Capping care costs will ease a terror felt by many. But leaders must beware: disaster lurks in promises the coalition can’t keep
Over the past few months, six people I’ve known have died, aged between late 50s and 90. One of the younger ones needed substantial, expensive care before he died. One of the oldest needed no care at all, not a penny. Another needed years of care. Life’s a lottery; death’s a lottery.
That’s why the government’s U-turn on funding better care for the elderly is both so welcome, and so tricky. It’s welcome because it is an honest attempt to introduce a little more fairness into that ultimate, existential lottery. It’s tricky, however, because an honest appraisal of the costs means that many people will be bitterly disappointed when they calculate the numbers.
To recap: the excellent Andrew Dilnot, commissioned to look at the long-running sore of older people being forced to sell their homes to pay for their care, and at the huge disparities in the quality of care, had made two important financial recommendations. One was that the threshold for having to pay would rise from £23,500 of assets to £100,000, thereby saving some worse-off homeowners from selling up. The second was that nobody would be expected to pay more than £35,000 for care during their lifetime. The coalition had indicated that, because this would cost £1.7bn a year, rising as the population ages, it would not agree to this. Now it seems it will.
This is a very important moment. After the unappetising and tedious games being played over Lords reform and boundary changes, finally the “quartet” of Cameron, Clegg, Osborne and Alexander have turned their minds to an issue which will potentially affect millions of us, and is basic to social justice today. Hooray. The cap, at £35,000, is still a lot of money, and we’re going to need to see an effective, affordable insurance system to help people meet that cost – but this ends some of the financial terror (and that’s not too strong a word) facing tens of thousands of vulnerable people.
The Tory rightwinger John Redwood is right when he points out that in fact, many people will end up spending much more than £35,000 because the cap covers only the care costs, not the living expenses in homes; and he’s right, too, to remind people that homes may charge much more, particularly in the south-east, than the tariff the government will pay for. There are lots of dancing devils in the detail.
But I think he’s wrong to suggest £1.7bn should therefore be spent in some other, more directly targeted way. Why? Because there needs to be some sense that we are all in this together – that we should jointly share the misfortune of dementia and other illnesses of an ageing population, which will only affect some of us. It’s the principle of the NHS, extended now to new needs that were far less of an issue in the earlier-death decades of the 20th century.
That still leaves the major problems of the £35,000 “lifetime cap” not covering the real cost of a long-term degenerative condition in a care home; and of the postcode lottery, whereby care in some areas is far better than others; and the vast press of financial expectation as the population continues to age.
The only way that politicians can deal with these is by deploying straight talk and returning to the theme of fairness. Alzheimer’s and Parkinson’s are a lottery; so we might agree that if I’m spared but you are not, then in a just society, I ought to pay a bit to help you. But around that lottery are other even bigger lotteries – the lotteries of class, age, education and inherited wealth.
These can’t be ignored. Money spent to look after older people needing care is money that can’t be spent on schools, or cancer screening. Famously, the baby boomers have recast political priorities to suit themselves as they have moved through life; older people are likelier to vote and are increasingly well organised and assertive. That’s good, but politicians have to keep challenging us with questions of intergenerational fairness. Younger people, who have missed the prospect of better pensions, and will now have to pay more to fund older people, are going to have a tough time. Their voices mustn’t be drowned out.
So it’s almost certain that whatever deal is announced this autumn will mean that some people still have to sell their family homes to pay for care. There can be no absolute guarantees for the elderly. It’s important that people are encouraged to save, and that they aren’t instantly turfed out of a much loved flat because they have become ill. Well done, ministers. But I struggle to see why the “right” to inherit a house worth a couple of million from someone’s parents trumps general questions of social justice; or why the most expensive care homes, offering superb catering and accommodation, should be fully funded by the taxes of young, lower earners.
People understand this. They get it. Nobody really believes that all social care will magically be paid for by the state, with no financial pinch anywhere else. The only thing that would be disastrous now would be for Cameron and Clegg to hype their decision at party conferences and, once again, make promises about the future they can’t keep. Let them talk about the lottery of life and death, and modest advances, and priorities. This is a step towards a more decent Britain, not a revolution. And for now, for today, that’s fine.