White paper fails to tackle the care crisis
So two years after the coalition government’s agreement to make reform of care funding a top priority and a year after the Dilnot commission reported, the government has published its white paper on the future of care for adults and particularly older people.
The publication has been greeted with disappointment and bitterness. Put simply, why has the government ducked the care challenge and not come up with a definitive way forward? Why have older people and their families got to wait until at least 2015 before any changes are implemented? And why has the government chosen to highlight the issue of deferred payments or loans as a way forward when they already exist and they don’t actually mean families don’t have to sell their home to pay for care – the loans only delay a sale?
Perhaps most fundamentally why couldn’t the government find the resources required to implement reform and tackle the care crisis? When £500 million can be found seemingly at the drop of a hat to defer fuel duty payments for example, why can’t urgently needed funding be found for the care of older people? Subsidising car owners over supporting the most vulnerable people is a sad indictment of our society.
Having to wait until the next government spending review is a poor excuse and older people and their families have had their hopes of better care cruelly dashed by the white paper. Government is about priorities and clearly this government has made its choice.
Everyone agrees that care for older people is underfunded and in crisis but we seem no closer to resolving the fundamental questions about how we pay for a new care system. Dilnot did not provide the magic solution. Better care will cost us all more. The issue is how to do so in a way that is fair, simple and sustainable.
The government should look again at taxation as the basis for a fairer care system whereby older people’s contributions reflect their wealth and the risks and costs of care are collectively shared. Care is a public good – like health and education – and none of us know whether we will get dementia for example. So sharing the costs of care through taxation of older people’s wealth must be the best way forward.
While some of the underlying principles in the white paper are right – for example, creating a national framework to end the care postcode lottery, new rights for carers and better information and advice – they are empty promises without proper funding to make them happen. Urgent action is needed now to prevent the care system collapsing.
Tax funding would not only be fairer than the cap on care costs proposed by Dilnot but it would also enable joint working between health and care as well as preventative work to keep older people out of hospital and better supported at home. Care costs should be tax-funded but not the hotel (accommodation, food etc) costs of residential care, thereby creating a level playing field for care homes and home care.
The Dilnot proposals are widely misunderstood. They would make the current confusing care system even more complex; they would be regressive; they would add substantial transaction costs like the US healthcare system; they wouldn’t meet current unmet needs and future growth in demand for care; and they would not support joined up care and health and promote prevention. And a cap of up to £100k as suggested today, would not cover all care costs, leaving some older people still facing massive bills.
A tax-funded care system using older people’s wealth would tackle these problems and could link, for example, payment from estates at death to what is in the main end of life care.