The chair of the Royal Commission into long-term care of the elderly welcomes the government’s ‘historic’ plans announced this week. But he calls for reform to go further and to include the merging of health and social care budgets
Health Secretary Jeremy Hunt is correct in describing the government's proposals to limit the cost of social care for each individual as 'historic'. After 15 years of prevarication, this is the first formal recognition that a policy is required to deal with the implications of demographic change. Hitherto, the facts have been plain, but government acknowledgement of them non-existent.
Hunt also referred to the proposals as ‘radical’. That, however, over-eggs the pudding.
The 1948 settlement created a National Health Service, free at the point of delivery, but omitted to make provision for the costs of social care. Too often the difference between the two has not been recognised by families until catastrophe strikes. Lack of a government policy has compounded the problems by leaving uncertainty amongst carers, providers, and the worried ageing.
The government proposals have now for the first time staked out the ground for action, debate and forward planning. There is a long way to go, and the uncertain position of our economy will limit how fast we can make progress. At least however, there is a road sign pointing ‘Forward’.
The proposals retain the distinction drawn by the Royal Commission, which reported in 1999, between the costs of care and so-called ‘hotel’ costs of those who require that care in a residential setting. The state’s responsibility is to provide for the former.
There are two very significant proposals.
The first is that care costs for any individual will be capped at £75,000. This is higher than Andrew Dilnot’s proposed £35–50,000. However, it represents £61,000 at 2011 prices, and it will give a benchmark for future generations who wish to save or insure against these costs. Undoubtedly this figure will be under intense scrutiny as and when the economy improves.
The second less-showy proposal is that there will be national eligibility criteria, for both allowances and needs. This will remove the reality of what is currently a post-code lottery. Equally it will make the goal of portable benefits achievable.
Other key elements of the package are to raise the threshold at which a means test applies to care costs from the current capital assets figure of £23,250 to the Dilnot proposed level of £100,000 in 210/11 prices, which sets the figure at £123,000 for 2017. A significant part of these costs to the state will be covered by freezing the Inheritance Tax threshold for a further three years at £325,000.
All in all, this is an advance that is properly described as ‘historic’, but it leaves much room for further discussion about the details and the means.
Top of my list of the latter is that the budgets for health and social care should be combined. To be controversial at the point of exit, my own view is that it is not simply social care that we cannot afford. We cannot afford the health service to which we currently aspire solely from public expenditure.
A good start, which would provide more effective spend, would be to combine health and social care provision and budgets.
Lord Stewart Sutherland chaired the 1997-99 Royal Commission into long-term care for the elderly
