Proposal #1: Create a National Care Service offering a minimum standard of long term care for all older people
Fairer funding of care for Britain’s ageing population is one of the biggest unmet social and economic challenges to be resolved by the Labour government. The forthcoming manifesto provides a chance to ensure that older people get the care they want and need through a radical change in the way care is funded.
We are living longer, with 1.3 million people now aged 85 and over. In the next twenty years the number of people over 85 will double, raising major questions about how we provide and fund care and support for older people and their carers.
The Government has acknowledged this with a green paper on funding care in England published in July. The green paper presents some long-term proposals to pay for the better care older people and their carers urgently need, particularly for the growing number of older people with dementia, disabilities and long-term conditions.
With our ageing population and the increasing expectations of baby boomers, the current care system simply isn’t fit for the future. Older people and their families have for too long settled for inadequate, under-funded care. Their expectations of the care system have been and remain low, informed by an experience which, all too often, can be even worse. But as the debate about personalisation and choice in health and social care takes off and as new generations approach retirement, those expectations are changing.
With the Government preparing for the biggest overhaul of the system for a generation, it is time to set our sights higher. Now is the time for an ambitious vision for the reform of social care. Ambition is also important because of past failures to resolve these issues such as the Royal Commission a decade ago, and because of the scale of the problem not just in terms of funding but in developing flexible care and support that reflect the needs and wants of British society in the 21st century.
Bold proposals in the ‘Shaping the Future of Care Together’ green paper to end the postcode lottery in care and make paying for care fairer for everybody therefore have to be welcomed. The proposals meet many of Counsel and Care‘s tests for a new system which must be simpler, fairer, consistent, transparent and flexible, meeting the needs of older people all over the country.
Creating a national care service is particularly ambitious and could put care on a par with the NHS. Making care a universal service that everyone has a stake in and everyone benefits from would certainly make a big difference. The proposal for a national care service with a universal entitlement to care and a national assessment and portability seeks to end the postcode lottery. People want to know what care will be available wherever they live and how much it will cost them.
What can’t be ducked though is that better care will cost us all more. So we need to find new ways to pay for the growing bill. But any new funding system must be fairer, simpler and transparent for all.
The green paper rules out paying for care entirely from taxation or from individuals’ own resources. It sets out three options for the state and individuals to share the costs of care in partnership, with different levels of contribution by indviduals.
Of the three funding options, I support the ‘comprehensive’ option as being the simplest way to share the risks and costs of care. Under this option, everyone would get the care they need in return for a one-off contribution. What needs to be debated is how that contribution could be made in a way that is fair. I have argued for some time that a ‘care duty’ on people’s estates would be a better way to pay for care – we already have a collection mechanism and the level of payment could reflect an individual’s wealth, rather than everyone being required to pay the same lump-sum.
How we pay for care is an issue that touches every family in the country. We simply can’t do nothing and ignore the needs of this and future generations of older people.
Stephen Burke is Chief Executive of Counsel and Care, the national charity working with older people, their families and carers to get the best care and support. www.counselandcare.org.uk.