At Age UK we will be listening very carefully to the Queen’s Speech to see if social care is mentioned and, if it is, what precisely is said. We sincerely hope that an intention to bring forward proposals for consultation will be stated, signifying that this new Government intends to press on with the Green Paper that was already underway before the General Election campaign began.
A lot of water has gone under the bridge over the intervening months, including the outcome of the General Election which very few predicted in advance. The furore about social care during the campaign was unexpected as well. Those of us with a keen interest in social care hoped that all the political parties would recognise the crisis in care in their manifestos and pledge action to tackle it, but at Age UK we were surprised that the Conservative manifesto advanced such specific ideas, and disappointed by these ideas too.
In summary, Age UK’s position is that we very much want a Social Care Green Paper to be developed and its proposals to succeed, but not on the basis of the propositions advanced in the Conservative Party’s manifesto.
In particular, we oppose the inclusion of housing wealth in the domiciliary care means test. This is for two reasons; firstly, we think it is right to continue to incentivise home care over residential care, given it is highly preventive in nature and supports older people to sustain their independence at home, which is supposed to be the central aim of Government policy towards older people; and secondly, we fear some older people would be put off getting home care when they really need it if they think the value of their house will come into play, electing instead to struggle on alone. This would not be in their best interests and it could also lead to them becoming sicker and frailer more quickly, ultimately adding to the pressures on the NHS – not a good result.
Winter Fuel Allowance
We also oppose the idea of means-testing the Winter Fuel Allowance. This is because the evidence is that when a benefit directed at older people is means-tested a significant proportion of those who could claim it do not do so. In the case of Pension Credit, for example, a benefit that tops up very low pensioner incomes, one in three of all those eligible fail to claim it. This statistic has remained stubbornly similar over many years, despite the efforts of various governments and Age UK too to encourage older people to apply. It is believed that there are a number of reasons for its low take up, including stigma associated with claiming a ‘benefit’, as opposed to accepting an ‘entitlement’ available to all as of right; ignorance about the eligibility criteria, leading to an erroneous belief that they would not qualify; the difficulty and hassle of filling in long forms; a desire to keep financial information private; and mental incapacity and cognitive decline.
Whatever the reasons for the poor take up of means-tested pensioner benefits the upshot is that any move to means-test Winter Fuel Allowance would be highly likely to result in some of the poorest, oldest, frailest and most vulnerable older people in our society failing to receive it. Given how important staying warm is for older people’s health through the winter months we believe it would be a public health disaster if this occurred.
Cap better than a ‘floor’
The idea of the £100,000 ‘floor’ in the Manifesto was novel and definitely better than no help at all with catastrophic care costs. However, as a number of commentators have observed, knowing that your expenditure on care will be capped at a reasonable amount, as Sir Andrew Dilnot recommended, would be rather more beneficial for many older people, including many home-owners in London and the South East, than being told you can keep £100,000 if you need care for a long time.
This is a challenge of principle but in addition there are innumerable practical problems that would need to be overcome too, were the idea of a ‘floor’ to be progressed.
Taken together, these proposals appeared to us at Age UK to constitute a significant transfer of financial responsibility onto individual older people and their families who are unlucky enough to need care in later life, albeit possibly slightly mitigated by the ‘cap’ the Conservatives subsequently said they would also introduce – though the value of it depends crucially on the level at which it is set.
This outcome is not what we would consider to be the ‘sustainable solution to social care’ that the Prime Minister talked about during the campaign.
No doubt some people will say ‘well, Age UK would say that wouldn’t they?’ And indeed, in the last few days, Nick Timothy, author of this part of the Conservative manifesto wrote the following in an article:
“We can ask older people to meet the costs, subject to certain protections, from the wealth they have accrued through life, or we can tax younger generations even more. Somehow we have reached a point where older people with assets expect younger, poorer people to pay for their care. With Britain’s demographics, that is not sustainable; neither is it socially just.”
But in our view Mr Timothy has misunderstood the reaction to his proposals – or at least our reaction to them anyway. The problem lay not so much in asking older people and their families to pay more, but in asking them to pay more in the ways specifically proposed and the likely consequences of this, whether intended or not, coupled with the lack of any clarity as to what they might receive in return which might make such policies fair and worthwhile from their point of view. There was also no recognition that many older people and their families are already paying a great deal for social care and not always receiving a good service in return, or that 1.2 million older people have an unmet need for care and require help.
In addition, the Conservatives’ decision as expressed in their Manifesto apparently not to contemplate a compulsory ‘risk pooling’ arrangement, backed by Government, whereby everyone is protected against the risk of incurring catastrophic care costs in exchange for some kind of payment in advance, or possibly in arrears if preferable, seems a big missed opportunity. This approach, interpreted in different ways in Germany and Japan, for example, is not without its difficulties, but it does at least provide the public of all ages with some certainty and reassurance, allowing different age groups to pay in different ways; this, coupled with a cast-iron commitment to fill the social care funding gap, would be far closer to the ‘sustainable solution’ for social care that we hope we will eventually get.
Social care is complex and riven with technicalities, and public understanding about it is generally quite low; for these reasons it is not very amenable to the ‘retail politics’ that typically dominate during Election campaigns.
Social care is, however, an incredibly important lifeline for many hundreds of thousands of older people, and disabled adults too, and it is really good that its significance to individuals and to our country came prominently to attention through the Election campaign in a way that had never really happened before.
The Conservatives were right to focus attention on social care during the Campaign, but in their Manifesto they started the conversation in the wrong place and their proposals were insufficiently well thought through. That is unfortunate but it is not terminal and a carefully considered Green Paper, developed by a team of clever and committed officials, would be an excellent vehicle for remedying the problems that emerged during the Campaign and getting social care to a better place.
At Age UK we would however be extremely disappointed if there is no mention of social care in the Queen’s Speech at all: that would be a tragedy that would simply pile up greater problems for millions of older people and their families in the months and years to come.