Funding Social Care costs

Andrew Dilnot, the economist who reviewed social care for the coalition government has described the social care system as a classic example of market failure  where the private sector cannot do what’s needed.

On the Tory plans, he said:

The changes just fail to tackle the central problem that scares most people. You are not tackling the big issue that people can’t pool their risks. There is nothing that anybody can do to pool their risk with the rest of the population, you just have to hope that you are not unlucky.

It is not providing insurance. You could easily have care costs of £300,000 each if you are a couple; you are not able to cover that extreme risk which is what we all want to do faced with anything else which we can insure. That’s the market failure and these changes do nothing to address that.

Shadow Health Secretary Norman Lamb has said:

Social care is in a state of total crisis. A million older people are missing out on care they need and services face a funding black hole of billions in this year alone. In Coalition we commissioned the Dilnot report – an independent, expert led review of social care funding -yet the Conservatives have chosen to ignore the recommendations. Now they are simply kicking the issue into the long grass again with more consultation, after their deeply unfair Dementia Tax was clearly rejected by voters.

Land Value tax (LVT) is well suited to funding the provision of social care. Policy ideas developed by ALTER include a tax free homestead allowance that would exempt many owner occupied homeowners from the tax altogether.

The tax free homestead allowance would be based on the capitalised value of land rents included in the Local Housing Allowance.

Land values in excess of this allowance would be subject to LVT at a rate sufficient to meet social care funding costs as part of an integrated health and social care service.

In Dilnot’s example, a couple facing care costs of £300,000 each need only pay the LVT on the value of land they own in excess of the homestead allowance.

For example, if this couple lived in a home worth £500,000 with a land value of £300,000 and an LHA land value of £200,000 they would pay LVT on the excess value of £100,000.  At a precept rate of say 1%, they would pay £500 each per year. If they did not have the income in retirement to pay the tax, it would be deferred until the property was sold or bequeathed, leaving only a modest charge against the property, which itself could be capped at the excess of land value over the homestead allowance.

Such a system of social care insurance spreads the risk across the whole community and would provide the necessary peace of mind to elderly citizens that even if they do need long-term care they will still be able to pass on the family home to their children.

 

* Joe Bourke is an accountant and university lecturer, Chair of ALTER, Chair of Hounslow Liberal Democrats and PPC for the Brentford and Isleworth constituency.

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36 Comments

  • Speaking personally I think the polical class in westminster are likely to converge on backing Andy Burnhams idea(another estate tax), further taxing middle england.

  • David Cooper 31st Jul '17 - 2:00pm

    A good proposal, so much better than levying higher income tax on everyone.

  • Laurence Cox 31st Jul '17 - 3:02pm

    @Joe

    Yes, this is a better approach than the original ALTER approach that ignored housing costs. However, we need to think about how our opponents would portray it. A couple would only be entitled to a single bedroom under Local Housing Allowance, so if the the house were, say, a three-bedroom semi they would be considered to have two surplus bedrooms (=25% rent reduction, so a capitalised £150,000 rather than £200,000). In effect, they would accuse us of introducing a new ‘bedroom tax’.

  • Matthew Huntbach 31st Jul '17 - 4:08pm

    Laurence Cox

    In effect, they would accuse us of introducing a new ‘bedroom tax’.

    OK, so the reply would be “So how would YOU pay for it?”.

    This really is the key issue: if you want it provided by government, it has to be paid for somehow. If you object to some tax proposed to pay for it in one way, you may find you have to end up paying it in some other way that is even more objectionable.

    That was the case with universities – people voted in the Conservatives, with the key Conservative pledge being to keep taxes down. So, if the Conservatives weren’t willing to raise the taxes necessary to subsidise universities, some other way had to be found to pay for them. We know what that was. Now we have also seen that by voting in the Conservatives again, a way has had to be found to carry on paying state pensions – raise the retirement age.

    Lengthening life-spans means there is going to be a growing need for social care. It has to be paid for somehow. If people aren’t willing to pay for it through taxes, it is going to end up being paid for by something like universities – a loans system, repayable from inheritance after death, with a clause like tuition fees loans that you don’t have to pay for it if you don’t have the money for it. If you don’t like that, and won’t agree to some sort of land tax, ok let’s say how much income tax would need to be raised, or VAT, and say “You want that then?”.

