Why is it so difficult for politicians to understand social care?

Social care is any extra help that a person needs with day to day living. It might be getting out and about, maintaining relationships, preparing meals, washing, paying bills or cleaning and maintaining the house. Anything that does not require really specialised knowlege but is, nonetheless, essential for a person’s wellbeing. Infants, small children and those with disabilities often need social care. Most adults can manage well into their old age by hiring someone like a gardener or a cleaner except if they have a medical condition such arthritis, Parkinson’s or dementia. Even then, most people can pay for their care themselves or claim attendance allowance to help them to do so. The problem comes in when their care reaches such a level that this benefit does not cover the cost of their care and they have depleted their savings. Currently, the local authority will help towards the cost of a person’s care – or even organise the care – if the person’s savings have depleted to £23,250. This does not currently include the value of the person’s house if they own it. If the person needs to go into a care home or other form of residential care, they are currently expected to fund their own care by selling their house and will only be eligible for support from the local authority when their savings have depleted to £23,250.

The problem that Theresa May has had is that the conservatives have tried to level the playing field by saying that the value of the person’s home should taken into consideration regardless of whether they have care in the home or in a residential setting. This means that a person with a home worth £500,000 will need to pay for their care for many years before receiving any public assistance. To top it off, the Tories did not agree to the £72,000 cap proposed by the Liberal Democrats in government so Theresa May was left holding the bag as many people realised that their life savings may go on care and that they may only be able to pass on minimal savings to their children and grandchildren. On BBC Question Time last night, Mrs. May committed that people would “not have to sell their homes in their lifetime” but this is rather a big promise and one which I, for one, do not believe she can keep.

By contrast, the Lib Dems have agreed to the cap (recommended by Dilnot) and committed to integrated health and social care. This would mean that there would be fewer problems between the NHS and the local authority trying to determine which is liable to fund certain areas, like giving medication for example. The cap would also ensure that people who have a substantial investment in their home will be able to pass on some of their accumulated wealth to their loved ones. It is an idea that the Conservatives refused to implement when in coalition with the Liberal Democrats but one which Theresa May and the Conservatives will now have to take a better look at. The Prime Minister has committed to a consultation to determine the proper level for a cap but it took a relaunch of the Conservative manifesto to add this provision. It’s a poor show in my opinion and one which should never have happened. Let’s hope that they take a long, hard look at the issue when the next government is convened.

* Gillian Douglass is a member of Tunbridge Wells Liberal Democrats

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  • Matthew Huntbach 6th Jun '17 - 10:42am

    I do not understand the point this article is trying to make. I can’t see anywhere in the article where it suggests that politicians don’t understand social care.

    The reality is that if you want something provided by government it has to be paid for somehow. Social care for the elderly is expensive. It has to be paid for. It seems to me that what is happening here IS politicians understanding that issue.

    As we showed with tuition fees, if you aren’t prepared to pay for something through general taxation, you are going to end up paying for it in some other way. It would be fairer to pay for social care for the elderly by a general inheritance tax imposed equally on everyone, so that no distinction is made between those who die while still fit so incur no care costs and those who die after a long period of incapacity so incur considerable care costs. However, we know very well that any proposal to impose a substantial increase in inheritance tax would result in outrage. So no politicians dare propose it. So we have this instead.

    Would we prefer massive increases in income tax to pay for it? As I said, it has to be paid for somehow. Why is there no more acknowledgement of things like this, meaning that we cannot have realistic discussion on how to pay for it, as politicians who try to make suggestions get attacked for doing so?

    Our party got almost destroyed because we worked out a serious compromise enabling us to save the university system from massive cuts without tax rises to pay for it because there was no way the dominant coalition partner would have accepted the necessary tax rises. Labour have managed to do well by attacking us over it, while only making vague hand-waving gestures about how they would pay for it.

    So here we are with social care. It seems to me this article is attacking the Conservatives for working out a way to pay for it, while simultaneously acknowledging that the Liberal Democrats would support much the same thing.

