paid the minimum wage and facilities and activities in many homes are in no way therapeutic but just amount to a television set and an armchair.

  • Simon McGrath 10th Jul '17 - 8:20pm

    @jenny barnes – trusts are (rather heavily) taxed

  • What is the current system and how does the Tory policy differ?

  • The problem is that taxing money twice is always contentious and there must be fairness across the income streams. Too often it seems to drift into the politics of envy. I have a nicer house than some of my peers on similar incomes. They have had nicer holidays and drive nicer cars – who’s the fool?

    We, like many others without the benefit of decent pensions, plan to downsize and use the proceeds to top up our pension income, we’ve even considered a buy to let when we do for the same purpose. We’d hoped to finally leave a bit to our kids to help them on life’s journey. Some see the fact our kids will benefit from our labours as unfair, but why is spending your money on your children less fair than having the sports car or the two holidays a year that others in my income stream do?

    In short any solution mustn’t be seen to punish the prudent or it may end up counterproductive…

  • Ed Shepherd 10th Jul '17 - 9:04pm

    An informed article based on knowledge and lived experience. Thank you.

  • Little Jackie Paper 10th Jul '17 - 10:53pm

    Steve Way –

    ‘We’d hoped to finally leave a bit to our kids to help them on life’s journey.’

    I don’t think that what was proposed would have prevented that would it?

    ‘Some see the fact our kids will benefit from our labours as unfair’

    Not me. The benefit of house price hyperinflation though is something rather different.

    I think that my problem with the reaction to May was not so much that her proposals were criticised, rather that that criticism skated rather close to suggesting that it was totally unreasonable to propose anything to do with wealth. Yes, there certainly are difficult questions here – not least about moral hazard as you mention. But equally given that a certain generation is sitting on something like half a trillion of property it doesn’t seem totally unreasonable to at least put it on the table for discussion.

    Being fair to all the current leaders, social care is a hot potato because previous governments have ducked it. It is to May’s credit that she didn’t duck it. I think that what left such a bad taste in the mouth about the estate agent stunt was that it was the worst kind of duck.

  • Ruth draws attention to a number of failings, negative campaigning that failed to consider the distress caused to dementia sufferers and more importantly the state of social care provision in the country. Care assistants in nursing homes are minimum wage workers (many of them immigrants). They are still better off than home care assistants who don’t get paid for travelling between patients and often have only 15 or 30 mins to spend with the elderly before moving on to the next client. You also bemoan the lack of attention to social housing.

    In Singapore, 80% of the population live in subsidised apartments built by the government, most of them as owner-occupiers. Singapore’s Housing and Development Board (HDB), the successor of the city planning agency created by British colonial governors) is the foundation of the city states economic and social policy. The government has since the 1960’s acquired much of the land and now controls around 90% of the territory. New built properties are sold every year to 1st time buyers (with a means tested discount) on 99 year leases. There is a mandatory national-savings scheme to which employees of working age and employers contribute 20% and 17% respectively. . The savings fund provides the source of funds for deposits and some or all of mortgage payments. Singapore has virtually no homeless problem and accommodation is more affordable than London. The savings fund provides for both housing and together with receipts from downsizing or selling back the unexpired portion of leases to the government, pensions and social care needs.

  • Lorenzo Cherin 10th Jul '17 - 11:38pm

    Pj

    I think we very often can have principle and be popular , tat is not populist.

    David Raw

    in those comments is getting at the issue , and there is a popular policy in his stance that is not populist , but he views it as a principle , and one to put into practice.

  • @Little Jackie Piper
    Hyper-Inflation of house prices doesn’t effect everyone. When we brought our (hopefully last but one) house we still had a 75% mortgage and in the years since house prices have not really moved – we live in Plymouth not an area of really high prices. We have been prudent, over paid and done our best to reduce this.

    Whichever way it is done we stand to lose more than those who have not been prudent (I am not referring to those that had no opportunity to do so as I believe society through general taxes should provide that safety net). It is also my problem with the LVT, people can suffer for working harder and putting more of their income into their property.

