Theresa May’s u-turned on her flagship social care policy, just four days after it was branded a “dementia tax”. But it is still far from clear what the precise details of the eventual policy will be.
Under the current Tory plans, if someone’s combined savings and property are valued at over £100,000 they will have to pay for care. May also clarified there would be a cap on how much someone would have to pay to cover the cost of their care.
A cap, promised by David Cameron in 2015, was initially explicitly rejected by May’s campaign before she changed her mind. The prime minister has yet to set out what the cap will be.
The election is just days away, but the debate over social care will not end on polling day. As part of our Beyond Brexit series, five experts in the field give their view on what the government needs to understand and what it should do.
1. Andrew Dilnot, reviewer of social care for the coalition government
Sir Andrew Dilnot is the economist who reviewed social care for the coalition government in 2011.
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Speaking to HuffPost UK, Sir Andrew said Theresa May was right to u-turn and return to the idea of a capping the amount of money people would ever have to spend on their social care.
“The obvious starting point,” he said, would be for a cap implemented in 2020 to be £80,000-£85,000 as that was “roughly” the same in real terms as the £72,000 cap it was suggested be brought in in 2016. “As a general rule I would like it to be lower rather than higher,” he said.
It would be “strange” to set the cap too differently from the figure first legislated for by George Osborne, Sir Andrew added.
And he criticised those, including health secretary Jeremy Hunt, who said a cap was not fair as the benefits would go to the very wealthy. “It’s not for example an argument we would use about the NHS,” he said.
“The people who, in principle, gain the most from the NHS are the better off. If the option is the NHS or a means-tested system the people who would benefit most from moving to an NHS would be the wealthiest.”
“Not all of us are going to need a lot of social care, but some of us will. And faced by that kind of uncertainty what people will always choose to do is insure it just as we can insure against our housing burning down or having a car crash or, through the health service, our health problems.
“We don’t say to everybody ‘well you must look after yourself if you have a serious health problem’ or if your house burns down, or if you have a car crash, we pool the risk.”
Sir Andrew said it was necessary for the government to be involved in the provision of social care because private companies will not pool the risk. “The reason they won’t pool the risk is the same reason you and I can buy health insurance next year but we cant buy it for 20 years from now, because providers just don’t know what the costs might be.”
“The lack of any way of pooling that risk is what makes people so frightened,” he said.
For people in their late 20s or early 30s now, the “worst case” could be 20 years in a residential care home costing £750,000. “Saving £750,000 and keeping to one side just in case you need social care is not an efficient or plausible thing for most people,” he said.
“At the moment social care feels like being in a shop with no prices because while people know how much it will cost per week or month to look after themselves, they don’t know how long it is going on for.”
A cap, Sir Andrew said, helps deal with this problem.
2. Dominic Carter, Policy Officer, Alzheimer’s Society
Dominic Carter from the Alzheimer’s Society, said people who have the “misfortune” developing conditions like dementia should not have to exhaust all their assets to pay for care.
“The social care crisis is a dementia care crisis. we know that 850,00 people in the UK live with the condition and they make up two thirds of all social care that is used in the UK,” he said.
The typical cost of dementia care, he said, is £100,000. “That would take about 125 years to see for this is cleat an impossible ask,” he said.
“There is one clear solution to this problem. That takes there steps. The first is to listen to people with dementia to include their opinions and ideas as to what they need.
“Second is to put a cap on care costs to make sure those who are spending a significant proportion of their money never have to use everything that they have on care.
“Lastly we need to ensure there is a long term solution. It is not good enough to merely put a cap on care. We need a long term sustainable funding care solution.”
3. Caroline Abrahams, Charity Director, Age UK
Caroline Abrahams, the Charity Director for Age UK, said there needs to be a “two pronged approach” to social care.
“One is to be prepared to invest a significant money now to keep the show on the road as there is a real risk it will just fall over.
“Secondly to do a proper review into how to pay for care which involves the public, agencies like ours, the people who provide social care and the people who receive it too.”
