This blog is a week late – but I’ve been busy! I wanted to highlight the Lords’ Economic Affairs Committee report published July 4th. This cross-party group of Peers calls for an immediate investment of £8 billion pounds into our care services “to restore social care to acceptable standards”.
North Devon, as many areas of the country, has an ageing population. Many move here to retire, and then as they enter their twilight years increasingly rely on stretched care services. I have been meeting with care providers and care users – there is a lot that needs improving in North Devon and it comes down to funding. £8 billion more for our care services nationally would make a real difference in North Devon.
In England, over a million vulnerable older people do not have proper care support. However, in Scotland, where health and social services are a devolved matter, care is free for the over 65s.
Many family and friends in England have caring responsibilities as their loved one does not meet the criteria for social care. This is wrong. The report highlights that most unpaid carers are women. 63% of women who care are aged between 50-64 and care for at least 50 hours a week. Our society is being propped up by the unpaid work of millions of carers.
I welcome another recommendation of the report, notably that a further £7 billion a year should be spent to extend free personal care to all by 2025. This would include help with cooking, washing and dressing. We need an integrated health and care system, with care paid for out of taxes. Any of us could need care at any time – this should not be a lottery where some get good care and others not.
Key findings are here, and include that the lack of funding means “local authorities are paying care providers a far lower rate for local authority-funded care recipients than self-funded care recipients, and those care providers with a high proportion of local authority-funded care recipients are struggling to survive.” North Devon in a nutshell.
The report highlights the disparity in care across England, saying that additional funding “should be distributed to local authorities according to a fair funding formula.”
One of the recommendations is that the Government should explore a cap on accommodation costs, as accommodation costs are excluded from the personal care proposals. The Dilnot Report, published in 2011, had proposed capping care costs but was never adopted. The idea of capping costs has been around for a little while, and in this Lords’ Report capping would apply to accommodation costs because other care costs would be funded from general taxation.
I hope these recommendations are implemented, but I lack faith that they will be in the current climate. We need real vision to create a society where all are valued – carers and those cared for. This report outlines how that could be achieved.
* Kirsten Johnson was the PPC for Oxford East in the 2017 General Election. She is a pianist and composer at www.kirstenjohnsonpiano.com.
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15 Comments
A very welcome report as you describe it Kirsten. I will read it with interest.
Is there any mention of residential care home contracts and the current uncertainty hanging over them ?
Kirsten,
“The Dilnot Report, published in 2011, had proposed capping care costs but was never adopted”.
The Dilnot Report recommendations were adopted in the Care Act 2014 with the rates to be set by regulation with a planned implementation date of April 2016. It was suggested by the Coalition government that the cap on the amount people would pay would be £72,000 and the upper capital limit would be £118,000. In July the new Conservative government set a new date of April 2020. In December 2017 the April 2020 date was removed with no new date set (https://researchbriefings.files.parliament.uk/documents/CBP-7265/CBP-7265.pdf).
Thank you for posting this report, Kirsten.
Sir Andrew Dilnot stated in his evidence to the HCLG select committee reviewing this issue:
“While consensus has generally been achieved around the nature of the problem and developing a vision for the future, consensus on the key question of how, as a society, we should pay for adult social care and support has eluded governments to date.
That is what is always politically most toxic for Governments. The debate is much more now about where the money should come from than about what the money should be spent on. My advice for any institution trying to build consensus would be try to focus on that.”
One key question is whether adult social care should remain at local authority responsibility or be centralised at national government level. In the Lords report Essex County Council called for “a funding distribution formula that accurately reflects the level of need in each area.” Sarah Pickup said a “funding formula” could remove inequalities without resorting to a national system:
“You can deal with distribution issues if you can get a good, fair funding formula in place … It does not mean that you need to have a national system; historically, we kept all business rates and council tax in local areas and had government grant, which was used to redistribute. It did not mean that services were not organised and delivered locally.
”The Health and Social Care Secretary said the Government was not considering centralising the funding of adult social care:
“we are not looking at changing the 1948 settlement in which it was decided that the NHS would be a national body and social care would be funded by local authorities … It is true that an awful lot of taxes are paid to the national Exchequer and then redistributed out, but not entirely. In fact, we have moved slightly in the other direction with the introduction of the social care precept, but that itself has an equalisation formula on top.”
Just after WW1 Lloyd George, promised that his government would “make Britain a fit country for heroes to live in”; it didn’t happen then and it hasn’t happened since.
