The Dilnot Commission may have come up with a workable solution to the adult social care problem but, as Peter Barnett explains, it has to get past the politician.
LIFE IMITATING ART?
In the 19th century, writers such as Lewis Carroll often concealed within their texts political metaphors that their readers could readily translate which described this lack of boldness.
For example, in Alice in Wonderland which he wrote in 1865 after getting wet, Alice and all the animals need to dry off.
The dodo recommends a ‘caucus race’, in which there are no rules – all of the participants run haphazardly around in no particular direction, everyone wins and all must have prizes.
The caucus race provides a thinly veiled critique of the absurdity of English politics at the turn of the century.
The animals run randomly in circles, progress nowhere and arbitrarily adjourn without any clear conclusion.
Carroll implies that politicians do the same when confronted by potentially unpopular decisions i.e. run round in self-congratulatory circles in an illusion of activity, creating lots of noise but actually achieving very little. Does this sound familiar?
So what can we expect to happen next with care funding? The government has said that this report and the recent Law Commission report would be taken together to inform a Social Care White Paper and ensuing legislation.
But the key to unlocking this funding question, the long sought-after political consensus, may prove as elusive as ever.
For as indicated, while the report potentially solves a problem for the politicians, it may not be popular with voters.
Especially those have always thought their care was free in its recent paper Who Cares on the issue, the CII called this misunderstanding the ‘perception gap’ and who, to their surprise, find they will now have to pay for it if they need it.
Moreover, according to the report the reforms come with a Treasury wincing price tag of £1.7bn a year to carry out although it actually represents only 1/400th of the annual GDP.
It is going to require a huge effort of political will to put long-term care for the elderly on a sustainable and affordable footing.
Yet the responsible minister Health Secretary Andrew Lansley has taken such a bashing over his NHS reforms that his Health Bill had to be ‘paused’ and have ‘substantive’ changes made to it.
This has delayed the Bill and, in turn, will delay consideration of any changes to adult social care funding which could not have been foreseen when Andrew Dilnot began his deliberations a year ago.
Lansley has said that the Dilnot Commission report would get a “positive response” from the government, which would treat it as a “the basis for engagement”.
Though he warned that the cap level and how it would be paid for were among “a range of issues that need to be resolved”.
At almost the same time, the care services minister Paul Burstow shied away from Dilnot’s call in the media for an urgent uptake of his conclusions, warning that some reaction would be “lukewarm”.
He remarked that while “the Dilnot report marked an important milestone on the road to reform, there are more milestones to come”.
He added that the report would not herald “the government’s final word on funding reform”.
Opponents to any increase in spending on care have already voiced concerns. In a recent paper, the think-tank Reform argued that:
“People are already required to pay something out of their own pockets for care, which must remain the case… [and] the [Dilnot] Commission must resist calls for new taxes and new spending. Long-term care can and should be funded predominantly by its users, not least through the sale of homes.”
More importantly, later in July the Office for Budget Responsibility (OBR) published its first annual Fiscal Sustainability Report.
Its long-term projections show that without future policy change, as a result of changing demographics, we can expect a huge rise in age-related spending over the coming decades of some 4.5% of GDP.
That’s about £70bn extra to pay for increased longevity.
The £1.7bn a year for Dilnot’s proposals will need to come from somewhere, but the prospect of an even bigger tax bill to pay for an ageing population and to cut debt poses a major dilemma for the Chancellor if he wants to risk grasping the demographic nettle. Realistically, and unfortunately, leaving it for the next parliament to deal with looks a much more tempting scenario.
Even if a political consensus is reached and the proposals do get the go-ahead, both the proposed cap and the threshold will come under strong pressure as the politicians try to shave some money of the final bill.
The government is now considering further consultation on care funding as to how the £35,000 owed by an individual without insurance cover might be retrieved, with a likely option being from their estate at death the much vilified ‘death tax’.
