Andy Burnham has promised to ‘fix’ social care and to ‘use some of his political capital on the issue’. The first steps are expected this week. Ed Davey, who has campaigned strongly on the issue, promises to work with him on a cross-party basis.
All good. The problem is that people mean very different things by the ‘social care’ problem.
The obvious priority is to help unpaid carers – around 6 million people, 1.7 million of whom provide care for over 50 hours a week – and those they care for at home. There are rather meagre carers’ benefits but, for the most part, carers make a financial as well as emotional sacrifice – while keeping their loved ones out of hospital and as part of the local community.
There is potential help in the form of local authority domiciliary care but the service has to be paid for since social care -unlike NHS health care – is not free, but means-tested for those with assets over £23,000 (and very expensive for -say- a live-in carer costing up to £50,000 a year). Moreover, the domiciliary care service is severely over-stretched and highly dependent on low paid, immigrant, care workers.
If funding were available it could be used to relax the eligibility criteria which keep around 2 million, mainly elderly people, from receiving the social care they need; or to improve the quality of service. Based on the Scottish model (where social care is free) the cost of a fully funded care service could be around £8 billion. That is a minimum.
But others are clamouring for ‘social care’ funding for a different reason. Many relatives with frail relatives, especially those suffering from dementia, choose not to assume caring responsibilities but to put them in a care home. Good care homes are expensive: upwards of £60,000 a year even without nursing care. Some residents are being forced to sell their family home to pay costs. Disgruntled relatives can see their inheritance disappearing in care home costs.
There is insurance to cover at least part of the cost but a formidable lobby has assembled to demand a cap on the costs of care to protect ‘the family home’. Professor Dilnot recommended a cap to limit the cost of care and the government I served in endorsed the idea. The Treasury baulked at the cost of the cap -now, around £4 billion- and it is not clear why this government would want to prioritise what is in effect an inheritance subsidy for those families with an expensive granny.
Even if the government ignores the more extravagant demands, such as cap on care costs, a meaningful new social care policy is likely to cost around £10 billion pounds. That raises the obvious and difficult question : who pays?. The Daily Mail is already warning its pensioner readers that they may face a ‘death tax’ – a levy on estates, on top of Inheritance Tax – of a kind that Andy Burnham once advocated as Health Secretary. Since the government has already made boxed itself into a position of promising more spending without raising the major taxes, the Daily Mail may well be pointing in the right direction. Care or inheritance?
* Sir Vince Cable is the former MP for Twickenham and was leader of the Liberal Democrats from 2017 until 2019. He also served in the Cabinet as Secretary of State for Business, Innovation and Skills from 2010 to 2015.