ALEX BRUMMER: There ARE solutions to the dementia crisis — if only our feeble leaders had the gumption to grasp them
Over the past 15 months my family, like many of the ‘baby boomer’ generation, has experienced the complexities of Britain’s broken system of care for the elderly and recognised the potentially disastrous financial consequences. I saw it first-hand through the eyes of two close relatives who subsequently died.
The experience was a sharp reminder of how politicians from our main parties have been too feeble to grasp the nettle of finding better ways to finance surging dementia and elderly care needs, and thereby ensuring that the post-war consensus of the state providing ‘cradle to grave’ care remains a reality.
The first of these relatives was my mother-in-law, who was suffering from memory loss. At my wife’s and her sister’s request, she was transferred from the University Hospital of South Wales to a modern residential care home on the fringes of Cardiff. The cost was high at around £1,600 per week.
The experience was a sharp reminder of how politicians from our main parties have been too feeble to grasp the nettle of finding better ways to finance surging dementia and elderly care needs, and thereby ensuring that the post-war consensus of the state providing ‘cradle to grave’ care remains a reality
Fortunately, she and my late father-in-law had been careful with their finances, so she was able to meet the bills for the home, which provided brilliant, loving, round-the-clock care services, from her own savings. The family was nevertheless acutely aware that the cash would soon run out and the last of her assets, her modest apartment, might have to be sold.
Sadly, cancer took her life before this step became necessary. But the experience was a sharp reminder of how those who have lived most scrupulously, by paying their taxes and building a nest-egg, could see the bulk of their resources draining away without direct assistance from the state.
The second relative was my elderly father, a refugee from the Holocaust, who received heroic care from the Brighton & Hove local authority. Many times the wonderful carers would arrive to help him at home, still breathless from the calls they had made to other people in need of care services.
They were totally overstretched but unfailingly professional and a huge assistance to my brother, who interrupted his business to be the main carer for our father. I was moved to tears when a young former carer turned up at his apartment with a bunch of flowers and a card to mark his 103rd birthday.
After he passed on, we were presented with a bill for several thousand pounds from the council for the extra calls and nights spent with him in his final months.
It was money well spent but it raised questions in my mind as to who would have met the cost had he come from a more impoverished background.
What these personal experiences demonstrated to me is the sheer lottery of a creaking system of care for the elderly, and the shameful absence of any decent, joined-up pathway from the NHS into the social care system.
Politicians have been very good at stating that there is a problem but they have done nothing about it. The long-promised Government Green Paper on social care has barely been mentioned in the Tory leadership campaign, where the candidates have been far too busy out-Brexiting each other.
In the 2010 election campaign, the Tories accused Labour of preparing a £20,000 compulsory ‘death tax’ to fund a national carers service. Labour weaponised the same issue in the 2017 election, skewering a Tory proposal to take care costs from the estate of the deceased, and claiming it was a ‘dementia tax’.
As this kind of dog-eat-dog politics has dragged on, the chances of creating a social care fund have been delayed.
There are all manner of ideas out there for paying for social care — from tax relief on contributions into insurance policies from the big providers such as Prudential, Aviva and Legal & General, to a social care Isa as promoted by former pensions minister Baroness Ros Altmann.
But it has long been my view that social care should be a universal, market-based system into which almost everyone should pay.
The model for this is the automatic enrolment system into pensions, proposed in 2005 by a commission headed by former chairman of the Financial Services Authority Adair Turner, and brought into law by the Blair-Brown and Coalition governments a few years later.
Under this system every employer (of whatever size) is required automatically to enrol its workers in a pensions plan. Employees have the chance to opt out, but few do.
Since automatic enrolment began in 2012, some 9.9 million workers have signed up and 1.4 million employers have rolled out pension plans.
The result has been a £4.3 billion-a-year increase in the amounts saved into private pensions, ensuring there is a sizeable and growing fund available for people to look after themselves in old age.
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A parallel system for social care might take time to get off the ground but it would at a stroke remove the iniquitous sting of paying for your old age by plundering what you hope to pass on to your children.
Contributions under this system would be tax-free and deducted from salary at source, and employers would be required at least to match modest cash amounts paid in.
The cash raised in this way would have to be ring-fenced from the Exchequer and managed by private insitutions in the free market on a low-cost commercial basis. Those contributing would have the freedom to choose between a list of types of funds, or could opt for a default fund.
As members of a universal scheme, which would build up a big endowment over the decades, citizens would be entitled to free or nominally priced social care — in care homes or their own homes — without having to sacrifice their other savings or family residences. Under this plan, the temptation of the feckless to spend their incomes rather than save for their old age would be eliminated.
Clearly a new system based on automatic enrolment is not an immediate cure-all for the social care crisis. After all, for those facing care-home costs today or in the near or even medium future, it would come too late.
But the build-up of the endowment fund in pensions demonstrates that the more people who pay into the system, the more viable it becomes in a relatively short space of time.
In the interim, the Government would need to step up its spending on social care and could, as a temporary measure, perhaps take revenue from a small increase in National Insurance.
My only fear about that is that, like so many emergency taxes, it would become permanent. But some type of early fix is hard to avoid given the current debacle which has placed impossible pressure and burdens on families up and down the country.
If a compulsory contributions system for social care had been brought in when the last Royal Commission on Long Term Care reported in 1999, we would not be facing the appalling crisis-ridden system we currently have in place.
A fund of billions, created by the workforce and employers opting in, would already be up and running and care homes would feel secure.
They could be run by outfits drawn from either the public or private sector and, to ensure efficiency, should be regionally based. This would help keep care homes out of reach of private equity cowboys whose investments in the sector have been so damaging.
Crucially, a multi-billion- pound fund of the kind I am proposing would enable social care to be taken off the balance sheets of local authorities, which are utterly unable to cope with the soaring bills.
If ever there were a system in need of an urgent, cross-party fix, it is this. And solutions are to hand — if only our feeble politicians had the gumption to grasp them.
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