After months of postponement, the government finally produced its social care green paper on 14 July. Perhaps because of its long hatching, the result is a curate’s egg, a mixture of well-judged proposals and putrid populism put in to pander to the prejudices of readers of the Daily Mail. The consolation is that the good bits are likely to happen, as green paper becomes white paper becomes law, and the bad bits are fairly sure to disappear down the fiscal plughole.
To start with the cheering news, the new National Care Service promises that everyone in need of care will get proper assessment and advice. At any age, the transition to needing care would be demanding, requiring for example, knowledge of the complicated benefit system, assessment of the pros and cons of care in a home and at home, and a hugely important choice, where a home is indicated, of which it should be. To an old person, faced with the dismal prospect of decline, and for their anxious families, the burden is intolerable.
Advice and comfort are needed. Where the government will get the necessary advisers is yet to be determined but I hope they will use the resources available through independent financial advisers – organised now for elderly people in the Society of Latter Life Advisers of which I am voluntary president.
Further comfort comes because the government now proposes that no old person should have to sell their home to pay for care. Instead, where they so wish, the cost of care will be rolled up and the proceeds paid from the sale of their home after their death. So old people going into residential care will no longer face the agonising prospect of cutting off their potential return home to pay the fees. As the son of an 87- year-old mother who now lives completely independently despite three months in a nursing home I know what a boon this is.
Finally in the good news column, the government proposes to help people who so choose to insure themselves, publicly or privately, while they are well so their care costs, should they incur them, are met. For people who care a lot about leaving money to their children, this is a way of protecting the kids’ inheritance which they will appreciate.
The bad news is that the government proposes to pay a third to a quarter of the cost of care for people however rich they may be. This is a sop to the free-care-for-all lobby which wanted personal care to be free, and the newspapers who say the system currently penalises those who have saved. It will be wildly expensive – this is a green paper essentially free of numbers. It will divert resources that should be spent on better care, especially for the least well off. And it will not satisfy the give-‘em-the-money lobby.
Fortunately it will probably never happen. The government cautiously floats paying for it by withdrawing attendance allowance, a state payment to those needing help. This would cause an outcry. A fundamental rule of politics is that if government takes something away from someone a benefit they feel they should be getting they revolt. If you give them a new benefit, they pocket it as a right. So the government will not be able to withdraw attendance allowance. In current fiscal circumstances, the policy is unaffordable if it doesn’t. That will prove to be that.
The worst hole in the green paper does not concern paying for services. It is how we get enough resources into them. The population is ageing. The period of ill health at the end of life is lengthening. Yet spending on services is due to rise only by some 1% per annum in real terms. As a result only the really poorly are getting help. The rest are increasingly left to fend for themselves.
We cannot run a civilised care service off current budgets. And it is far more important to provide good services than to subsidise the rich so they can leave bigger inheritances to their children.