Care of the Elderly and the Odious Dilnot Report


Last station nursing home
Image by ulrichkarljoho via Flickr

What Matters is the Care She Gets, Not Whether Her Kids Get Her House When She’s Dead


As we all go forward with fear and trepidation (or hope and optimism) into 2012, the media are full of the debate about care of the elderly.

The debate has predictably focussed on the funding of care. In the current system, those with more than a small amount of assets have to fund their own care out of their assets – including their home if they own one. This has led to many elderly people being forced to sell their homes to pay for nursing home care.

More accurately, of course, we should say, “led to their families being forced to sell”. The people kicking up a stink about this are not generally the elderly people concerned. They are their heirs, who hoped to inherit those homes.

Frankly, I have to say I have little sympathy for this. Certainly, there are problems with the existing system. There is room for endless debate on the right threshold for that cutoff of State funding. More extensive systems for deferring the expense until the elderly person’s death would be useful, preventing the urgent need to sell the home as soon as the person goes into care.

But the necessity of selling one’s home to pay for care is not unfair. On the contrary, it is completely fair.

Does that sound cruel and heartless? Consider then a millionaire who lives in a 25-bedroom mansion with 10 acres of rolling countryside attached, worth £10 million. If that millionaire needs to go into a nursing home, should the State (i.e. taxpayers) pay for his care, and then his heirs inherit the mansion in full? Would that be fair? If not, then the principle of means testing has been conceded and the only debates to be had are around the detailed issues like the level of the threshold.

The government recently commissioned the Dilnot Report, which recommended that people’s liability to pay for their care should be capped – they suggested a figure of £35,000. Any expenses above that figure would be met by taxpayers. If the Report’s recommendations were accepted, that millionaire’s heirs would get the £10 million mansion minus a token deduction of £35,000.

In other words, the report turned the existing system on its head. The current system protects the poor at the expense of taxpayers. The proposed new system would protect the rich at the expense of taxpayers. As such, the report is a disgrace, and it was pitiful to hear the Labour spokesman on Radio 4 this morning demanding that the government accept the recommendations. (Indeed, the Archbishop of York has also urged the same, telling us that Dilnot has

shown us the way forward

John Redwood was on that same programme on Radio 4. He mentioned this same point, that we are really talking about protecting the heirs, not protecting elderly people. He mentioned it twice. And was ignored both times.

He also raised the more important issue right now – that many elderly people are facing neglect or even downright cruelty. We need to make the necessary changes to the system to stop that. He raised that issue twice as well. And was ignored both times.

That is the crucial issue we need to address though. Our elderly are facing neglect while their heirs fight over their inheritance.

In years gone by, families would look after their own elderly. Of course, there are some elderly people without families, and some who are simply too frail and ill to be cared for at home. But the general model was that families took care of their own. That is still the model in many countries, and indeed still happens very frequently here in the UK. We rarely hear about the needs of those families who are still supporting their own elderly relatives.

The Dilnot Report talked about the need to support elderly people who want to go on living in their own homes, with simple tasks like shopping and cooking. In many or perhaps most families, those tasks are carried out by their children or grandchildren – yes, even now in today’s Britain.

As a country, however, we have in general moved on from family care of the elderly, for good or ill. Yes, it means that we are more free while we are young – but it means we face not having family support near the end of our lives.

We no longer look after our own elderly. We put them in nursing homes, and then pay national minimum wage to “carers” to look after them. And now we are squabbling over whether the cost even of that should come out of our inheritance when they die, or whether taxpayers should foot the bill while we enjoy the freedom that not caring for elderly relatives gives us.

If we are no longer to accept the responsibility of caring for our own elderly relatives, then we should at the very least accept that the cost of looking after them by professionals needs to be paid for, and not at national minimum wage either. Care should be professional and well paid, and funded as such. The cost of that should come first from the elderly person’s own resources (i.e. the inheritance of their children) and only after those resources are exhausted, be met by taxpayers.

Those are the principles that should underpin a reformed system for care of the elderly. Unfortunately the Dilnot Report seems to have missed them all.