At the same time as ‘the great and the good’ were praising the sacrifice of ‘D-Day’ the BBC programme on adult care in Somerset was transmitted…The lack of care for the D-Day generation was in stark contrast to the praise of their achievement.
Twas ever thus…Care costs money; praise is free.
It would be helpful to consider how other European countries organise adult social care. I do not see this issue discussed in the French or German press so I have no idea what is different there, but wouldn’t it be worth enquiring. The UK has an unfortunate tendency to act like there is nothing that can be learned from experience or practices of other countries and it seems that the writer of this article shares that tendency.
Should I be taxed even more heavily than I already am to pay for the care of elderly people whose children choose not to care for them even if those elderly people have a lot more money than I do and could pay for their care themselves?
I’m sorry, I completely reject that. What the writer proposes is bad policy for all sorts of reasons, but it’s simply unacceptable to me as a parent of two young children already paying towards the care of my elderly parents in another EU country. It may be a vote-winner in areas like North Dorset but it’s unacceptable to those of us who live in the parts of the country that are already subsidising the nice lifestyles of those living in well-to-do parts of rural England.
Rob Cannon 11th Jul ’19 – 7:34pm,,,,,,Should I be taxed even more heavily than I already am to pay for the care of elderly people whose children choose not to care for them even if those elderly people have a lot more money than I do and could pay for their care themselves?……………..
Should I be taxed for education if I have no children, for the NHS if I have private care or am never ill, for the roads if I don’t drive a car, for welfare when no one in my family have ever used it, for libraries and public parks if I choose not to use them.?
Rob,
looking at best International practice is important, but there is no universally adopted model. It is also important to understand the nature of the problem and get the facts https://fullfact.org/health/adult-social-care-england/
Around 1/3rd of adults receiving social care are of working-age not pensioners and roughly half of the funding goes to this category of users. These are not well to do people.
Pensioners and others pay for their care on the basis of means testing. If they move into residential care the equity in their homes is used to fund care/nursing home costs. Around 1/10th of these property owning pensioners will face catastrophic care costs as a result of Dementia or other serious disabling illnesses. It can happen to any of us and there will be no home to pass on to our children.
Many adults in need of social care are no longer able to access services and their care needs are not deemed severe enough to qualify for assistance under harsher qualifying criteria.
Spreading these costs as part of a cradle to grave social security system in the same way that we do for the NHS protects us all from losing all our capital at the end of our lives and having nothing left to pass on to heirs.
With so many older folk not able to get the care they need the current system is failing us. If you can measure the civilization of a society by the way it treats the elderly, we are in danger of falling back into the dark ages.
It’s something called Society Mr Cannon. You clearly don’t want to be part of it and no doubt you’ll have a notice on your gate ‘No ambulances here.’
It’s disappointing to see glib responses like those from David Raw and expats. Any person with a modicum of intelligence and common sense can see that the state does not have infinite funding so has to determine funding priorities. I don’t see why someone in their 30s paying off student loans and supporting children should be paying tax to pay for care for someone in his 70s sitting on hundreds of thousands in wealth, but that would be the effect of the caps on costs that the writer of the article is advocating. I note that even though I made this point in my original comment nobody replied to it.
Compared with other European countries too many British people don’t support other family members. Too many parents throw their children on the state at 18 (or earlier) and too many children throw their parents on the state (they want the inheritance but they don’t want to look after their parents themselves). Is this the society that we should be encouraging?
Unfortunately, one of the major problems with the LibDems is the strong skew of its members towards white English 50 and 60 year olds. Among most immigrant communities in the U.K. there are much stronger family ties and much more family support. Those immigrant communities are also much younger in average age. The writer of this piece is basically saying that such communities should pay for the care of white English 50+ year olds in order that the wealth of those 50+ year olds can be passed down to their children. That’s wrong as a matter of principle and as a matter of electoral politics.
What’s particularly revolting but something I have witnessed more than once are middle class British citizens living abroad for 15, 20 or 25 years in tax havens like Dubai, Cayman and Bermuda, earning large amounts, paying nothing into the tax system, and then benefiting from proposals such as that which the writer of the article is making.
Rob Cannon,
“The writer of this piece is basically saying that such communities should pay for the care of white English 50+ year olds in order that the wealth of those 50+ year olds can be passed down to their children”.
Kirsten, has not written this. She has stated that she supports the House of Lord’s Economic Affairs Committee report which, if I have understood it correctly, calls on the government to increase spending by £8 billion on the existing social care system (back to 2009/10 levels) and I think an extra £2 billion up from the planned £5 billion on treating personal care (such as washing, dressing and cooking) like NHS care, that is to be provided free, over five years. (These sort of figures can be provided without increasing any taxes, as government income is over £800 billion, just from increased government revenue because of economic growth.)
