Taxing issues for future of social care

THE COMMONS Public Accounts Committee’s latest report is a damning indictment of the treatment of Britain’s most vulnerable, frail and elderly citizens.

It is demanding that Government report back within the next few weeks on how it proposes to improve the way the NHS and Social Care operate, enhance co-ordination between the sectors and draw up its plans to prepare for a possible second wave of Covid-19 cases in coming months.

This is a multi-faceted problem, with so many elements involved, that there is no single solution. Every aspect of the care system is under pressure – from funding, to delivery, to prevention, to homecare and care homes.

It is clearly socially unjust to ensure free care for people, regardless of means, only if they qualify for the NHS, while imposing exceptional costs on those very people who also need care because of poor health, but do not qualify for the NHS.

At the moment, there is no money set aside for long-term funding of social care. These are the headline measures the Government will need to be considering:

A long-term funding plan to meet care costs of the ageing population: At the moment, there is no structure for money to be earmarked for future care needs, not by local or central government, nor by individuals.

Funding is allocated at the point of need, but if there is not enough money then the people who suffer are the individuals who need care.

Therefore, there should be a taxpayerfunded system, which recognises that society has a duty to look after its population and there is no justification for the arbitrary distinction between different illnesses that we currently use.

Central Government and Local Government will need taxpayer funding for social insurance: Tax will have to be collected – whether this is called a ‘care contribution’ or ‘care insurance’ or some other name. It should be paid on a similar basis for everyone.

Taxpayers cannot cover the entire cost, but can provide basic care, in return for a lifetime contribution to cover future costs. This could lead to a system of free basic care for everyone, as we offer in Scotland and in the NHS, or a system of co-payments that require people who are able to do so to pay, say, 50 per cent of the cost up to a maximum lifetime amount.

Private sector care home operators who are financially fragile need to be required to improve their resilience: The Government and regulators do not currently have powers to require these homes to improve their funding, but this is something that is long overdue.

Heavily indebted providers and offshore structures should not be permitted and if that requires Government taking over some providers, it may be the best of otherwise unpalatable options. Bringing the care sector into the funding umbrella of the NHS would help resolve some of these issues.

New immigration rules to allow health workers special visas must include provision for social care:

With over 120,000 vacancies in the care sector and the low pay levels of staff, the new immigration rules would prevent recruitment of any overseas care staff.

The frail, vulnerable people cannot just wait until the sector finds home-grown workers. A transitional arrangement is urgently required to allow overseas care staff to come to the UK.

Encourage individuals to set aside funding for later life care – via Care ISAs or Care Pensions or national equity release schemes: Currently, over six million older people have ISAs, each worth on average around £40,000, and millions more have pension funds.

Before these people spend all this money, the Government has an opportunity to introduce new incentives to encourage them not to touch the funds and keep them for their 80s or 90s, in case they need to pay for care, beyond that which the Government can provide.

Second wave must not repeat the mistakes: Urgent reform is long overdue – and there are options for improving the system with cross party support.

This must no longer be a political football. Our national health emergency response failed those relying on social care, in order to protect others who might need NHS healthcare. That distinction must not drive thinking in any second wave of the pandemic. Equal treatment for NHS or social care is vital.