Abrahams welcomes the Conservative plan to have a consultation, but warned looking at the value peoples’ homes when means-testing social care would be a mistake.
“You probably wouldn’t be suggesting you took peoples’ housing into account for home care because you would want to incentivise home care,” she said.
“What some people will do is get so frighted about all this stuff they will decide not to have any social care at all. They will try and stagger on on their own.
“We should be trying to encourage people to have social care because it helps them. If you don’t do that, you put more burden on the NHS as that’s the default service.”
And she warned a lot of people have unrealistic expectations about what care will be provided by the state.
“Lots of people think if they develop a social care need and aren’t very well in later life there are things like meals on wheels, community nurses, district nurses, and all that.
“All those services are either going or they are stretched. Lots of people’s assumption of what its going to be like if they find themslves in that position is wrong, the world has changes and those services don’t exist anymore.”
Abrahams welcomed a cap. But said it was “not the most important issue”.
“We have 1.2 million older people in England who have a social care need who aren’t getting any service at all. So what are we going to do about them?
“We have got loads of people with dementia who aren’t getting a good enough service. What are we going to do about them?
“We have got significant number of people over 80 trying to be carers without enough support. How are we going to help them?
“We have got people providing social care and finding there isn’t enough money in it.
And we’ve got people who want to be proving social care on the ground, but it’s hard to get them to do the job because the terms and conditions aren’t good and it’s really tough.”
4. James Taylor, Head of Policy and Public Affairs, Scope
James Taylor, from the disability charity Scope, warned the social care system is “buckling under the pressure of increasing demand and limited resources”.
“Approximately a third of the people who use care are under 65, and account for half the budget. But they are repeatedly excluded from the public debate on social care,” he said.
“Far too often the system does not take into account the needs and ambitions of disabled social care users. This year the Communities and Local Government Select Committee found just one in twelve councils think they meet their duty to deliver the care disabled people have a right to under the Care Act.
“Sixty per cent of young adults who use social care have told us they aren’t getting the support they want in key areas of life like relationships and employment. We urgently need a care system that works for disabled people.”
5. Denise Burke, director of United for All Ages
Denise Burke is the director of United for All Ages, a charity focused on bringing younger and older people together.
She said the Tory u-turn on its manifesto showed how difficult it was to reform this area of public policy.
“The fiasco explains why so little progress has been made over the last twenty years despite countless commissions, inquiries and reports,” she said.
“The Tories started at the wrong place. Rather than defining a vision for a new care system, the Tories jumped straight to the question of how much individuals should pay for their care.
“A new care system needs to be fairer, simpler and sustainable and must deliver better quality care for all who need it. It must also resolve the growing care crisis with more than one million older people not getting the help they need, others relying on family carers or paying bigger bills because councils have cut care budgets.
“An immediate, substantial cash injection would bring stability to the current system while plans for a new care system are developed.”
Four principles Burke would like to see underpinning a new care system are:
Universality - everyone should be able to get something from the care system and therefore will be prepared to share the risks and costs like the NHS.
Planning ahead - thinking about care we might want towards the end of life should involve us all focusing on our housing and health, so that we remain in control of the support we need.
Sustainability - more funding is needed but we must make much more of all the people involved if we are to build a care system that lasts - from those using care and their families and carers to the care and health workforce.
Mainstreaming care - care should be everybody’s business and a key part of our economic and social infrastructure. That means not just integration with housing and health, but also involving other agencies, employers, schools etc.
Burke added that “true integration of health and care will require a single source of funding. “That is the point to decide how much funding will be required and how it will be raised. Taxation is the fairest way to do so.”
HuffPost UK is looking at voters’ priorities outside the hubbub of the election campaign trail and what they want beyond March 29, 2019, not just June 8, 2017. Beyond Brexit leaves the bubble of Westminster and London talk to Britons left out of the conversation on the subjects they really care about, like housing, integration, social care, school funding and air quality.