Michael Meacher MP

It would be a pity if the Government’s latest proposals for a National Care Service were submerged in electoral sloganeering.   It is a hugely important issue, with enormous implications for millions of people in the years ahead, but it requires a broad public consensus.   There are several alternative proposals on the table, and the key issues of course in each case is how many mainly, but not exclusively, elderly disabled and infirm people will be covered and how will the scheme be funded.

As a comparison, the current system of social care for older people is projected to cost £8.1bn in 2015, rising to £12.1bn by 2026.   The problem with this system is that it covers far too few elderly people in real need.   It only covers those with a means-tested income, excluding their house, below quite a low level, and in most local authorities only those in ‘critical’ need of care, not even those in ‘substantial’ need, let alone those who are still in need but in less severe categories.

A so-called partnership model, whereby the State would pay 50% of the cost plus £1 for every additional £2 that individuals pay for themselves, is projected to cost £10.1bn in 2015 rising to £15.5bn by 2026.   This would increase the coverage by almost two-thirds  and would halve the extent of unmet need by 2015 – good value for money at an extra £2bn cost.

A third option, ‘free personal care’, would raise the cost by 2015 to £10.7bn and by 2026 to £16.8bn.   The disadvantage here is that, whilst it covers costs fully, it would apply to only a very small core of people in the very highest need category – around 2% of pensioners.

Unfortunately it’s impossible to judge between the latest proposals put on the table just over a week ago – the Government’s National Care Service and the Opposition’s home protection scheme – because no detailed figures are given.   They would both remove the strongly felt objection of the better-off that they stand to lose their homes if they need extended care, but by the same token the schemes offer more of (now extremely tight) public spending to those with most resources which is not a scheme focused on need.

Once the election is over, this should command the attention of the new Government as one of their most urgent priorities.

The horrendous case of the father who raped and abused his daughters over 35 years almost defies belief,  yet it follows a steady trickle of other horrific cases – Victoria Climbie, Baby P, the Edlington brothers to name but some.   Every time there is desperate hand-wringing and a passionate pledge that this will never be allowed to happen again.    Yet it does, again and again.   Can it ever be prevented?

Not without a much more rigorous, and probably also more intrusive, framework of supervision.   Essential elements are that:

*  social work departments must be adequately resourced.   That means enough social workers (so that caseloads can be managed properly, not skimped), enough training (to deal with difficult and threatening situations), and enough funding (that is, substantially more than at present),

*  there must be clear and precise rules of conduct about how to deal with every type of contingency, even the worst cases.   That could include visiting the most intimidating families in pairs, and where necessary access was denied, calling in the police straightaway,

*  the most difficult and threatening cases should be dealt with by senior staff, or at least with constant reference to senior staff,

*  it should be understood that where these principles have been breached or broken down and an appalling tragedy results as in this latest case, those responsible – not just junior staff, but the managers and the safeguarding  children board -  should lose their jobs, not primarily as a punishment but rather as a signal that society will not tolerate culpable failure where it leads to such crippling of innocent lives.

Only if the resources are provided, the rules are rigorous and clear enough, and the sanctions against failure are powerful enough can we expect that terrible tragedies like this will be pre-empted.

All of us who live long enough face the very considerable costs of social care if we need it in old age. Care home fees amount to £470 a week on average (£24,500 a year), slightly more than the average wage, while nursing home care can cost £665 a week (£34,600 a year). Very few people can afford that for long. Government estimates that a 65-year old can expect to need social care costing £30,000 in their retirement, and about one in five will need care costing more than £50,000. So who at present pays this? About 40% of the near-half million care home residents are obliged to pay these sums because their income is deemed too high to merit means-tested help (i.e. the combined value of their savings, stocks and shares, and home is over £23,500). The result if that most people can only meet the cost of the fees by selling their home, which is often much resented by the elderly person’s family. To meet this problem the Government’s Green Paper, published today, proposes 3 options. Significantly, however, it excludes a 4th which certainly ought to be considered.

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