    The uselessness of Corbyn is shown by the way he has no answers to these questions, and doesn’t even have the vaguest idea of how much it’s all going to cost. It really is amazing that he was allowed to do so well in the general election vaguely waving his hands on university funding, and only afterwards coming out with “Duh, I didn’t realise it would cost that much”. Oh, COME ON, anyone with any competency in government should at least have been able to get a rough estimate together.

  • Joseph Bourke 31st Jul '17 - 4:09pm

    Laurence,

    I am sure you are right that it would be opposed, just as the Conservatives dubbed the recent Labour proposals as a Garden tax. However, the Tory proposals would have left only £100k to the couple in the example above, taking £400,000 from them for domicillary social care costs. Under this scheme, the maximum deferred LVT would be the excess of land Value over the LHA. If the LHA was £150,000 the maximum they could have as a charge against there estate would be £150,000. At £1500 per year they would have to live for another 100 years. Even if the LVT was at the maximum possible rate of circa 5% on land value, it would take 20 years before they reached the cap and in this worst case scenario, they could still bequeath a £500,000 family home with a £150,000 loan against it.

  • Richard Cripps 31st Jul '17 - 5:12pm

    We (as a society) have to recognise that as we applaud advances in medical procedures, there are consequences of people living longer with variable quality of life. Hence social and health care merge. I suggest that a National “Health and Social Care Service” replaces the centrally-funded NHS plus the locally funded Social Care (and the inherent conflicts of budgets therein) with one service. Clearly, someone has to bite the bullet and recognise that whatever system we employ will need more taxation to pay for it. At least at the last Election the LDs were honest enough to admit this!

  • I don’t like the LVT approach at all. It seems to be fairly artbitary as people who lived in different parts of the country; one who had to spend their money on an expensive house to live in for their work and the other who didn’t, because exactly the same house was a lot cheaper, would be treated differently, even though they earned the same. It would be far better if we did 2 things 1) set up mandatory personal insurance funds that people had to pay into from say 21 (state inputs where income is too low). The fund builds up till the néed to draw on this. 2) having lived in the Netherlands, I have experience of a worldwide wealth tax, which I think is really interesting. Your residence is exempt, but all other wealth, cash, shares, 2nd homes and other investments are subject to a % tax. So if you have £100,000 of wealth, and the tax rate was 0.03% then you would pay £3000. – simple and fair! A good way to throw the net a little wider and help fund the NHS and Social care.

  • Paul D B,

    the local housing allowance (LHA) is based on the bottom third of rents in the area. A land value allowance based on the LHA automatically accounts for regional differences. There is also a strong argument that the preponderance of public infrastructure investment in London and the Southeast is a major part of the reason as to why Land Values are so much higher in the South. That public investment is paid for by taxes assessed on a national basis at the same rates.

    Most people have little wealth outside their family home and/or pension funds and those that have great wealth hold it via offshore trusts and foundations to avoid being caught by such things as wealth taxes and inheritance taxes.

    It is said that there is no shortage of housing accommodation in the UK, if the many unused bedrooms came onto the market and were available to rent. With an LVT, it may be we will see many more rooms for let to lodgers either privately or via the local authority, as used to be the case with war widows. The rents would of course pay the LVT and leave the estate charge free to pass on to heirs, if that was the choice made by homeowners.

  • Laurence Cox 31st Jul '17 - 9:43pm

    @Matthew Huntbach

    Businesses use “red teaming” to identify weaknesses in their planning. However, you deny that we should do the same in politics. Look at Ruth Bright’s posting here on the ‘dementia tax’:

    https://www.libdemvoice.org/dementia-tax-project-fear-54836.html

    which was widely welcomed in comments BTL. Perhaps if we had more “red teaming” we might shoot ourselves in the foot less often.

    Incidentally, calling it a ‘bedroom tax’ is one for Labour (you may recall that we voted for it in the coalition Government) rather than the Conservatives; the Tories would probably wheel out single women pensioners who don’t want to leave their family homes. Joe’s 7:26 pm comment, concerns me; if people perceive our reasons for doing this as social engineering, rather than simply making care affordable, then it is doomed.

