THE BLOG

Recovering From The Dementia Tax

17/07/2017 12:36
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The Queen's Speech last month confirmed that social care reform is not dead, thankfully, despite the election debacle over the so-called dementia tax.

There have been many years of discussion and debate on social care but little action. Being able to access high-quality care and support when you need it in later life is essential if we are to enjoy a decent quality of life for as long as possible and to die with dignity. It is what we would want for ourselves, our partners, our parents, and grandparents. But the big question is, are we willing to pay for it? And if so how?

Before society can sensibly answer that question, there needs to be a much greater understanding of how the system works and is currently funded.

Back in 2007, The King's Fund led a series of events around the country on the future of funding of social care, which found that most people thought social care should be funded in the same way as the NHS. For many people it is a shock to discover that when they or their nearest and dearest need care, it is heavily means-tested and also only funded for people with extremely high levels of need.

Then there is the question of quality. The process of finding a residential or nursing care place in a timely way, and being able to assess the quality of care on dimensions that matter to you, is hard. Prices don't necessarily bear any relation to quality, given that the cost to you (if you are a self-funder) also typically includes a significant subsidy for local authority funded residents. Interestingly, some providers are refusing to provide local authority funded care because they are not able to deliver the level of service they want to at the price the commissioner pays. Factors such as location or rurality of your area could also significantly limit your options. So, it was heartening last week to see a broad coalition of people and organisations, including the Care Quality Commission, coming behind a renewed effort to improve the quality of care and make a person-centred approach the norm for all.

But good quality comes at a price, and at the heart of the debates about social care funding are difficult questions of fairness - between those who have wealth and income and those who don't; those whose needs are a result of cancer or heart disease and someone whose needs result from dementia or frailty; those who need care today and those who are working and paying taxes; those who own their own homes, and those who don't.

These issues partly fuelled the public outcry in response to the Conservative Party's manifesto proposal on social care. Under that policy, those lucky enough to own their own home but unlucky enough to have a condition not fully cared for by the NHS, such as dementia, would have to spend down the value of their house to a floor or lower limit of £100,000 (and only applies to residential care) while others who die suddenly without the need for prolonged social care would be able to pass on the full value of their home to the next generation.

So, as the Government promises to consult on social care options and encourage a wider debate, where do we go from here?

Fundamental is that proposals are properly understood and have the support not only of those who require social care today but also of younger generations.

We believe that action is needed on at least three fronts.

Firstly, more funding is needed for the current system of means-tested social care. There will always be people who have little or no income and assets. We need to be willing to pay more in taxes to ensure the rising numbers of people with care needs have access to high quality care before they reach a crisis.

Secondly, we need to find ways of paying for care that are fair and equitable. This could mean putting a cap on the liability an individual will face in their lifetime as proposed by Andrew Dilnot in his original review - the provisions are already set out in the Care Act 2014. It could mean raising the floor to enable everyone to preserve a proportion of their equity for future generations. It could mean promoting market solutions that enable home owners to release equity through products such as lifetime mortgages or, if a cap were introduced, to insure against the costs up to the cap. But these do nothing to pool the risk and still leave some individuals facing catastrophic costs. More radically it means harnessing a proportion of the housing wealth assets for example by increasing wealth taxes, including inheritance tax, or tightening up on those people who shelter their assets to avoid being judged liable for paying for care; reforming NHS Continuing Care so your diagnosis does not determine entitlement; or scrapping the means-test and funding social care on the same basis as health care (Labour's proposed National Care Service).

Thirdly, it requires action to fix the, arguably broken, market so that there is a wider range of products and services available that are of high quality and which are accessible in all parts of the country. This means valuing the workforce, providing training and career opportunities to attract good people into the care sector, encouraging innovation in new models of care, and ensuring the higher costs of delivering services in some areas are reflected in the funding available.

Above all there needs to be an acknowledgement that social care is a shared challenge for society. It must not be pitched as a war between rich and poor, young and old, or one condition against another. Investing in and developing good quality and affordable care for everyone - regardless of their circumstances - so that everyone enjoys a decent quality of later life is a goal that should unite us all.

Dr Anna Dixon, Chief Executive, Centre for Ageing Better

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