Yet beneath the gloss what is actually being said?
The two key headline changes being proposed are that there should be a ‘life-time cap’ of £35,000 on the contribution costs service users should be expected to make towards their care costs and that the mean-tested threshold for savings below which people become eligible for state-funded residential care should increase from £23,250 to £100,000.
These two proposals are probably why Andrew Lansley met the publication of the report with what can only be described as indifference – ‘welcoming’ the report but warning that the costs may not be able to be met – raising questions about whether the Report will progress much further.
If further ‘evidence’ was needed here then it came on Thursday 7/7/2011 when Peter Hay from the Association of Directors of Adult Social Services claimed that cuts to adult social care are going to get even worse in 2012-13 compared to this year’s already desperate situation.
However, there are serious issues that Dilnot fails to address.
First, the Report proposals are regressive not progressive in terms of their impact on wealth redistribution – with the wealthiest 20% of society the biggest gainers. Stephen Burke, from the campaign group United For All Ages claims:
“Under the commission’s regressive proposals, the winners would be richer families whose inheritance will be relatively protected while most families will face a more confusing and potentially costly care system.”1
For the millionaires in the ConDem Coalition cabinet a £35,000 flat rate fee for a life-time of care is a drop in the ocean. For the vast majority of us, it’s much more. On top of that the flat rate cap does not include the ‘board and lodging costs’ of residential care which can be charged to service users (which are estimated at somewhere between £7,000 and £10,000 per year). As a result, First Stop Care Advice point out that that people who are in residential care for five years would face an £85,000 bill – £35,000 for care and £10,000 a year for living costs – which for many would involve selling their home.
Second, the proposals will not end the market in adult social care, but will mean more money will be diverted to the large ‘oligarchic’ providers of social care. Do we really want to give more to Southern Cross and their ilk? Undoubtedly there are insurance companies, banks and other financial institutions licking their lips at the prospect of creating new financial ‘products’ to insure vulnerable people against the fear of what might await them in terms of their care needs in later life. But why should these companies (whose behaviour was one of the key causes of the present economic crisis) be given yet another opportunity to make vast profits from social care services?
Finally, the Report doesn’t consider what to most of us would seem like the obvious and logical answer to how adult social care should be funded and provided i.e. free at the point of use and paid for out of general taxation. SWAN steering committee member Peter Beresford was an almost lone voice putting this case in the Community Care discussion of the Dilnot Report.2
No doubt this will be dismissed in some circles as a fantasy – especially given the ‘debt crisis’ but despite the near daily claims from politicians and media pundits that ‘there is no alternative’ to austerity and marketisation we have to emphasise that:
(a) The debt burden as a proportion of GDP is smaller than it was at any time between 1919 and 1961 – when we built the welfare state!3
(b) Britain is the fifth richest country in the world! We could easily pay of the debt and provide fully funded high quality adult social care by increasing top tax rates (which, for the highest earners are 10 pence in the pound less than when Margaret Thatcher was Prime Minister), closing tax avoidance loop-holes (the UK Treasury estimated it failed to collect £42bn in tax in 2009; the Tax Justice Network puts the estimates for that year at closer to £95bn, ending military intervention in Afghanistan, announcing that the Trident missile system won’t be replaced (the total costs of Trident renewal will amount to between £94.7bn and £104.2bn over the lifetime of the system, estimated at 30 years. This equates to £3.3bn per year, and introducing one-off levies on bank bonus payouts given the banks’ role in initiating the crisis (the bonuses for Christmas 2010 in London’s financial sector amounted to an estimated £7bn.4
We should not be fooled by Dilnot. His Report does not challenge the market in adult care, nor does it offer any kind of answer to the unfolding crisis facing older people who need support and care in their later years.
1 Community Care 5/7/2011 “Dilnot reaction: the cheerleaders, the sceptics and the downright hostile” http://www.communitycare.co.uk/blogs/adult-care-blog/2011/07/dilnot-reaction-the-cheerleaders-the-sceptics-and-the-downright-hostile.html
3 PCS (2010) There is An Alternative: The case against cuts in public spending http://www.pcs.org.uk/en/campaigns/campaign-resources/there-is-an-alternative-the-case-against-cuts-in-public-spending.cfm
4 Treanor J (2010) “Banks Agree £200bn for businesses but pay talks unresolved” The Guardian 21/12/2010 http://www.guardian.co.uk/business/2010/dec/21/banks-agree-lend-business-pay-talks?INTCMP=SRCH