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Social care funding and the cost of short-term thinking

Posted on 23/10/2017 by

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A royal commission recommended the extension of free care as long ago as 1999, says Robin Wendt; plus Gillian Dalley on private sector planning; David Herriott on a ‘death tax’ andBernie Evans on short-term thinking in government generally

You suggest (Editorial, 17 October) that “the gradual extension of free care, starting with critical care and extending to those with substantial needs as money became available” would be a key part of the reform of social care funding. A solution on these lines has been available to governments since 1999 when the royal commission on long-term care (of which I was a member) recommended that the costs of intimate personal care should, in principle, be met by the state from general taxation, with individuals being responsible like the rest of the population for their housing and living costs subject to means testing.

The unassailable justification for this proposal is the gross injustice whereby cancer sufferers have all their needs met by the state while others, notably Alzheimer’s sufferers, are liable for their own care costs unless they have negligible resources. However, the proposal was brusquely rejected by Westminster, though adopted in Scotland, where it works effectively. Had it been accepted back then, “free care” would now be a seamless part of health and care provision covered by mainstream funding.
Robin Wendt

• As long as social care is provided almost entirely by the private sector (under 10% remains in public hands) it will be impossible both to plan strategically and operate efficiently. The private sector plays no effective collaborative role in the strategic planning of service provision (the duty of national and local government) modelled on expected demographic change over future decades. Indeed, private providers are essentially disparate and short-term focused – even handing back contracts mid-term when they prove or are predicted to be unprofitable. Moreover, they have no interest in providing care as a public good.

The private sector, in the market as it is currently structured, will always follow the money (that is, affluent old people who can pay for care out of their own pockets, and who are then placed in the position of cross-subsidising those who are paid for by cash-strapped councils, themselves unable to pay the full going rate as set by the providers). Depressingly, this does not even address the issues around quality that are shown to arise time and time again in services that have been outsourced (which is essentially what the private provision of social care is really all about) – just look at the parlous state of many of our privately provided (but publicly funded) prisons, immigration centres, probation services and primary healthcare services. The only difference is that social care is a hybrid form of outsourcing – private payers and publicly supported clients coexisting side-by-side within the same privately provided service.
Gillian Dalley

• If dementia is a disease needing NHS treatment why, apart from care costs, is it singled out as a condition to which normal NHS care processes should not apply? My concern is that a dementia tax is a slippery slope down which other elderly needs will eventually slide.

This government’s idea that such costs are unfair between generations ignores the fact that younger generations have a tendency (thanks to the NHS) of turning into older generations. Second, there is great unfairness between persons who are unlucky enough to need dementia care and thereby have to suffer a charge on the value of a property and those who are lucky enough not to need care.

The only fair way of affording good elderly care is by a ringfenced “death tax” – a percentage death duty on the value of estates. This would be proportionate to an individual’s wealth and those with no residual wealth would rightly pay nothing. As with all tax, the lucky ones in life will be those who only have to pay the tax without ever having the need to claim a benefit.
David Herriott

• Your editorial’s conclusion, that successive governments have failed to “think clearly” about the crisis in health and social care, making it “a bleak indictment of short-termist democracy”, sadly can be applied to all aspects of government policy. Short-termism leads to all sorts of apparently unforeseen problems; did no one see that cutting council grants would bring about quality reductions in public services? Was no one in authority able to predict recruitment crises in nursing and teaching, through overwork and a pay freeze? That tax reductions for the rich would not lead to increased inequality and decreased revenue for the Treasury? Selling weapons to the Saudis would bring in revenue, but the longer-term effects of the weapons on human targets, let alone on the government’s ethical standing, mattered not a jot. Promising £350m a week for the NHS might lead to a Brexit vote, but with drastic consequences later.

Similarly, short-termism in business has led to companies focusing more on immediate profits, rather than the benefit of improved productivity from longer-term investment in technology and training. With the effects of such policies now coming home to roost, is it any wonder principled politicians, with plans to transform the way our society is managed, are on target to win the next election?
Bernie Evans

Source: TheGuardian