  • Matthew Huntbach 31st Jul '17 - 10:14pm

    Laurence Cox

    I really am not sure what you are trying to say, because you seem to be assuming the opposite about me than what is my actual position. I myself think it was a disastrously wrong thing for us to condemn what was called “dementia tax”: I said that here in LDV at the time of the general election when that phrase was first used, and I have said it many times since. Condemning a suggested way of paying for social care without saying how we would pay for it, or even acknowledging it does need paying for os PRECISELY the sort of thing I am saying we should not do.

  • Bill Fowler 1st Aug '17 - 8:00am

    The only advantage of this scheme is that you can blind people with its complexity… personally I would say treating inherited wealth as income and therefore taxing it without any kind of allowance would be the fair way to deal with it but probably not politically expedient. An extra inheritance tax set at a low rate but ignoring the allowance and applied to everyone, say 5 percent?

    You do have the fairness problem, though, someone on benefits for their whole life then gets free care in old age whereas someone who has worked their guts out to buy a house then loses that house, even if after he dies, to pay for his care, or a large part of his house.

    You can go round in circles with this, though, if families know they are going to lose the inherited house they may after all suddenly find they want to look after the parent.

    I thought May’s idea was not that bad in parts, for instance if someone said to me you can have care in your home for free until you die but you will lose the value of your house after death or you can pass the house on but will have to be placed in a care home then I would chose the former. As to spare bedrooms there might be a case for allowing nurses or carers to stay for free in return for some level of care, solving two problems at once.

  • Cllr Ron Tindall 1st Aug '17 - 8:42am

    it is important to remember that the Dilnot cap was intend to promote an Insurance market which cannot be formed at the present time because actuaries cannot work with unlimited and unspecified risks. Before we move on, let us implement all of the Dilnot proposals and then discuss how to fund the balance.

  • Steve Spear 1st Aug '17 - 8:48am

    Let’s not forget that as well as the issue of how we pay for long term care the system itself forces couples apart and provides low quality accommodation. We consider this to be a “care” issue but as 70% of the costs are tied up in real estate and hotel costs it is in reality a housing issue so it is right that we are looking at the wealth held in property. Currently home owners are forced into rented property and have no choice on their food provider if they require intensive care. I suggest one obvious solution to this is to give people the “right to buy” their care accommodation. This inject funds into the care system whilst allowing the individual to retain their capital built up in their property. It would also improve the quality of the accommodation available including the provision of accommodation for couples. For those who do not own their own property then they would continue to receive the same support as they would receive if the7 stayed in the community.

  • Sue Sutherland 1st Aug '17 - 12:46pm

    The problem with the Tories’ proposal was that it involved a health lottery which is unfair. I much prefer the idea of the community sharing the risk as Joe proposes because it seems much more in tune with our party’s values. Taxing the value of property and wealth passed on to the next generation should be a separate issue.

  • Andrew McCaig 1st Aug '17 - 1:37pm

    Personally I would favour increases on inheritance tax at a much lower threshold to pay for this. The injustice in the current system and in the Tory proposal was that one family might inherit little or nothing, while another might inherit a great deal if their parents die without needing healthcare in old age (please let’s stop calling it “social care”, which sounds like something optional and removes it from the free at point of delivery NHS). The most logical way to even this out is at the point of inheritance. If that seems also like social engineering, then so be it: Inherited wealth is creating huge unfairness in our society. So I am with Bill Fowler on this.
    LVT is a separate issue and should be replacing Council Tax and perhaps income tax. It is a long term plan whereas inheritance tax is already in place, and just needs amending.. But to recover significant amounts you need to extend it to much lower levels than now, let alone the Tory threshold increase.

  • Phil Beesley 1st Aug '17 - 2:35pm

    @Richard Cripps: “I suggest that a National “Health and Social Care Service” replaces the centrally-funded NHS plus the locally funded Social Care (and the inherent conflicts of budgets therein) with one service.”

    I’d go the other way. NHS Trusts should be dissolved into local authority providers of Health and Social Care. Local authorities might understand that really simple stuff like failing to grit roads and pavements imposes a cost on others.