Sir Humphrey Burnham and Care of the Elderly

Well Done, Sir Humphrey, It Was Perfect.

“However, this is an urgent problem and we therefore propose setting up a Royal Commission.
Translation: This problem is a bloody nuisance, but we hope that by the time a Royal Commission reports, four years from now, everyone will have forgotten about it or we can find someone else to blame.”

Who could forget “Yes, Minister”? That was Minister for Administrative Affairs Jim Hacker telling his Permanent Secretary, Sir Humphrey Appleby, what he thought of a civil service report.

Today the Health Secretary, Andy Burnham, announced the government’s long-awaited proposals on care for the elderly. With great fanfare, he launched a White Paper, saying that the government proposes to set up a National Care Service to look after people in their old age.

The government are promising that it will be set up along the lines of the National Health Service. Not a good example to use, since the NHS provides healthcare that is second rate in comparison with other developed countries.

The government are proposing that “membership” of this new Care Service will be compulsory – sorry, what am I saying, the Service will provide everyone with the Care they need regardless of ability to pay.

And how will they pay for it? Um…well, send for Sir Humphrey. They want a Royal Commission to propose how it should be funded. After the next election. In fact, after the next election but one. Safely far into the hazy, distant future. Look, this proposal isn’t meant to actually be put into effect. It’s just to win the election, see?

The Commission could propose, say Labour, compulsory levies into a fund during people’s working life (Translation: higher taxes on all of us), or diverting some pension benefits after 65 (Translation: higher taxes on pensioners) or a levy on people’s estates after their death (Translation: higher taxes on dead people).

Apparently the Times “understands” that Ministers are also “exploring the idea” that people on benefits should pay something towards the new service too. One part of government would provide the benefits, while another took back some of the benefits and provided a shoddy State “Care” service in return. “Exploring the idea.” How very Sir Humphrey-ish. He would be pleased with that one, as I’m sure Labour’s spin-merchants were as they led the newspapers to “understand” that they are “exploring the idea”.

Never mind that, though, don’t worry about paying for it. Just think about all that wonderful Care to be provided by those wonderful Caring State employees. It wouldn’t be a shoddy service. Oh, no. It would be a caring, loving service to brighten our final days, provided to us by a generous Big Brother, who loves us all.


But enough of Labour’s fantasies.

Right now, care of the elderly is provided by a mix of public and private sector provision. It is not fit for purpose, and there is consensus across the political spectrum that the system needs to change. The present system uses people’s assets, including their home if they own one, to pay for their care. So we have the spectacle of old people’s homes being sold to pay for their stay in Old People’s Homes.

The Tories’ answer to this is a sensible one, although they have struggled to get it heard in the din of ignorant Labour posturing in the media. They want to give people the opportunity if they wish to pay an insurance premium of around £8,000. People who chose to pay the premium would not have their assets taken to pay for any care they needed. Those who don’t have assets would still have their care provided by the State, as now. But those who do have assets, such as a home of their own, could choose to protect those assets by paying the premium.

That wouldn’t be a complete answer to the problem, but it would be a big, solid step forward.

In contrast, Labour’s proposals show them at their domineering, controlling, foolish and fiddling worst. Their National Care Service would, like our dear old NHS, waste money hand over fist. Expect a new Department of Care Services, with thousands of civil servants. It would, most likely, provide poor and careless “Care”, as the State usually does when it knows you have no choice but to pay.

It would be compulsory to pay your dues to it, whether or not you wanted its services. Think your family are going to look after you in your home? Forget it. The State will do a better job, and that’ll be several thousand pounds please.

Labour want us to think the new proposal is “visionary”, like the NHS they created in 1945. But we have the benefit of hindsight. We know what a disaster Labour’s creation of the Nationalised Health Service has turned out to be. We have seen the NHS’s filthy wards, long waiting lists, rationed drugs and truckloads of red tape.

And unlike in 1945, Labour haven’t even got the guts to tell us how they’re going to pay for it.