Most people agree the UK needs to do better at providing social care. Some think it is just a case of increasing the money to pay for it by more than it has been increased in recent years. Others say there needs to be reform of the way public sector care is organised and provided. Underlying the debate are two major issues which need discussion.
The first is how much should the state pay and how much should the individual pay? The tripartisan approach for many years has been to say healthcare should be free, but living costs are down to the individual. If the individual has little capital or private pension income, then the state will pay the living costs as well.
Some say the state should take care of more of the living costs of more people. This would require substantial tax rises to meet the bills. It would mean that instead of selling the old person’s home when they move into residential care to pay the living cost bills, the money from the estate would be preserved and pass to the children. People ask why is it fair that someone who has saved and been careful all their active lives has to pay their own living costs, whereas someone who has lived beyond their means will be paid for?
Others say the current system is fine in this respect. If someone is well off, why shouldn’t they use their own assets and income to pay for their living costs? If someone cannot afford a reasonable standard of accommodation and food, don’t we have a duty to be good neighbours and to help pay? This is a cheaper solution for taxpayers.
The second issue is internal to government. At the moment central government pays for and runs the NHS, whilst local government pays for and runs much of the social service provision. It is true local government relies heavily on national government grants paid for out of national taxes, but local taxes have a part to play in financing social care. Many people like the idea of devolution of power over policy and spending to Councils from Whitehall, yet when problems emerge in a local service the cry often goes up for government intervention. Quite often it is easier to blame the government for alleged underfunding, than to blame individual Councils for poor or unduly expensive provision.
The public is generally not much exercised over who runs the service. They want a good outcome. The main problem with Councils running care and the NHS running health treatments comes at the borders. An elderly person who has been treated in a hospital often needs improved care services in order to be able to return home. Some Councils are reluctant to commit in a timely and sufficient way to the need to provide social care. The elderly person then remains in a very expensive hospital bed. This costs the state more overall. Someone no longer needing treatment occupies a bed needed for someone who does require treatment. It is often against the wishes and interests of the patient, who wants to get home.
Any thoughts on what reforms are needed?