  • Before deciding (or more likely speculating) on which particular pot/tax/ expat billionaire’s pockets or shroud manufacturers corporation tax we’re going to get the money from – how about an informed evidence based analysis of how much and what is needed to adequately provide these services (including the current rock bottom wages) ?

    Dilnot was only a start, and as a former Cabinet Member for Social Work, I certainly agree with his comment that the current system is “a classic example of market failure where the private sector cannot do what’s needed”. (Stand back for the blood curdling thirsty warrior chants of our more extreme so called classical liberal, i.e. Thatcherlite chums.

    For a start local government could be adequately funded instead of being progressively starved since 2010 and a thorough review of current contracts could be undertaken. We suffer from a terrible post code lottery at the moment.

    For a start people could read Andrew Dilnot’s recent comments on the current system :

    Social care reviewer condemns UK system and calls for new tax …
    https://www.theguardian.com › Society › Social care
    6 Apr 2017 – Thursday 6 April 2017 13.48 EDT Last modified on Friday 9 June 2017 13.34 EDT. Andrew Dilnot, who carried out the government review into …

  • The Reform research trust iargue that using housing wealth can offer sustainability for social care finances
    http://www.reform.uk/reformer/housing-wealth-can-offer-sustainability-for-social-care/

    The report notes estimates the UK needs an extra £10 billion for social care costs and the amount of unmet care need and lack of private insurance options, mean that the Government will have to commit more resources to care.

    The alternative resource to increasing income taxes or borrowing is the housing wealth of the older population.

    With a 40 per cent inheritance tax, it is hard to convince the older population that more taxes on their estate would improve their welfare. The current threshold on inheritance tax, however, means that 60 per cent of over 65s are exempt. A simple calculation based on the English Longitudinal Study of Ageing (ELSA) suggests that the housing stock of those exempts is worth £566 billion.

    Tapping into this resource could deliver the funding that social care needs without putting a significant strain on the economy. Reform has suggested deferred payment agreements as a way to liquidate housing equity and use it to pay for care. Alternative models, however, such as lowering the inheritance tax threshold to £100,000 and earmarking the proceeds for care could be the step forward that government has been so reluctant to take.

    Using the housing equity of older people may give authorities the needed fiscal space in order to pass a more radical, long-term reform such as a pre-funded model. In brief, the system would work by requiring the working-age population to save in a pooled fund for the future care needs. While these savings mature, taxing housing wealth will provide for the care of the current old. Reform has argued that such a model provides more intergenerational fairness, as well as value for money.

    LVT solves both of these problems. Inter-generational fairness and progressiveness is maintained as the tax is assessed on the owners of land i.e. primarily the older generation and Landlords, large and small. LVT is collected annually and can be deferred where the cash flow of older landowners is insufficient. It provides the basis for integrating domicilliary care with the NHS (relieving the problem of bed blocking) and for developing preventative care, so that elderly patients receive treartment before ilness become so serious that hospitalisation is required.

  • Matthew Huntbach 1st Aug '17 - 6:34pm

    Sue Sutherland

    The problem with the Tories’ proposal was that it involved a health lottery which is unfair.

    It is how residential care for the elderly is paid for. I remember facing just this issue when my mother-in-law had to go into residential care quite a few years ago. So if it is “unfair” why did we not propose scrapping it as the way to pay for residential care?

  • Its worth noting that over 50% of people are estmated to not require care at all and another significant % (cant rememeber what exactly) will need not to much care and a small minority will require extensive care. With that in mind I am suprised people are saying how much care is will cost as the years go by. I would also question why people need care in the first place, The lazy lifestyle and the changing workplace in the last 100 years contribute. As does the flu jabs promoted judging by some stories I have been told by people.

  • Matthew Huntbach,

    as Steve Spear notes in his comment above residential care is the provision of specialised accommodation generally with 24 hour care assistants. When the home property is vacated it becomes available for sale or rent, which is why it is then taken into account as part of available assets.

    Care home costs will normally considerably exceed the rental income that can be derived from a family home and in many cases there are significant capital sums required to prepare a property for letting, so it is not an option for many. The sale proceeds of the home can be dissipated quite rapidly with private care home fees averaging around £900 per week.