  • David Evershed 6th Jun '17 - 10:58am

    Council Social Care Services also pay for the full time residential and nursing care of those whose assets (including their house) are less than the £23,250 floor. At a cost per person of £800 – £1000 per week I believe this is the major part of Council social care costs – not care at home.

    Those with assets above the £23,250 floor (including their home) have to pay for their own residential or nursing care, apart from a small weekly amount for the health care element, assessed on the seriousness of any illnesses.

    Where a person’s assets are largely tied up in their property and/or their partner still lives in the house, the council will lend the money to pay for the full time care against the security of the house. The council is then repaid out of the estate at death.

    The effect of introducing a cap on individuals social care payments of say £72, 000 (suggested in the Dilnot report) is to increase the amount of any inheritance set out in the persons will. At present those paying for care should be left with at least £23,000 in their will.

    The Conservative proposal is to increase this floor from £23,000 to £100,000 and to implement a cap on total social care payments by individuals (of perhaps £72,000?).

    I my view the £100,000 floor is reasonable and there should be no cap. It is better for people to pay for their own upkeep when they get elderly than to have taxpayers in general pay for it. Don’t forget that care costs are largely for accommodation, food, heating, lighting, cleaning, personal assistance, etc and the health element is paid for by weekly amounts from the NHS based on an assessment of the need.

  • Ruth Bright 6th Jun '17 - 12:53pm

    Matthew Huntbach is quite right. For years we have wrung our hands on this issue, shouted “Alack the day” those naughty old parties won’t tell you the truth about paying for stuff but when they come up with something we turn round and go for cheap points. Tim was very good on QT the only point where he looked iffy was when he was asked by a member of the public: “It’s not about dementia. It’s not a tax. Why call it the dementia tax.” Why indeed?

    Incidentally the LD manifesto does not cost Dilnot it just talks in aspirational terms about finishing the job on the cap.

  • Andrew McCaig 6th Jun '17 - 2:58pm

    So presumably you are suggesting that anyone in hospital should pay all the costs except the drugs they are given and the costs of surgery etc, and pay £1000 per week or whatever once they are just “being looked after” ?

    If you have dementia, MS, or Parkinson’s who are ILL, and if we believe in a National Health Service, it should be paid for just the same as if you were a child dying of cancer.

    Finding the money is of course a problem, but we should not pretend treatment for illness is just “social care”. Inheritance of the vast amount of unearned wealth sloshing around in our economy is the obvious target to pay for it..

  • Dave Orbison 6th Jun '17 - 6:23pm

    Matthew Huntback ” – Would we prefer massive increases in income tax to pay for it?”

    I think that is a very emotive and one-sided way at looking at this. I found through personal experience that the whole funding issue and who pays what, NHS vs social care, was a complex issue where there is considerable ignorance as to what people currently are entitled to.

    If someone has a Primary Health Care need and social care is secondary then both the health care and social care is paid for without means testing by the NHS. This is not readily appreciated by many. Patients with advanced dementia, or more likely their families, will have to battle through the system as this is treated as something akin to this being a State secret, but it is nevertheless a fact.

    I would encourage anyone who are having to face this now to look up Guidance on NHS Continuing Health Care Assessments and current case law “R v North and East Devon Health Authority ex p Coughlan (decided by the Court of Appeal in July 1999”.

    Also, go to http://caretobedifferent.co.uk – it is a fantastic resource.

    Dementia and the forms it takes is an illness which strikes us randomly. Why should people suffering this illness be treated differently from anyone else who through, illness or accident, have the misfortune to need nursing and social care?

    Trying to claw back some of the costs by putting a charge on a property is fraught with all sorts of complications and inequities. Progressive taxation through income tax is fairer. Matthew to your point – the cost is the cost whatever it is – progressive taxation would remove the element of lottery that exists in any other type of funding alternative.

  • Matthew Huntbach 7th Jun '17 - 1:51am

    Dave Orbison

    Again, I don’t understand your point. The term “dementia tax” was invented for political reasons. What this actually meant was paying for social care provided at home, not specifically only for those with dementia. So there is no different treatment as you are suggesting.

