Training | 2010.02.08
Free care sounds nice, but why redistribute to the rich? | Polly Toynbee
In pursuit of a gripping headline, Brown has scuppered a fair, sensible and long-term plan for care of the elderly
Here was such a sound and solid piece of policymaking, rare long-term thinking about a wicked issue you wouldn\'t expect just before an election. There might be few votes in it, with a political risk of a backlash. Last summer\'s green paper on how to pay for social care was a model of how to approach an unpalatable problem with no easy answers. It was a coherent plan for financing a much needed National Care Service.
Sure enough, it was too good to be true. Gordon Brown, eager for an eye-catcher for his party conference speech, made an extravagant promise of free personal care at home for all those with "critical" needs. It blew the green paper out of the water by offering what the green paper and most experts agreed was impossible – the mirage that the state can pay for all care of the elderly. Andy Burnham, the health secretary, had laid out the reasons why at length as he put forward his proposed fairer insurance scheme. It is completely incompatible with this "free" plan of Brown\'s – though now Burnham lamely says this is an excellent "interim".
As under every previous government, those with money pay towards their own care. As we all live longer and need more care, the cost is growing, adding to the heavy pensions burden on younger generations. Luckily now that 70% of people own property, the cost can increasingly be shared between the state and those with the means to contribute. But Brown wanted a "free care" headline – though it is doubtful that a £670m free gift to voters in the middle of a great recession is a convincing way to buy support. Not even the charities for the aged whooped with glee at this one.
In the Lords this hastily assembled personal care at home bill was greeted by social care experts with a raspberry, in speech after speech. However, the Conservatives and Liberal Democrats decided to vote for it for fear of falling into one of Gordon Brown\'s badly camouflaged elephant traps, and being branded as anti-free care during the election. But the social care experts in the Lords – objecting to a brief bill with no published regulations explaining how it will work – may over the next weeks stop it being enacted before the election.
Today the Association of Directors of Social Services (ADSS), the local authority managers who would have to implement this free care, reported on why Brown\'s plan won\'t work, and certainly not at the price the government claims. Nothing about social care is simple – not least because each local authority offers different levels of care at different rates and interprets the official criteria arbitrarily: that\'s why we need a National Care Service.
The government plan offers free home care for those with "critical" needs, but not for those with only "substantial" or "moderate" needs. To be "critical" someone must score four serious needs, such as inability to feed themselves, go to the toilet or get out of bed. They will get £100 worth of free care, but, say the social service directors, that only buys six and a half hours of care a week – nothing like enough for people so frail, who need several visits a day and often two carers at a time to help with lifting.
Another problem: 70% of councils bundle together "critical" and "substantial" into one category. They will have trouble separating them, so as to offer only the "critical" bit free to those who can afford to pay the rest – the "critical" better off will still have to pay for whatever is defined as the "substantial" and "moderate" bits of their care out their own pockets. So expect thousands of challenges to the pricing decisions made. The ADSS says free care will cost twice what the government plans. Councils are being told to foot a large slice of the bill from extra efficiency savings, on top of this year\'s already required 4.7% efficiency savings. This breaks the usual protocol for central government to pay for any new services it demands of local authorities.
Here are the big objections: those with little money were never paying anyway, so free care does nothing for them. The beneficiaries are those who currently pay but will now get it free. No one knows how many better off people are already paying for their own care privately, and will now claim their free help. Any family that has used the care system knows it desperately needs money and more and better trained staff for less rushed, kinder care, allowing time to talk to the lonely and sick. But paying out in the middle of an economic decline for the better off to get more free care is no answer.
Part of the plan is a good idea: to ensure everyone gets six weeks – £1,000 worth – of intensive rehabilitation at home on leaving hospital to prevent them shuttling straight into residential homes. But there is no good reason to make it free, redistributing state money towards the richer. Does it contravene clause 1 of the equality bill, which expects public bodies to consider the effect of their policies on inequality?
The excellent plan in the green paper suggests a long-term solution, fair and sensible. On retirement anyone with the money would pay a lump sum – around £20,000 – to cover all future care, at home or nursing home. They would never need to pay another penny. If they own a home but have no money, the sum can be taken from their estate after death. Those with neither savings nor property would be paid for by the state.
That spreads the risk: one in six people end up needing residential care, and may have to sell their home and spend all that they hoped to leave to their children. This way no one loses everything, and all who can will pay something. The Daily Mail didn\'t like it, decrying a " New stealth tax on the middle classes ", who would be "unfairly penalised." Could the Mail\'s moans have anything to do with this sudden "free care" offer?
One benefit of devolution is the real-life social experiments it offers as each nation adopts different social policies. But the chance to learn from one another is often ignored at Westminster. The Scottish parliament brought in similar "free care" with a great fanfare, but it cost twice what had been planned: 36% more people entered the system, including the better off who had been buying private care.
Creating a National Care Service is one of those long-term polices that needs broad consensus between the parties on old age planning. It is no subject for a quick electoral whizzbang.
For more information, please visit
http://www.guardian.co.uk/commentisfree/[...]2/free-care-rich-brown-elderly
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