What’s the biggest decision facing the coalition? Lords reform? A euro referendum? Punishing greedy and incompetent bankers? No, no, no. Let’s talk instead about David.
David was in the Royal Navy and worked hard until he was 70. Now aged 76, he’s done all the right things … well, except for one thing – which is to suffer from a severe neurological disorder. He needs carers four times a day for dressing, washing and feeding, and can only get a shower once a week. Recently, his wheelchair brake broke and his carers refused to lift him out of his chair and into bed for health and safety reasons, so he spent three days sitting in it.
I spoke to David last week. After half a century of hard work, his payments for the care he needs – shared with his local authority – have recently risen from £260 to £324 a month, and he struggles to pay the bills from his dwindling savings and pension. Nobody told him it would be like this.
The point, of course, is that almost all of us are David, potentially. We live longer, we are infirm for longer, we need the help that all too often there aren’t family members around to provide. This is the huge question mark in the later stages of most lives – how will we cope and how will we pay?
If you are still not convinced, consider the likely effect of the rising cost of social care on everything else your friendly local council does – and on the NHS too.
The Local Government Association, in its report last week, said social care could soak up the vast majority of council spending by 2020 – so libraries and leisure centres will have to close to pay to ensure older people aren’t sitting in urine-soaked clothes or starving in their own flats.
As to the NHS, Age UK and the Royal College of Nursing have joined forces to warn that unless “brave and radical decisions” are taken now, hospitals will be flooded with tens of thousands of people who could be cared for at home, but don’t have the funds to pay for carers. A Nursing Times survey earlier this year found that 80% of nurses were warning that older patients were left unnecessarily in hospital beds. How many people are we talking about?
According to the Department of Health, in just two months last year 120,000 days in hospital were used up by older people, who should have been somewhere else. This is unpleasant for them and, of course, terrible news for everyone else who needs hospital admission.
So this affects most of us as ageing individuals, it affects us as users of other council services, and it affects everyone who might need to go to hospital – so, basically, it affects everyone. What’s needed is a properly funded new national deal. This is more important than any Westminster-constitutional or City-scandal legislation.
It may not be a sexy subject for newspaper headline writers or television bulletins, but we can’t any longer say it hasn’t been properly thought through. Social care was put through the policy mincer in the Dilnot report. It made sensible recommendations on integrating social care and health care and, crucially, on paying for this.
According to Andrew Dilnot’s commission, the contribution any individual makes to their care, not including general living costs, should be capped at £35,000 and the level of assets at which people living in residential care should have to pay the full costs should rise to £100,000.
This simply makes the cost burden to the individual a bit less scary, and plannable-for. It would mean nobody would have to spend more than 30% of their assets paying for their care. Would it cost the taxpayer? Yes, but not massively; the commission reckons £1.7bn, rising to £3.6bn by 2025-26 as the population ages.
And so? We have had months of delay and agonising behind the scenes. There were fears that we would hear nothing before the autumn. Now I hear that the “quad” – David Cameron, George Osborne, Nick Clegg and Danny Alexander – agreed last week that the resulting white paper will be published before parliament’s recess, within the next fortnight.
Good news indeed. So are reports that the four ministers have agreed organisational changes suggested by Dilnot, including the integration of health and social services, and more personalisation of care.
Sadly, that’s where the good news stops because the word is that no “bold and radical” decisions have been taken on funding at all. It’s all for the next spending review. Long grass. Hard times. All that …
So let’s go back to David and ask ourselves what government is actually for. Many older people are now having to go to bed at 6pm because they can’t get help after that. Many visits are just 15 minutes long – too short to be much help. Eight out of 10 councils are now only helping those with “substantial and critical needs”, and the postcode lottery is particularly cruel. The local government shortfall – if there is no real reform, is estimated at about £16.5bn by 2020.
The glib response is presumably that the country cannot afford this; that as the economic outlook worsens, and growth proves elusive, it remains a time for cutbacks – not for extra spending.
Putting to one side how quickly ministers can find money to help motorists if it seems electorally sensible, the problem is that this is about the future shape of our society. It isn’t a passing decision, a momentary crisis. If ministers think that a new deal for older people is unaffordable – or that it should be paid for by closing 90% of libraries and leisure centres – then at least let’s have that debate.
Politics, after all, is the language of priorities. That’s even truer in hard times. I’d wager that most groups of thoughtful people, armed with the facts and thinking about their own situation, would place social care pretty high up any list. I strongly suspect that once voters understand the issues clearly, this is going to be a far hotter topic than it has been.
What won’t work is muffled muttering and flip-flopping. If the white paper fails to deal with financing the new deal on care, it isn’t worth the paper it’s printed on. And MPs of all parties should rise in revolt. There are plenty of things they can’t do much about: this is one thing they can.