    You seem to be criticising me for noting that if it were paid by income tax it would require big increases, that is due to the increase in number of elderly people, yet also saying that it should not have to be paid for individually from assets. So how do you think it should be paid for?

    Actually, I do have experience of this sort of thing, as my wife and I faced just this issue of having to pay for residential care for my late mother-in-law.

    Also please note that the name “Huntbach” comes from the West Midlands where there are a number of places with names ending in “bach”, although Sandbach in Cheshire is the only big one. There was once a village called “Huntbach” in Staffordshire, that is where my surname originates. It has never been spelt “Huntback”. See here.

  • Matthew Huntbach 7th Jun '17 - 1:59am

    Dave Orbison

    Also, if you do support paying for it by income tax, fine, all I was doing was noting that if we accept that we need to accept that there would have to be big increases in it, and that’s difficult to get across. The Liberal Democrats are already proposing a small increase in income tax to pay for the NHS, and apparently that isn’t going down too well in opinion.

    Why do you seem not to support inheritance tax, as I suggest applicable to everyone? Why should people pay tax on money they have got by working, but nothing on money they have got by having the right sort of parents? The lack of inheritance tax except at high levels means house prices are pushing up house prices because people inherit money from houses and use it to buy houses, thus resulting in an unlimited upward spiral of prices and a squeezing out of the possibility of ever owning one for those who don’t have house-owning parent to inherit from.

  • Large White Bear 7th Jun '17 - 7:57am

    @Jayne Mansfield: I can only feel sorry for you because you are obviously an envious person who wants to level everyone down.

  • Large White Bear 7th Jun '17 - 8:06am

    Ditto Matthew Huntbach: do you honestly think that taking property from middle-class people – mostly not ‘rich’ at all – will do anything to help people on lower incomes? This is a kind of neo-Puritan moralising and it is also based on envy and resentment: why should anyone have what I don’t have? And yet you say nothing about the vast sums of money paid to worthless celebrities and media folk.

  • Dave Orbison 7th Jun '17 - 8:58am

    Matthew Huntbach – what an impressive coat of arms you have.

    I think social care should be paid from income tax for several reasons.

    The whole emotive reaction as to the ‘dementia tax’ demonstrated how it stirred up lots of resentment, confusion and fear. Even if capped it is hard to justify why someone truely weathly would have but a small fraction of their wealth taken whereas those whose homes get them into charging territory could lose a significant proportion of ‘wealth’. Yes of course ‘wealth’ is a relative term compared to those who have no wealth at all.

    Then there are all the practical issues. How and when will funds be released, how do councils deal with long term cash flow issues as care needs of today will have to be paid but capital from homes make take years to come through.?

    Progressive taxation through income tax is a fairer and simpler concept. Popular? Of course not but it’s just my humble opinion that it would be better that way. Whilst it’s fine if you disagree, I’m not sure why you are confused by this.

    Apologies for typo re your name didn’t realise it was such a sensitive issue.

  • Peter Martin 7th Jun '17 - 9:18am

    ” Would we prefer massive increases in income tax to pay for it?”

    That’s not the right way of looking at it. Our ability to support the old and the sick depends on the available resources in the economy. The number of people available to work as doctors and nurses. The number of hospital buildings, ambulances etc.

    Those resources are limited. If we try to spend without regards to the available resources then we’ll create unnecessarily high levels of inflation in the economy. That’s where the taxation comes in. It creates the fiscal space to spend on those kinds of things. It creates a demand for the currency and gives it a value. But it doesn’t mean that our spending has to equal taxation revenue.

    Sometimes, in any given time time period, it has to be less than taxation revenue if the economy is overheating. But not usually. Usually, Govt can spend more without causing inflation. The Govt spends net spends currency into the economy as a currency issuer. It can’t receive back more than it spends into existence in the first place. That’s just not possible!

