In March 2012, the National Pensioners Convention called for a tax-funded National Care Service. More than 60 years ago, the Labour Government initiated a tax-funded National Health Service (NHS) which is now widely recognised as a major national achievement.
When the NHS started Britain was a much poorer country than it is now. But no recent Government or major political party has even considered initiating a National Care Service.
Most old people want to stay in their own homes as long as possible, and keeping them at home and properly looked after would often be better and less expensive than them having to live in residential care homes.
Elderly people have the same basic needs as everyone else, but some needs increase greatly with age, and some decrease. Everybody needs food, clothes, clean water, heating, education, transport, health, companionship and care to varying extents. Elderly people’s needs for health services and caring services increase sharply with age.
There are changes over time in what services are provided to individuals free – financed by public expenditure – and the services which we have to buy for ourselves, largely as a consequence of the political climate. For example, in the UK today, it is accepted by all political parties and the government that most health services should be provided free of change to everyone. This represents a complete change from the situation seventy years ago, and is completely different from the situation in the United States today.
An increasing number of people are living longer, but more are suffering from complex conditions such as dementia and chronic illnesses. The population of elderly people is predicted to increase by 70% over the next thirty years. By 2022, 20% of the English population will be over 65. By 2027, the number of over 85 year-olds will have increased by 60 per cent. By 2026, there are likely to be more than one and a half million more adults who need care and support.(Source: Office of National Statistics.)
2. AIMS OF CARE FOR THE ELDERLY
Care and support describes the activities, services and relationships that help people to stay as independent, active, safe and as well as possible, and to participate in and contribute to society throughout the different stages of their lives. People rely on a whole range of support, from their families, friends and communities, as well as from state-funded support such as care in their own home or a care home, financial support from the benefits system and help with housing. All these services combine to help people live active lives.
People should be supported to live independently as long as possible: people prefer to be supported to live in their own homes rather than having to go into nursing homes, old age homes or hospital, as people prefer to live at home, and the costs –whether borne by people themselves or by the state –are much lower.
Old people want to exercise maximum control over their own lives; to stay healthy and recover quickly from illness and to sustain a family unit which avoids children being required to take on inappropriate caring roles: to participate as active and equal citizens; to experience the best possible quality of life, irrespective of illness or disability, and to retain maximum dignity and respect.
Like everyone else, old people need a reasonable income: this can contribute to all these objectives. In the extreme, high incomes can buy all the services we need. In addition to old age, there are many reasons why people need care and support, such as:
• long-term illnesses
• being disabled
3.USE OF RESOURCES IN THE CURRENT SYSTEM
Too often our existing system makes poor use of its limited resources. Ever-increasing pressures on local authorities mean that resources are increasingly used to offer care and support when people’s needs are highest. Money could often be better invested in prevention, rehabilitation and keeping people active and healthy.
The cost of care and support is high. A 65-year-old can expect to need care costing on average £30,000 during their retirement. But there are very great differences in people’s needs and the amount that they pay: 20 per cent of people will need care costing less than £1,000 during their retirement – but 20 per cent will need care costing more than £50,000. Some people who spend years in a care home could face bills of much more than £100,000
4. VOLUNTARY CARE
The vast majority of care is given voluntarily in people’s homes by family and friends of people needing care. There are at least six million carers in Britain making a contribution to society which has been valued at £120 billion – something like the total costs of the National Health Service.(Source:Carers UK) A very high proportion of the people needing care are elderly, and quite a high proportion of the carers themselves are elderly.
Over one million people in Britain experience ill health, poverty and discrimination at work and in society because they are carers. (Source: Carers UK). Neither Local Authorities nor the general public care very much about these wonderful people: voluntary unpaid carers get little help and recognition from the rest of society.
