A fortnight ago, Age Concern suggested on this website that Labour had passed the first test of its handling of our ageing population, by legislating for important pension reforms. Rather than job done, however, we argued that the party would need to see this as the first in a series of challenges, and that care funding should be next.
There have been several false starts on care funding. Much of the debate has focused on strong and vocal views that say having to sell one’s home to pay for care is a step too far. A Royal Commission in 1998 failed to build consensus around an alternative, and left ministers convinced that it was not the goal of a Labour government to use public money to help middle-class people avoid having to sell up. A popular decision, no, but an understandable one, yes.
So what happened next? Was a well thought out policy solution developed? Unfortunately not. Labour’s approach was technocratic rather than principled, complex rather than transparent. It decided to pay for some costs (deemed ‘nursing care’) but not others (deemed ‘personal’) when few families could see the difference. And worse, Labour risks leaving a failing system in place, which fast-tracks many into residential care, when they would have preferred to stay at home, and forces people to fight for basic entitlements that the ‘system’ has no intention of paying. Many are simply too frail to fight for their rights.
Funding of long term care is not an issue that will go away if it is ignored. In fact, the opposite is true. It will be a big issue for Labour in government, not least because of the huge projected increases in the number of people living until they are very old. The number of people with dementia alone is expected to more than double in the coming decade.
The failure to build a sustainable policy so far has left the public with unrealistic attitudes. The last British Social Attitudes survey showed that the public do not intend to save for care costs and do not want to sell their homes. Not an ideal position to be in, if you have ambitions to radically overhaul the system and persuade government and individuals to think again about how they will fund care.
It’s time to take a fresh look at this issue. The government should lead the policy conversation by helping the public understand the hard choices we’re all likely to be confronted with in old age. Values should inform this conversation: it must not just allow the strongest voices to dominate the debate.
Fairness is not just about selling your home. Why do many poor people, whose local authorities are supposedly funding their care, have to pay unaffordable top-up fees because there are no places at the prices councils are prepared to pay? Why do people with very small assets – less than £21,000, including their home – get left with £19.60 a week allowance after costs are paid, less than government pays young people to stay on at school? Why are people who have already been assessed as needing care and support get told a year later that they will no longer get help, because eligibility criteria have changed – again – thanks to diminishing budgets?
But to focus too much on who pays for care misses the point. The fact is that there is simply too little money in the system to improve the quality of care. This lies at the heart of the recent review by Derek Wanless for the King’s Fund, which argued that a significant injection of cash was needed to provide a basic minimum standard of care for those who need it – with the better off then encouraged to pay more, if they choose to do so.
At present, relatively few people know at first hand just what a mess we have drifted into. As our population ages, more and more people will be confronted with this uncomfortable truth. And you can see the anxiety already. As one woman told Age Concern in a focus group: ‘you worry what would happen to you if you ended up in one of those homes’. Now is the time to kick start a national debate. To discuss honestly and openly about what type of care we want and what as a government and as individuals are willing to pay for. The answers may surprise you.