    Which brings me back to my core view, that across the income stream (above the minimum wage where the threshold should be) we should be paying more tax, proportionately yes but everyone has a stake and all should pay accordingly. Tax all income the same, merge NI into it and simplify the whole system…..

  • I’m not sure what were are debating here? Is it a name which the media popularised or is it a policy which we can agree or disagree with?

    If we are debating a name, then we have to remember that it was the Alzheimer’s Society who coined the term in 2011 and brought it into popular culture. See: https://www.alzheimers.org.uk/download/downloads/id/1147/dementia_tax_report_2011.pdf. This term was then re-used and ‘branded’ by the media in the wake of the Conservative manifesto. When on a general election footing it is important to prepare responses which can be easily linked to a specific topic being discussed. Hence why LD and Labour consistently referred to the ‘Dementia Tax’ so that it was clear what they were referring to. We may not like the term but we can certainly understand the reasons for using it otherwise the electorate don’t know what parties are objecting to.

    If we are debating a policy then we have to remember that the policy which caused all the furore was in a Conservative manifesto policy which had little detail. In other words we have no idea how it might or might not have been implemented. You may recall the discussions about ‘floors and ceilings’ all of which elicited suitably vague responses from various Tory ministers. It was a ‘toe in the water’ which the Tories have now withdrawn rather sharply because the water went to boiling in an instant. It is now a ‘non-policy’ based on ‘non-detail’ and subsequent to the election, non-existent.

    However, this is an area where the Liberal Democrats could take a lead but we need to remember that ‘those who ignore the mistakes of history are doomed to repeat them.’ Let’s form a policy committee to look specifically at Adult Social Care, let’s take evidence, let’s formulate policy and let’s take it to conference and debate it but announce the results with care. Poorly thought out policies announced to attract soundbites carry their own rewards as the Tories discovered.

    In my opinion, debating names and poorly formulated policies isn’t helpful. This is history. Let’s take a lead and formulate a well thought-out social care policy for the future.

  • Hi Tony. having worked for the Alzheimers’ Society I know it does a tremendous amount of good but it is not perfect. Like any charity it has to get attention in a crowded market and its’ comms team can pitch things wrongly like any other.

    The last two paragraphs of Little Jackie Paper’s contribution sum it up very well. I am not saying that the Tory “down to the last 100K” policy was perfect but it was a good start for a discussion and it was wrong of us say overblown things during the campaign like: “If you or your spouse get dementia they are coming for you”.

    Joe – thank you. I have read your comments really carefully. Steve Way – I was brought up in a house my father largely built with his own bare hands so I am not averse at all to people enjoying the fruits of a parent’s labour!

  • Katerina Porter 11th Jul '17 - 8:52pm

    We have all or almost all paid National Insurance, a label even though the money this collects I believe goes into the general Treasury fund. The point Graham Evans makes is that it is like all insurance which relies on the many who do not make claims to pay for those that do. For care one can either label the cost of care as coming out of National Insurance or Income tax. The point is one must prepare to accept higher tax. I remember when Income tax went up or down according to need without it causing great drama. During the thirty years after the War the West created welfare states with mixed economies. These were also the years which saw very high growth of prosperity but taxes were very high. Even in America the marginal rate of tax was 90% for the first 20 years and 80% for the next 10.

    Scandinavia generally has very high tax but friends there have said they accept this as they get such good public services.

  • Katerina Porter 11th Jul '17 - 8:57pm

    PS One would not be going up to those post war heights, but some increase would be simple and cheap to administer without setting up new complicated systems which would have all sorts of disadvantages.

  • There is a balance to be struck between leaving something for your descendents and paying for your care. A cap seems sensible and perhaps it should be graded like Council Tax. After all, often most care still falls on the very relatives who benefit from the inheritance and could provide an incentive to travel those sometimes vast distances.

  • Little Jackie Paper 13th Jul '17 - 9:41pm

    Steve Way – ‘Hyper-Inflation of house prices doesn’t effect everyone.’

    You’re not serious? House price hyperinflation has profound effects across society.

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