One of the few services that Councils pay for on a means-tested basis to help carers is respite care – to give carers a few hours a week out from their onerous but unpaid caring work, and this is much appreciated and highly cost effective. Until recently, the vast majority of respite care has been provided by voluntary organisations which try hard to match the skills, experience, attitudes and personality of individual workers who provide respite care to families’ needs. But, encouraged by the previous Labour and Coalition Governments, there has been a rapid increase in the number of Local Authorities who go out to tender to buy respite care services. By doing this, Councils typically save themselves £3 or £4 per hour of respite care. They justify this by saying that they want to get better value for money, but this is not their principal motivation. Often voluntary organisations lose contracts for respite care to privately owned organisations.
While voluntary organisations’ aims are to help carers, commercial organisations’ main aim is to make a profit. So the services they provide are indeed cheaper, but generally less thoughtful, less caring and less reliable. Councils save money at the expense of both carers and the people they care for. The end result is that the health of both carers and the people they care for suffer, more of them end up in residential care and in hospital, and this costs the NHS, the public and Councils far more than the Councils save.
5. FUNDING OPTIONS
Fundamental reform of the system could offer the opportunity to make better use of resources, to keep people independent and well for longer. But neither the current Conservative Governmnet nor the largest opposition party – the Labour Party – have any intention of carrying out any such reform in the foreseeable future. If the system fails to identify people’s needs early enough, both the NHS and Local Authority care and support bear additional costs.
The current system is very patchy both in terms of the relationship between needs and support, and by Local Authority area. The last Labour Government remarked on this patchiness. It seemed to think that it was someone else’s fault. But it was their fault: they were in charge for thirteen years.
At present, if someone moves into a care home and their house is empty, they are expected to use the value of their house and nearly all their savings to pay for their care and accommodation.
What are the alternatives?
1. Pay for yourself
Under such a “system” you could take out insurance to cover your care costs, but that would be very expensive, and only rather rich people could afford to do so.
2. Partnership between state and individual. Depending on your means, the state could pay between a quarter and the whole of your basic support costs.
Everyone has a share of their basic support costs met by the state, and can cover the rest by taking out insurance, Once they had paid their insurance premiums, care and support costs would be free
4. Comprehensive funded by a state insurance scheme. Contributions could be fixed in accordance with income and assets.
5. Tax funded. Care and support provided free by the state.
An extract from a consultation paper by the last Labour government follows:
many people told us that they thought an NHS-style system, where the full costs of care and support were met through taxation (i.e. it was provided to people free when they needed it), would be the fairest option.
“I would rather pay more tax or National Insurance money to ensure that my parents or I are eventually looked after if needed in old age.”
This would have required significant increases in the tax that people already pay. This is because taxation would be funding all care and support, including the parts that people currently pay for themselves. Taxation would have funded all of care and support, including the parts that people currently pay for themselves when they need it. For this reason, the last Labour Government ruled out this option. The present Labour Party is a pale shadow of its predecessor which initiated the National Health Service against fierce opposition.
More than sixty years ago, a real Labour Government faced a similar problem – how to fund health services in a much poorer country just recovering from a World War. They made the brilliant, imaginative decision to adopt a tax funded National Health Service, against vehement opposition by the Conservative Party and powerful voices in the medical profession. Their decision has stood the test of time.
More than sixty years later, only a tiny minorityof British people oppose the NHS. Nevertheless, the Coalition which governed Britain between 2010 and 2015, consisting of Conservatives with support from Liberal-Democrats, continued the process of wrecking the NHS initiated by the 1997-2010 Labour Government. None of these political parties included their NHS wrecking proposals in their Manifestos for the 2010 or 2015 General Elections. None of them even considered proposing a National Care Service in their 2015 General Election Manifestos.
A new Care Act has come into force, and some of its provisions are quite helpful. There is also a lot of discussion about integrating care and health services. However, public funding of care through Local Authorities has been sharply reduced in recent years, and funding cuts seem likely to continue with greater intensity. If there is any improvement in care, it is likely to be extremely slow and patchy; and to continue to fall far short of people’s growing needs.