    I think this is an area that could be addressed in a more equatable fashion e.g. by local authorities taking homes vacated by care home residents into their social housing stock until such time as the disposition of the property is settled by the executors of the estate and deferring any excess of costs over council rents.

  • Philip Rolle 1st Aug '17 - 7:59pm

    The real failure is not by markets but people. It generally. When it comes to their health, people have got used to “free stuff”. The truth is that this cannot continue. Some form of social insurance to cover health and social care is inevitable and there should be the same premium for everyone of the same age. It should not be progressive. What has how much land you have got to do with the health services you need? Nothing whatsoever. If an individual cannot pay the premium, the government must offer a subsidy. But the primary responsibility for obtaining the right to health and social care ( together ) must pass from government to the individual.

    Is that blood curdling enough for you David Raw 😉

  • Phillip Rolle,

    there is extensive academic research on the relationship between housing conditions and health e.g. this World Health Organisation study http://www.euro.who.int/__data/assets/pdf_file/0013/113260/E92729.pdf.

    Why is it that 70 years after the establishment of the modern welfare state, health outcomes and life expectancy in the North remain significantly poorer than in London and the Southeast? Perhaps the answer lies in the so called postcode lottery i.e. if you live in an area of high land prices your chances of surviving a heart attack or cancer are much improved and a UK citizen in the south can expect to live several more years on average than a UK citizen in the North.

    The NHS for all its travails has been rated as the best healthcare system in the world https://www.theguardian.com/society/2014/jun/17/nhs-health, and its care found superior to countries which spend far more on health.

    The same study also castigated healthcare provision in the US as the worst of the 11 countries it looked at. Despite putting the most money into health, America denies care to many patients in need because they do not have health insurance and is also the poorest at saving the lives of people who fall ill, it found.

    The health insurance system you describe is similiar to that of the USA with medicare and emergency medicaid subsidies.

  • Nonconformistradical 1st Aug '17 - 8:57pm

    @Sam

    “I would also question why people need care in the first place, The lazy lifestyle and the changing workplace in the last 100 years contribute. ”

    Haven’t you noticed the increase in human lifespan? People used to die early of some nasty infectious disease, cancer is being treated much more successfully etc. People are surviving to an age when other bits of the body and mind start to fail and limit their ability to care for themselves properly.

    “As does the flu jabs promoted judging by some stories I have been told by people.”
    Can we have details of these stories please….

  • Philip Rolle 1st Aug '17 - 8:58pm

    The safety net is not sufficient in the States. Health outcome is dependent on the dosh you have and that must not happen here. But if you have money, the cancer outcomes for example are way better in the States than here.

    It is a matter of personal responsibility. Part of the reason the NHS does not improve as it should is that they are trying to do more and more with nearly same amount of money. People at heart know this but turn a blind eye because they don’t want to have to pay – they prefer free stuff. It is the duty of government to cut through this by airing proposals to fund healthcare in the future. The criticism that greeted a firm manifesto pledge for social care was bad for all of us as politicians will henceforth be wary about making such proposals. The consequence will be that care withers on the vine and some people will suffer more than they should. That is a shame.

  • @ Philip Rolle “But the primary responsibility for obtaining the right to health and social care ( together ) must pass from government to the individual.”

    Is that blood curdling enough for you ? No, just chill.

  • Little Jackie Paper 1st Aug '17 - 9:56pm

    Some interesting comments here. Being fair to the current party leaders the reason this is such a hot potato is that governments in the past have ducked it. Theresa May at the very least put forward an idea and she deserved better than the reaction she got because none of the other parties came up with anything convincing.

    Indeed looking again at the 2017 LDP manifesto p20 says, ‘[We will] Finish the job of implementing a cap on the cost of social care, which the Conservatives have effectively abandoned.’ That’s watery at best – and on my reading isn’t even a firm commitment to the much-quoted Dilnot proposal.

    LVT is interesting, though I suspect the best answer here lies in IHT – but absent that I fail to see quite what is so wrong about looking to (often unearned) property wealth. In 10-20 year’s time we may as a society be looking again at May’s proposal.

  • Of cause we could always send them to cheaper countries. That way they get the care but it costs less, I believe Norway already do this. Personally I’d rather fund a functioning health and social system, but if the country won’t pay the unthinkable will have to be thought and we may have to export the frail and old.

