My friend’s enemy may be his friend

Those commenting on Andrew Dilnot’s report on social care aren’t quite sure where the story lies. Is it in the recommendations themselves or the ambivalence of the Government about implementing them?

For those looking for an overview of the difficult politics of social care reform, I can recommend this piece by my old colleague Gavin Kelly, former senior advisor to Prime Minister Gordon Brown.

If Gavin’s piece doesn’t make up your mind, you can always use a trick I have sometimes found helpful when wanting to form an opinion of a complex set of proposals. This is to listen to the critics of whatever is being proposed (criticisms are often easier to understand than proposals) and judge whether they are being fair.

Thus it was that, apart from the glaring and growing need for reform of some kind (and the fact that I have always found Andrew Dilnot to be sensible and intellectually independent person), the thing that most positively inclined me to Dilnot's views was a press release I received this morning from Stephen Burke, Chief Executive of the charity,United for All Ages.

I like and respect Stephen; he has a lifetime of experience and insight into matters relating to care policy. I’m sure too that his charity is well-intentioned, I certainly admire its mission. However I baulked at the first two points in the press release:

Point one: ‘The cap is regressive - everyone (except those below the proposed assets threshold) would be required to find the same amount of money regardless of their wealth. This could be seen as a care ‘poll tax’ for the so-called squeezed middle’.

The implication is that Dilnot should be opposed on social justice grounds. But let’s think about this. Most of the poor will have less than £100k in assets so will not have to pay. Many of the poor to middling will be very much helped by a rise in the threshold from £23k to £100k. So, if we assume that most people’s main care costs are close to their end of life, the main effect of the cap will be reduce the amount of assets available to better off older people to pass on in legacies to the next generation. I have to admit I find it hard to see this as a strong social justice case for opposition.  

Point two: ‘Not many people have up to £50k liquid assets and therefore would be required to find it by selling their home and/or using their estate for a deferred payment or by taking out an insurance policy which again would cost the same regardless of income or wealth’

There are two problems here. First, although his report describes a range of possibilities, Dilnot has said the threshold on individual payment should be £35k not £50k. More importantly, this is not a single one off payment threshold (which is what is implied in the press release’s phrase ‘liquid assets’) but a lifetime cap.

If people are getting home care (which is often the care that will kick in first) it will probably take them a number of years before they reach the £35k limit.  So for a typical case this might mean someone being required to spend about £10k a year of a total asset base of in excess of £135k (if their assets were less than this they would reach the £100k limit before the end of the four years).  Given the need for difficult decision if we are to address the social care funding crisis, this really doesn’t seem unreasonable.

It is true that Dilnot’s proposals do not help the asset-poor, but that’s because already they don’t pay. The major issue affecting this group is the current overall level of central and local spending on social care (the fact, for example, that social care for anything but severe needs has virtually been abolished) , which was not in Dilnot’s brief.  As Kelly says in his piece, there are bound to be lots of bad stories over the coming years about social care failings. A reason for the Government to promise reform  is they would then have something positive to say when these stories emerge.

One reason we find it hard to have a sensible debate about social care and (incidentally a reason why I am not convinced by Dilnot’s hope that an insurance market for social care will spring up) is that is that we simply don’t like to think about getting old and frail. It depresses us and we may even have the superstitious belief that misfortune is more likely to happpen if we think about it.

And so today I will not try to make up a new joke but share with you one of my all-time favorites.....

An elderly woman approached an elderly man in an old people's home...

‘Bet you I can tell you old you are’ she says

‘Really?’ says the man ‘go on then’

‘First’ she replies ‘I have to see you naked’

The man is a little surprised but they go up to his room, he takes off his clothes and stands while she gives his body a very close inspection

Eventually she seems satisfied: ’You’re 87’ she announces

‘My word!’ says the man ‘That’s amazing – spot on, but how did you know?’

‘Easy’ she replies with a twinkle in her eye ‘you told me last Tuesday’