As the prime minister announces this month’s budget, and effectively the May election, Channel 4 News is bringing the three main parties together to debate the future of social care for the elderly.
Social care provision is likely to affect almost all of us in one way or another during our lifetimes – and as the general election looms it has become a political hot potato.
Talks between the three main parties broke down when – after early signs of consensus – they became caught up in the party dogfight over spending.
And it is perhaps not surprising, given the scale of the sums involved.
The Scottish government, which introduced free home care for some older people in 2002, has been under increasing pressure to scale back the provision after an auditor’s report warned the cost could rise to half a billion pounds a year by 2012 – four times the level of the original budget.
How the system works
As things currently stand, different arrangements apply in England, Wales, Scotland and Northern Ireland.
But in England alone, 1.2 million people over 65 are currently receiving some kind of government support. They and their families often have to pay crippling costs, and frequently receive poor care.
In England, anyone with more than £23,000 of assets (excluding their main residence) has to pay for their own care at home. Anyone with less should get care paid for by their local authority.
“When a person needs residential care, their home can be considered as an asset – so many families face having to rent or sell a relative’s home to fund the costs of their care.”
But here the famous postcode lottery applies. Care is assessed according to four different bands. 73 per cent of local authorities will only provide care for the two most severe levels of need, “critical” and “substantial”, while the remainder fund moderate needs too – none are known to fund low level needs.
When a person needs residential care, their home can be considered as an asset – so many families face having to rent or sell a relative’s home to fund the costs of their care.
Former railwayman David Gower, now in his seventies, lives in sheltered accommodation in Luton. He has severe mobility problems and depends on carers four times a day.
But he has received such poor care that it has threatened his life.
“All of a sudden and without any warning [my carers] refused to take from my press packs my medication. They claimed they were instructed not to do so. I could not get it resolved, I landed up in the Luton and Dunstable hospital for the whole of Christmas and new year.”
He pays more than £400 a week to fund that care, plus rent.
By contrast, Valerie Tugwell in Essex is happy with her care. She has no savings, but her care is funded by the state. So while some can receive good care without paying for it, others are forced to run down their life savings and in extreme cases sell their homes to fund inadequate care.
Options for reform
At the Labour party conference in Brighton last year, Gordon Brown produced one of his customary “rabbit out of the hat” surprise announcements. This one was to provide free care at home for the elderly.
The prime minister told delegates: “The people who face the greatest burden are too often those on middle incomes who have savings that will last a year or two, but then they’ll see their savings slip away. For those with the highest needs we will now offer in their own homes free personal care.”
This eye-catching proposal became the personal care at home bill, which could be implemented as soon as October 2010. But it only covers those with “critical” needs, who number around 350,000, costing £870m.
“For those with the highest needs we will now offer in their own homes free personal care.” Gordon Brown
The cash is meant to come from savings from the health and communities department budgets – easier to announce than achieve in practice.
Local authorities worry that the costs would be higher than that estimate. The Association of Directors of Adult Social Services estimated that it could be double that figure.
It was seen by opposition politicians as a betrayal of an ongoing, cross-party project to overhaul the entire system.
A green paper entitled Shaping the Future of Care Together, looking at all aspects of caring for the elderly, from residential care and care at home, for every level of need, was published last July.
It considered five possibilities for funding care. It could all be paid for from general taxation, or left entirely up to individuals to fund themselves – but these two options were discounted.
The three most viable plans were –
The “partnership model”: everyone gets a contribution from the state, depending on their means. It would be free for the poorest, while the wealthiest would get, say, one third or one quarter paid.
The “insurance model”: individuals have the option to buy insurance, from private companies or the state, to cover their share of care costs. Premiums would probably be between £20,000 and £25,000.
The “comprehensive model”: those with sufficient assets make a compulsory payment – possibly upfront, at retirement or even after death.
The consensus on the green paper broke down early in February, amid Tory accusations that Labour was planning a “£20,000 death tax” – illustrated on posters with a tombstone bearing the words RIP Off.
This accusation, when in fact this tax was being considered by all parties, led to a bitter political row – with accusations of stand-up rows in the lobby.
Elderly care is now likely to become a major election issue – and the political row only increases the uncertainty faced by those trying to work out how to fund the costs of their care.
Today Channel 4 News, in association with Age Concern and Help the Aged, has brought together the leading spokesmen on social care for the three main parties, in front of an invited audience, to debate the issues.