The treatment of elderly people who desperately need proper social care, but cannot afford it, is a shocking disgrace, arguably one of the biggest in Britain today. The Dilnot report proposed a compromise that most people believe is broadly fair – that (i) the asset threshold below which people would be entitled to Council-funded home help or care home places should be lifted from £23,250 (the asset threshold for receipt of income support) to £100,000 and (ii) that there should be a cap of around £35,000 on what people should themselves pay before they get help from the State. The Treasury has turned this down because the cost is estimated at about £1.7bn a year, rising to £3bn a year as the number of elderly people steadily grows. This compares with a total expenditure by Councils on social care of £14bn a year, i.e. the Dilnot proposals would increase the annual cost by 15% initially. Are those proposals the best solution in today’s circumstances?
In the short run they will solve the problem where today some 20,000 persons a year are forced to sell their homes to pay for long-term residential care in old age, a typical room in a care home now costing about £26,000 a year. And Dilnot is clearly fundable when restricting pension tax relief to the standard rate would raise £15bn a year, a Financial Transaction Tax on a UK CHAPS basis could raise £20bn a year, and a wealth tax and/or capital gains tax on the wealth gains of the richest 1% would yield at least another £20bn. Take your pick.
What the Dilnot proposals will not solve is the far bigger and more important problem that local authority funding is so cramped that home care visits are often restricted to half an hour or even a quarter of an hour which is impossibly short for proper care. They won’t solve either the key problem that funding is so tight that home care providers can’t provide the high standards they want to and which elderly and infirm persons need.
The real answer to this huge and growing dilemma of good-quality social care is a national insurance system that exists in many other European countries. The Tories will never introduce this – indeed Thatcher in 1986 scuttled the excellent Barbara Castle SERPS pension scheme based on the same national insurance principle – because their aim is to privatise the State tout court. Yet it is unquestionably the right answer. Everone contributes proportionately for services they may or may not need, just like the NHS principle, and over a 10-20 year run-in period it will provide the high the hgih-quality care in old age that any civilised society should aspire to. And if that is still not good enough for you, then you can contribute to the Guaranteed Minimum Care Standard laid down for the nation as a whole, just as the Castle plan provided that you could opt out so long as you contributed to the Guaranteed Minimum Pension.