Hard choices, difficult decisions. You know when a politician has some bad news for the public if they use any combination of those words, and they were being scattered everywhere in Andy Burnham’s interview on the Today Programme this morning. But the problem is that merely stating that there is a tricky issue at stake doesn’t get us a step closer towards the solution, which is why it has taken so long for this government to develop a genuine strategy for paying for social care.
The plain truth is that we can’t afford high quality social care unless we either contribute more through the tax system and/or our pay more from our own personal income or assets. The good news that we are living longer through better healthcare and living standards translates into longer years of poor health which often require high levels of personal support and care. The Wanless Review of social care, commissioned by the health think tank the King’s Fund, predicted that the number of over 85s would increase by two-thirds in the next 20 years. The Review’s best case scenario suggested that a decent social care system would have to spend £31.3 billion, or 2% of GDP. Our current spending at that time was around 1.1% of GDP.
So yes, there are hard choices and difficult decisions, which is why the social care green paper today is definitely better late than never. Many people are suggesting the government simply adopts the majority view of the original Royal Commission on Long-Term Care which reported in 1999 and argued that all personal care (so excluding accommodation etc.) should be paid for by the taxpayer. This is pretty much what is happening in Scotland, and the problem is that it is hugely expensive. It will require young workers today to pay increasing amounts of tax for the older people of today. Yet this solution ignores the fact that despite the recession, there is equity stored up in housing assets which we need to make much more use of. The unpopular element of this of course is that older people, many of whom have scrimped and saved since the war to own their own home, wish to leave it to their children, grandchildren and great-grandchildren.
It’s to be welcomed therefore that the social care green paper launched today is likely to recommend a one-off levy on older people’s assets to ensure that they are not forced to sell their home completely. It is about time too that the government is proposing a minimum level of state funded care for everyone. There is a real sense of injustice among older people that they have done their best to pay into the social insurance model which was promised to protect them from cradle to grave, but many can’t access even small amounts to cover chiropody or home adjustments which we know help to avoid larger costs down the line. Investment in the early stages of elder care, just like with early intervention with young children, pays its dividends later on in savings to the public purse.
This is just a green paper, however. For Labour to be taken seriously it has to make real decisions soon on which option it thinks will provide older people with the care they deserve while levering extra money from those older people who have the assets or income to afford it. The Tories seem to have no other answer than to say they will come out with proposals before the manifesto, which basically means they are too scared of the Daily Mail and their core constituents to say anything serious now. Let’s beat them to it, but with a new contract between older person and state which recognises the severity of the funding crisis while ensuring that all older people see some benefit from years of taxation paid to the state.