What chance of a free for all?

Since July 2002 Scotland has shown its caring side with a policy
that is the envy of the rest of the UK. For since then, older
people have enjoyed free personal care, a level of provision that
has defined social care north of the border.

For England and Wales there is one certainty when the new
government is formed after the general election on 5 May: unless
there is a huge political upset and the Liberal Democrats come to
power, neither Labour nor the Conservatives will be bringing the
Scottish model down south.

Nevertheless, there are differences in approach.

If Labour is returned for a third term, free personal care will
continue to be unavailable to over-65s who have assets worth more
than £20,000. For the majority, costs will continue to be met
by the recipient or the local authority through means
testing.

According to community care minister Stephen Ladyman, Labour does
not believe that universal free personal care is the “best use of
limited resources”. He says: “It would consume most of the
additional resources we are making available to allow older people
to remain longer in their own homes.”

Labour claims this will improve general standards of care for all
older people. However, there are caveats to its pre-election pledge
that all pensioners would be in control of a personalised budget of
up to £10,000 to pay for their personal social care by the end
of the decade.

First, this is not new money, but a re-organisation of existing
funds into one pot. Second, older people who need social care will
still be means-tested and it remains unclear as to how this will
relate to the size of the personalised budget an individual would
receive. Third, the success of this scheme would depend on the
quality of services that older people could access with their
personalised budget. More detail would be known about this policy
after the pilot schemes that Labour plans to introduce early into a
third term have been completed.

In line with its wider commitment to the partnership ethos, Labour
prefers to look at the system of health and social care as a whole.
Paradoxically, on paying for services, the availability of free
nursing care means the distinction between the two sectors will
remain. In principle, some commentators see this as illogical.
Others find it hypocritical that a party insisting that integration
between health and social care is essential to deliver the best
care still clings to that distinction. This undermines the
strategy, they say, and appears to be motivated purely by
economics.

Like Labour, the Conservative Party does not plan to introduce free
personal care for all over-65s, but retain it for those with assets
of less than £20,000. However, rather than have them sell
their homes, a Conservative government would encourage people to
take out insurance policies against the first three years of care,
after which the state would meet the costs.

But is this a realistic attempt to deal with cost, or a cynical
attempt to make the public believe that the party is dealing with
the needs of the over-65s without making a financial commitment?
Figures suggest that most people are not in long-term care for as
long as three years. The average is about two and a half years and,
when the odd exceptional case is considered, the median figure is
much lower.

The Conservative Party estimates that 12,500 people a year would be
funded by the taxpayer under its scheme – incurring additional
costs of about £500m a year (an additional 20 months of care
at a maximum of £25,000 a year for those who now pay their own
fees).

Cynics might also claim that the prime motivating factor behind
Conservative policy is to boost the insurance industry. Although
the possibility of paying out premiums for many years’ worth of
individual care has deterred some companies from involvement in
this market, it becomes more attractive if a three-year cut-off
point is introduced. Moreover, homes do not have to be sold and
legacies remain untouched.

The three-year partnership scheme covers care in residential
settings only, but proposals explaining how a Conservative
government would seek to support voluntary carers are imminent. It
is expected that at its heart is the party’s belief that family
members and friends should be supported more while caring for older
relatives.

Of all the major parties, only the Liberal Democrats are committed
to introducing free personal social care for all over 65s. Unlike
Labour and the Conservatives, the Liberal Democrats are prepared to
raise taxes to meet the cost in the form of a 50 per cent tax band
on incomes above £100,000.

It could be said the Liberal Democrats can afford to be idealistic,
as opposed to the more serious contenders for office, but much can
still be learned from the party’s ideas. People living with
long-term illness or disability want the NHS and social services to
fit around their lives. What is more, it might be difficult for
someone to understand, let alone accept, that while they have to
pay for one type of care other types are free – or that the nature
of their condition might determine the cost of their care.

Liberal Democrats also plan to go further than Labour –
integrating, rather than simply fostering, closer working
relationships between those responsible for the commissioning of
social care and health within local government. This would involve
big organisational change, not to mention winning over the hearts
and minds of those responsible for implementing and delivering the
new policies. For people who have been used to working in a certain
way for so long, such a change might prove difficult and a new
layer of red tape could appear.

In contrast, the Conservatives plan to instigate an immediate
review of all long-term care regulations, says shadow health
minister Simon Burns, with a view to attacking this sort of
bureaucracy.

“We will abolish regulations which do nothing to enhance the
quality of care,” he says. “No longer will care homes close against
the will and instinct of their owner because they cannot afford the
adjustments required to meet over-prescriptive regulations dictated
from Whitehall. No longer will care home owners and staff have to
spend their time filling in forms and doing paperwork when they
could be caring for their residents.”

Although laudable and always popular, the idea of mass attacks on
red tape overlooks the crucial distinction between wastage and
need. Which quangos and other administrative organisations are to
be cut? How will departments be streamlined? Will the inspection
and regulation process itself be loosened? If so, how can we be
sure that care homes provide a quality setting and are not run
simply to make a profit?

If a future government wants to make a difference, rather than
cutting bureaucracy to make things cheaper or increasing it so it
can apparently do more but usually does less, how about simply
refocusing it? So, rather than a bureaucracy that has the needs of
providers, local authorities, government or itself as its
underlying motivation, it actually focuses on improving the quality
of life for the resident.