  • Matthew Huntbach 7th Jun '17 - 11:50am

    Large White Bear

    Ditto Matthew Huntbach: do you honestly think that taking property from middle-class people – mostly not ‘rich’ at all – will do anything to help people on lower incomes?

    What I am saying is that if you want it provided by government, it has to be paid for somehow. Would you agree with Dave Orbison that you would rather have it paid for from income tax? But isn’t that just the same – taking money from people who may not be that rich? Is it fair that if someone inherits a house they don’t need and sells it and gets a £200,000 pounds for it they pay no tax on it, but if they work for 10 years to earn that amount they have to pay a considerable amount of tax on it?

    Of course, if you don’t want it provided by government, it will be the same thing as the so-called “dementia tax” anyway, apart from having no cap. And those who have no wealth to pay for it, will just be left to die. Is that what you want?

  • Matthew Huntbach 7th Jun '17 - 12:04pm

    Dave Orbison

    Progressive taxation through income tax is a fairer and simpler concept. Popular? Of course not but it’s just my humble opinion that it would be better that way. Whilst it’s fine if you disagree,

    You are completely missing my point.

    What I am saying is that it has to be paid for somehow. I am NOT saying, as you seem to suppose, that the so-called “dementia tax” is my personal preferred option.

    I am saying it is wrong to denounce “dementia tax” without admitting that if it were not used, some other way to pay for it would have to be used. There are other ways it could be paid for, and they may be better. However, look at “Large White Bear” complaining at one other suggestion. And, as you yourself actually say, coming out and proposing a big increase in income tax to pay for it, is just as likely to meet with large scale opposition.

    That’s the problem with politics here – taxation and government spending are treated as if they are two unrelated issues. So right-wingers win by opposing tax rises because people don’t link that with the inevitable cuts in public services it will lead to.

    I felt the Tories were at least being a little honest when by coming out with this they admitted that a way would have to be found to pay for the growing need for care of the elderly. I felt it was a cheap and damaging approach to denounce them for that without saying what would be the alternative, as if somehow care for the elderly could be provided without having to pay for it.

    If you want the populace to accept higher income tax, you need to make clear why it is needed, and that is actually what I am saying here.

  • Matthew Huntbach 7th Jun '17 - 12:11pm

    Peter Martin

    That’s not the right way of looking at it. Our ability to support the old and the sick depends on the available resources in the economy. The number of people available to work as doctors and nurses.

    Er, have you ever tried being a local councillor? The main thing it is about is deciding how you are going to pay for things that the council is meant to provide. It was bad enough when I was a councillor, over 10 years ago now, and with big cuts to local government funding since then, it is even worse now.

    Sorry, but if the local council has no money to pay for care-workers (which is actually what we are talking about here, not doctors and nurses), how is it to provide them? Do you think they are going to find people willing to do the job for free?

    According to what you are saying, people should vote Tory because the Tories support low taxes, and that’s not a problem, as public services can still be provided by waving hands around, no need to have money to pay wages to the people who provide them.

  • Malcolm Todd 7th Jun '17 - 12:23pm

    Matthew Huntbach

    I think you need to read Peter Martin a little more carefully.
    Local councils are not money-issuers, as I’m sure you are aware from your own experience. That makes all the difference.
    Nor does he suggest that we can infinitely lower taxes without penalty or that money is produced by “hand waving” (which is about as economically literate a comment as Amber Rudd’s “magic money tree”).
    Please do other people the courtesy you persistently and insistently demand for yourself: read and respond to the actual argument made, not some other argument you’ve apparently half-heard from someone else some other time. Otherwise I’ll be forced to call you a Cleggie.d

  • Malcolm Todd 7th Jun '17 - 1:53pm

    Oh, Jayne, what a wonderful response! 🙂

  • Peter Martin 7th Jun '17 - 2:27pm

    @ Malcolm,

    Thanks. Possibly my fault to some extent though! I should have emphasised the difference. Central government does have the extraordinary ability I have outlined, but politicians generally aren’t too keen on anyone else knowing about that – hence their use of the silly Magic Money Tree phrase. Local government does work exactly as Matthew describes.