  • Frankie,

    where would they go? Not back to the EU as it appears the cabinet is wondering what to do if there is a mass exodus of retirees back to the UK from Spain and other parts of Europe http://www.telegraph.co.uk/news/2017/03/25/cabinet-ministers-warned-social-care-crisis-could-exacerbate/

    Norway seems to have quiet a good international reputation for elderly care having made good use of their North Sea oil reserves http://www.telegraph.co.uk/news/worldnews/europe/norway/11133156/Why-Norway-is-the-best-place-in-the-world-to-grow-old.html.
    I think it is Germany that is making quite extensive use of care homes in Hungary, the Czech republic and elsewhere in Eastern Europe https://www.theguardian.com/world/2012/dec/26/german-elderly-foreign-care-homes.

  • Little Jackie Paper, whether property price increases are earned or not a lot of people depend on that said windfall to be able to get on the property ladder these days and the state is the one propping up ever higher prices with low interest rates help to buy/right to buy etc, so it would be a bit to much for goverment having inflated a property bubble to then turn around and say we need to extract those whom have done thanks to us!. and as for IHT given half of european countries have no iht at all increasing that still further seems hard to believe there is no other alternative but that. Unless where saying lowing the rate in tandem with the exemption.

  • A lot of people do rely on their parents or grandparents having a windfall due to the rise in property prices to get on the housing ladder, but a great many more do not have that windfall through no fault of their own, yet have to compete with those people and invariably they are the ones failing to get on the property ladder, despite having just as good a job, and instead are faced with ever increasing rents.

  • Fiona you may have a point but whats the alternative? To make those people now also have to struggle/rent as well? Which in turn means even more state assistance will be required for the only ‘relativly’ affluent’ middle class types?

  • jayne Mansfield 2nd Aug '17 - 1:45pm

    @ Frankie @ Joe,
    Please don’t send me to Hungary or Poland.

  • Fiona/Sam,

    housing price bubbles always burst regardless of what the government does and when they do there will be another damaging economic slump that the government will be powerless to prevent.

    The hyper-inflation we have seen in land prices doesn’t create a windfall that enables people to get on the housing ladder, it just means the next generation have to take on debt that is 30 to 40% of their lifetime earnings effectively trapping them in a spiral of debt for the rest of their working lives.

    Inheritance tax is not the answer and as you note many European countries have abandoned it altogether.

    Land Value Tax acts to dampen land speculation and the inflationary pressure of higher population density and publically funded infrastructure spending on land prices.

    The Guardian carry’s a feature today on homes left unoccupied in the Borough of Kensington and Chelsea https://www.theguardian.com/society/2017/aug/01/names-of-wealthy-empty-home-owners-in-grenfell-borough-revealed. The reason so much capital flows into London’s property market is the vibrancy of the economy and the hundreds of billions of taxpayer funded infrastructure spending that is poured into the capital. ALTER has recently published a proposal based on recovering part of this taxpayer funded windfall to Non-doms and offshore companies https://www.libdemvoice.org/property-uplift-recovery-tax-54023.html

    Fiona is right to point out the plight of those renting. A century ago, during the great war, when Landlords sought to take advantage of increased demand for housing from munitions workers being brought into Glasgow, Mary Barbours’ Army of women and children organised a rent strike. Lloyd George was forced to intervene with a rent restriction act https://remembermarybarbour.wordpress.com/mary-barbour-rent-strike-1915/. Let’s no go there again.

  • Rebecca,

    I lived and worked in Japan at various times in the 1980’s and 1990’s seeing it go from boom to bust in those years. The Japanese economy has never recovered its former vigour since the real estate and stock-market crash of the 1990’s;and the stability of jobs for life is long gone with the off-shoring of much manufacturing to China and SE Asia. We would do well to heed the lessons of Japan’s economic stagnation and inability to get out of its slump, despite massive fiscal and monetary stimulus stretching over two decades..

    Its ageing demographics, restrictive immigration policies and falling birth rate are pushing more and more of the population into the over 65 category and placing an ever larger burden on the shrinking working population. Simply increasing national insurance contributions on firms and those of working age is bound to run up against a ceiling if these demographic trends continue as they are now..

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