Thursday 16 July 2009
Deborah Orr: Old age is not an illness and its care needs to be paid for
Nobody rails at the idea babies should be cared for primarily by their families
Care home. Two words that fill people with such dread that they prefer not to think about such places, until they have to. The new Health Secretary, Andy Burnham, insists that we do have to think about care homes though. And we have to think more generally too, about how we care for those among us who are elderly now, but living at home, and how we want to be cared for ourselves, when we find that our own independence has been curtailed or lost, and we need other people to assist us. He's quite right. This issue needs urgent thought.
A Green Paper, Shaping the Future of Care Together, has been published. It is hoped that when the time comes for a white paper to be drafted, in November, a vigorous national debate about its contents will have taken place. Is this too short a time for such a debate to have been satisfactorily completed? Of course it is. Especially when the debate, at this early stage, is so very crude.
The green paper focuses on funding. The government admits that there will be many more elderly people to be looked after, and no more money to do so. It wants to maintain state funding at its present £14.7bn, and wants people to become aware that unless they are very poor indeed, they will have to pay some of their care costs themselves. This is one of those things that you think is common knowledge, only to discover, when something like a Green Paper comes along, that people are astonishingly ignorant.
It is already plain that people fondly – or not so fondly – imagine two things. One is that old age is an illness and that its symptoms should be treated by the National Health Service. But that is not the case. If the inability to get to the loo unaided, or to eat or to dress or to wash or to get out of bed unaided were an illness, then infancy as well as old age would have to be treated as a disease.
Nobody rails and screams at the idea that babies should be cared for primarily by their families. But for some people, even the prospect of sacrificing one's inheritance – usually in the form of the parental home – in order that others can be paid to keep their parents safe and comfortable, is an abomination.
This is a pretty shameful attitude, and it speaks volumes that people think nothing of vociferously complaining that it is "unfair", to the point where those who are "good at playing the system" can offer all kinds of advice on how to ensure that the state rather that the family assets meet the cost of paying for help, even – especially – if they are rich in property assets.
The other is that national insurance contributions should pay for social care, because national insurance contributions fund state pensions. Again, this is actually quite a daft assumption. The state pension is there to provide the essentials of living – and barely at that. Food, accommodation, utility bills – those are the things that the state meagrely provides under NI. People would do well to note right now that the changes proposed in the green paper assume that people would go on paying for their own food and board.
It's the cost of care – the laying on of human hands that is at issue here – not the cost of food and shelter. In fact, one interesting aspect of the new proposals is that they all would make this distinction more plain.
The Government has already ruled out funding social care through general taxation, arguing that it would place too much of a burden on the working population. Instead it wants to set up a "national care service", and sets out three possible ways of funding it. Two of them seem like non-starters to me. A "partnership model" promises that the state will pay for a third of basic costs, whatever the individual's financial situation, unless it is dire, while a voluntary insurance scheme attaches an extra bit onto this undertaking, for those who fancy it.
Neither of these appear to address the basic problem – which is how to get people whose retirements are healthy, wealthy and short, to supplement those whose retirements are feeble, poverty-stricken and long. Only the third, a compulsory insurance scheme requiring all people over retirement age to shove £20,000 in the kitty, so that the 20 per cent whose care costs £1,000 or less can subsidise the 20 per cent whose care costs £50,000 or more, seems actually to grasp the nettle.
Needless to say, this proposal is the one that has caused outrage, with even The Independent describing how people could be "forced" to pay this money. Yet, if you look at the average cost of care – about £31,000 – it's a bargain, especially when payment options are quite flexible and generous. This is the suggestion that really needs to be examined and debated, because it is a real opportunity for us to look at the sort of society we are and the sort of society we want to be.
Clearly we do not, generally, wish to feel that the care of elderly relatives is our own responsibility. We are not alone in this. In France, where social care is actually funded through the health service, there is a legal obligation that stipulates that adult offspring are required to look after elderly parents who do not have the means to look after themselves.
After the heatwave that killed 15,000 mostly elderly people a few years back, the law was actually tightened to confer an obligation to keep in touch with elderly parents, rather that just set up a standing order. This legislation was brought in after so many died without their families even discovering the fact for weeks on end.
I think this is a pretty appalling testament to how the "breakdown of the family" across Europe is not just a question of how children are brought up, but how we all care for each other. Perhaps it would be good for all of us if we brought social care away from the margins of our society, and into the centre.
The compulsory insurance scheme has been called "the comprehensive model". But perhaps it is not quite comprehensive enough. This idea needs to be embraced and, in fact, needs to be extended. Many campaigning groups have leapt at the opportunity to remind us that not only the elderly need social care. Some families need social care for a lifetime if they have family members who are born with disabilities.
Others find that an accident or an illness provokes a need for social care that no one was prepared for, sometimes for a short period, sometimes for the rest of a lifetime. Maternity or paternity leave is actually social care as well, even though we tend not to see it that way.
In the short term a lump sum upon retirement makes sense. But perhaps it is worth examining the idea that all social care should be financed under a national insurance scheme, one that we can make claims on at various times in our lives for various members of our families. The social structure whereby we look out for each other is no longer sustainable. Maybe this is our opportunity to shore it up, so that we all look after each other.
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