    This is something to be borne in mind, IMO, when the topic of devolution is raised.

  • Peter Martin 7th Jun '17 - 2:50pm

    “So right-wingers win by opposing tax rises because people don’t link that with the inevitable cuts in public services it will lead to.”

    There’s nothing inevitable about it. If we are talking about Central government we need to think in terms of tax rises only being necessary to keep inflation under control. Tax rises and spending cuts generally speaking don’t do anything to reduce deficits. But they do depress the economy and reduce inflation. On the other hand tax cuts and spending rises don’t increase deficits but they do stimulate the economy and an over stimulated economy can produce too much inflation.

    Diane Abbot , surprisingly enough, was much closer to the right answer than everyone else on the costings of Police recruitment. If we recruit an extra police officer that costs us about £30k. Is that right? But don’t they, like everyone else, lose about a third of their pay in tax and NI? And what about the increase in revenue as the remaining £20k is spent in the economy? And what about the multiplier effect when it is respent?

    So what’s the real cost? £30k, £20k, £10k, or nothing at all?

    And what’s the ‘saving’ if we make one redundant?

  • Matthew Huntbach 8th Jun '17 - 3:51am

    Peter Martin

    Central government does have the extraordinary ability I have outlined, but politicians generally aren’t too keen on anyone else knowing about that

    Why would that be the case? If it is all as easy-peasy as you are trying to make out, with wonderful public services being able to be provided at no real cost to anyone, surely politicians would be jumping to offer that?

    I do take more of the points you are making than Malcolm Todd is suggesting, but I am sorry that you have not got the point I was making.

  • Matthew Huntbach 8th Jun '17 - 3:59am

    David Orbison

    Apologies for typo re your name didn’t realise it was such a sensitive issue.

    You have being doing it continuously, and I thought you were trying to make some silly point by mis-spelling my name. The website I gave was just the first one that came up when I did a quick web search to find one which gave the historical background to the name. As the website shows, the name is neither German nor a disguised form of “Hunchback” which many people seem to think is where it comes from.

  • Peter Martin 8th Jun '17 - 9:38am

    @ Matthew,

    I didn’t say that “public services being able to be provided at no real cost to anyone”.

    But you have to consider the cost, to the Government, in other ways than money. You and I can have a certain amount of money (in the form of pounds). We are holding a certain number of the Governments IOUs. But the Government can’t have money in the same way. It can’t express its own wealth in terms of the number of its own IOUs which it holds. An IOU is an asset/liability pair. No matter who holds the IOU the Govt holds the liability. So when it holds its own IOUs the two cancel to zero.

    The “cost” of social care is not having the resources available for something else that we might wish to use those resources for. Just like the “cost” of unemployment and underemployment in the economy is the waste of available resources.

  • Peter Martin 8th Jun '17 - 10:15am

    because the Tories support low taxes ???

    Of course they say they do. But every VAT increase I can remember has been implemented by a Tory Government. With the possible exception of the last one which was by a Coalition government.

    Everyone can have a valid political opinion on what the ideal size of Government should be. There’s no single right answer on that. It’s a matter of political preference. Economies can be successful with greater or lesser amounts of Government involvement if they are properly managed.

    But we can never be successful, whatever the size of Government, if we don’t get away from the idea that a Government’s expenditure has to match its income in dollar or pound terms. It may be possible for a country like Germany to do this by running a huge trade surplus, but for every country running a surplus, another country has to run a deficit.

    That’s us in the UK. Pounds leave the economy to pay for net imports. They have to be replenished by Government deficit spending to keep it going and keep the wheels turning.

  • Caron Lindsay Caron Lindsay 8th Jun '17 - 10:37am

    This is an unacceptable ad hominem comment and breaches our comments policy. I’ve just been made aware of it. Its author will be put on pre-moderation and will not be allowed to comment further on the site without moderator approval. I would delete it, but Jayne and others have responded.

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