Kirsten also mentions the Dilnot Report (please see my comment of 11th July 2.24 pm for proposed rates). I think it is this which you are really objecting to. I think that the proposals would benefit those with more wealth more than those with less wealth. I think the cap on the amount a person can pay for their accommodation costs is unfair. I might be persuaded that the cap should be 50% of their wealth. This would mean that someone owning £900,000 of assets would be capped at £450,000, someone owning £400,000 at £200,000, someone owning £200,000 at £118,000.
Rob Cannon 12th Jul ’19 – 10:28pm……………….It’s disappointing to see glib responses like those from David Raw and expats. Any person with a modicum of intelligence and common sense can see that the state does not have infinite funding so has to determine funding priorities……….
When you are losing an argument resorting to insulting the intelligence of your opponent merely adds to the weakness of your argument…
Regarding…”Compared with other European countries too many British people don’t support other family members”…. Did you miss the bit about how…”Many family and friends in England have caring responsibilities as their loved one does not meet the criteria for social care. This is wrong. The report highlights that most unpaid carers are women. 63% of women who care are aged between 50-64 and care for at least 50 hours a week. Our society is being propped up by the unpaid work of millions of carers.”
Age is a ‘terminal illness’ that usually comes to us all…Should other terminal illnesses be treated in the same manner you propose for infirmity?
If we all paid according to our income and wealth into a central pot, then we could receive what we need when we need it. It is tempting to then take another slice from the rich by means testing the accommodation and nursing costs but is this fair? When home, care and nursing services are run as businesses, they must be well regulated to ensure everyone receives a basic level of care according to need and no-on is ripped off.
There’s nothing glib or unintelligent about attempting to provide the best possible social care for the frail and vulnerable Mr Cannon as someone who for a number of years was responsible for an £ 80 million budget in that area I’m afraid I can’t take your prejudices seriously.
David Raw: It’s frankly embarrassing that someone who was responsible for “an £80 million budget” responded to my original comments with “It’s something called Society Mr Cannon. You clearly don’t want to be part of it and no doubt you’ll have a notice on your gate ‘No ambulances here.’ ” .
I am glad that Michael BG at least has acknowledged and agreed (at least in part) with the point I have been making. Unfortunate that others commenting here would prefer to put on blinkers and refuse to engage with their own prejudices.
To take up the question from Peter Hirst, personally I’m not a fan of means tested benefits. One of the very few intelligent things that Nick Clegg did was insist on universal free school means for Key Stage 1 children. However, the LibDems must bear the shame of agreeing to means testing of child benefit – making a simple system much more complicated – imposing an effective marginal tax rate of over 70% on those earning £60,000 and having two children, resulting in a significant number of mothers being at risk of losing pension credit. So you’ll forgive me Peter if your comment of “if we all paid according to our income and wealth into a central pot, then we could receive what we need when we need it. It is tempting to then take another slice from the rich by means testing the accommodation and nursing costs but is this fair?” sticks in my throat coming from someone who has been a LibDem for many years.
I’m afraid it only shows again that there are too many in the LibDems who are interested in protecting white middle class 50 and 60 year olds who are sitting on wealth and are happy to screw over those with young families in order to do so.
Rob,
the point you make as to how adult social care should be paid for is a valid one and is just as salient with respect to funding the NHS. The increasing burden of meeting health and social care costs for an aging population cannot fall solely on a younger generation – many of whom find themselves locked out of the housing market. It is something that both the Dilnot report and the Lords report referenced in the article focus on. Past experience in this area , such as that of the Conservative meltdown in the 2017 election when the idea of what was dubbed a Dementia tax was floated, has made a cross-party consensus an imperative.
ALTER has prepared proposals based on a hypothecated Land Value Tax precept in this area. This earlier LDV article refers
https://www.libdemvoice.org/a-residential-land-value-tax-approach-to-funding-adult-social-care-59639.html and the briefing paper is available at https://docs.google.com/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxjb2FsaXRpb25mb3JlY29ub21pY2p1c3RpY2V8Z3g6NTU2NjYxM2M0MWJmY2M0OQ
The full fact report https://fullfact.org/health/adult-social-care-england/ notes:
Adults of all ages can need extra support in day to day life for various and often complex reasons. In 2015/16. Social care includes short term support to maximise independence. Many of these instances involved people needing help after leaving hospital. Other adults under 65 needing help include those with learning disabilities and mental health problem.