Democratic politics is a funny old game. The whole point of it is that politicians give us competing solutions to the problems we face and then voters decide which they want. Yet sometimes really big issues turn up which politicians claim are too important to be treated as ‘political footballs’: what matters, they say, is to reach consensus.
It seems that one such issue is how we should care for the elderly, whose numbers are growing rapidly and for whom the costs of care are rising at least as fast. Frontbenchers from all three main parties got together recently to see if they could agree a common policy. And for good reasons: social care is a problem that has remained unresolved for years. Furthermore, it’s not the sort of issue where changing policy every few years is a clever idea. People want security and to know what they are going to be entitled to when they need it.
That attempt at consensus-building, however, broke down and now the politicians are at each other’s throats. But is that just because there is an election a few weeks away or because there are genuine differences of approach and even of political philosophy over which voters need to adjudicate?
The reason the issue has become pressing is that few people believe the current situation is satisfactory. In England, those who need social care in their own homes – help with washing, dressing or eating – have to pay for it if they have savings in excess of £23,000. If they need to go into a residential home, the value of the home they have had to leave (if they own it) is taken into account too. That means a large part of someone’s life earnings can be swallowed up by the cost of the care they need in old age.
What’s more, many local councils, facing severe budgetary problems, have been tightening up the criteria used to decide when they are prepared to offer care. As a result the number of people receiving help in their own homes has fallen by a fifth in the last eight years to 340,000. Many old people are left to fend for themselves or to rely on family, friends and neighbours to look after them.
Some people argue that while this can all be pretty tough, the state should be careful about how it intervenes. On this argument, families have always had the prime responsibility for looking after their elderly and that is as it should be. Furthermore, it’s claimed, savings and indeed the value of assets such as houses, are exactly what should be used to pay for necessary care in old age. Why should we assume some sort of right for people to pass on their inherited wealth to children, they ask?
But this argument is challenged in several ways. First, regarding the role of families, it’s pointed out that no one is actually stopping them from looking after their elderly but the facts are that more families are dispersed these days so it can often be a practical impossibility for younger members to look after the older. As regards savings and assets, it is not so much a right to bequeath that is being defended as the incentive to save. Why should anyone bother to save, it’s argued, if those savings are going to be taken away to fund care that would be provided anyway to those without savings?
This is the context in which the parties are setting out their stalls on social care. Today, Andy Burnham, the health secretary, announces that Labour intends to set up a National Care Service, an idea first floated by Gordon Brown as something he claimed to be of historic importance, to match the creation by his Labour predecessor, Clement Attlee, of the National Health Service in 1948.
The idea is that there should be a compulsory system set up through which, as with the NHS, everyone would be insured for the social care they might one day need. Mr Burnham said: “A new National Care Service, providing personal care and support to adults on the basis of need and free at the point of use, will ensure that an ageing society remains a decent and fair society.”
In fact the decision is only in principle. It won’t actually be set up until 2016 at the earliest. One reason for that is that no decision has been taken about how to fund it. Instead that vexed issue has been handed to (yet another) commission to work out. When Labour first started talking about the idea one option it was considering was a levy of £20,000 on everyone’s estate when they died. The Tories immediately dubbed this a death tax and went into full campaign mode to attack it. Labour has now ruled this out for the next parliament but it could re-emerge as the way to fund any NCS after that.
In the meantime, Labour says it will make residential care free for everyone after two year’s residence, a measure to be funded by freezing the threshold at which inheritance tax is paid and by raising the retirement age beyond 65. Critics point out that the average time someone spends in residential care is two years for men and three for women so this interim measure is hardly going to help much, they say.
Regarding any longer term solution, the Tories reject the whole notion of compulsion. Andrew Lansley, the shadow health minister, says compulsion is “unfair on the people who meet their caring responsibilities” (because they will have to pay for others’ care in addition to sacrificing in caring for their own elderly). Instead, he proposes a voluntary system. At 65, everyone would be given the option of paying what amounts to an insurance premium of £8,000. Those who paid it would be entitled to free residential care should they ultimately need it. Those who chose not to pay would run the risk of having to eat into their savings (including the value of their houses) should they end up needing care. The party has yet to announce its policy on non-residential care.
Critics of this approach say it is not ambitious enough and is attractive only to the relatively well-off. Furthermore, the system would work financially only if enough people signed up and paid the £8,000 premium.
The Liberal Democrats initially advocated entirely free personal care for the elderly following the example of Scotland which, under devolution, put such a scheme into practice. But financial stringency has forced the Scottish government to tighten the criteria by which free care is provided and the LibDems have abandoned such a generous policy in the light of the need to rein in public spending. Their policy is to seek a consensus with other parties. Their spokesman, Norman Lamb, says: “We should sit down together after the election, accepting that we need to raise more money and arguing the case for a partnership between the state and the individual.” The LibDems argue that any system run by the state should include a top-up provision to allow people to enhance the care to which they will be eligible.
So, although all parties espouse the wish to reach consensus, there are real differences, both of policy and philosophy, in their approach to the issue.
What’s your view? Do you think the existing system needs change or not? Do you think it is right or wrong that, under the current system, people’s savings (including the value of their homes) should be taken into account when deciding who should pay for care? At a philosophical level, do you think providing care for the elderly should be the responsibility primarily of the state or of families? Do you think that any new system set up should be compulsory or voluntary? If it is compulsory, how do you think it should be financed? What do you make of the proposal to tax everyone at death for £20,000? What do you make of the criticism of the Tory proposal for a voluntary system, that it is insufficiently ambitious and favours only the relatively well-off? Do you agree or not with the LibDems that all the parties need to agree a solution rather than have a government impose its own? And what do you make of the fact that this issue has still not been resolved after all these years?