the UK “dementia tax” and the welfare state

Since 1948 most health care has been provided in the UK free of charge; and most of the funds come from central government; and it is raised through national (social) insurance and taxation.

Since 1948 (at least) social care has been subject to charges, based on means testing.  Some users of services pay little or nothing.  Early on, few people availed themselves of social care.  Most men died shortly after retiring at 65.  Home helps were directed towards assisting mothers giving birth to children at home, as the fathers carried on working.  (There was no provision for paternity leave – and none for maternity leave either.)  By today, the situation has changed enormously.

Changes to the funding of social care have been considered by successive governments, but the matter has been placed, repeatedly in the “too difficult” tray.

The 2017 General Election campaign has reminded me that home and day care charges are based on income, but residential care charges are based upon assets and income.  (Assets include houses and flats.)  Any major change to this regime by an incoming Conservative government, as proposed – taking account of assets – has great implications for many people in England but also for other countries, notably Wales, as the block grant to Wales will be affected by any adjustment to funding in England.  In other words, if the Westminster government spends (through its reduced allocation to local authorities) LESS on social care, then budgets in Wales will be influenced.  (Remember the implications of student tuition fees, led by England.)

How should social care be paid for?

The possible sources are these, and they may act in combination:

  • People paying for themselves, in full or in part
  • Charges based on a means test related to income
  • Charges based on a means test related to assets (capital)
  • Public moneys raised through taxation (and, in the UK, national insurance).

I believe in principle that social care should be free at the point of delivery, and, like health care, it should be funded out of taxation.

A less idealistic approach has to consider a modified version of this.  From one end of the telescope, in a manner of speaking, a residual minimum of savings can be protected from charges.  This is where we are now.  From the other end of the telescope, a “cap” on cumulative payments by users of services can be imposed.  This has been considered but not implemented.

Private insurance against the costs of social care has not proved to be a realistic option, as the risks are hard to calculate.

I would like to suggest that, in the interim, social care for people over the age of 85 should be made free and exempt from means testing and charging.  (The threshold is arbitrary and can be changed.)  One reason is that advanced ageing results in an increasing incidence of frailty – multiple frailties, indeed.  Secondly, what social workers and local authority finance officers wish to chase frail elderly people for payment?

A note on people with impairments and disabilities, aged 0-85.  Many young and middle-aged people are rendered poor – with low incomes and diminished earning capacity – and therefore are ineligible for charges.  Who would charge children?

I would hope that a threshold around age 85 might encourage insurance companies to offer policies for coverage for any care needs that arise before the age limit – and might encourage people to investigate the option of insurance.

The time is overdue for change – and for fair policies for social care.

Liberalism v authoritarianism – comparing 17th century England & Wales with the UK in the 21st century

On 3 May 2017 UK Prime Minister Theresa May made a verbal attack on unspecified critics associated with the work of the European Union.  But is she blaming them for her own problems?  Is attack seen as the best form of defence?

The UK governments of recent years – Conservative-Liberal Democratic, 2010-15, and Conservative, 2015 till now – have been characterised by massive cuts to social expenditure and the demonisation of certain minorities, especially benefits claimants, migrants and asylum seekers.  There have been claims to be liberal but the practice shows features of authoritarianism.  Theresa May was an illiberal Home Secretary (2010-15).  She has advocated the repeal of the Human Rights Act and UK withdrawal from the European Convention on Human Rights.

Politicians as a bunch can display, and act upon, both liberal and authoritarian tendencies, at different times.  These have been noted in Labour, Conservative and Coalition governments in recent years.  Insofar as Mrs May keeps championing “strong and stable leadership” (in other words, her own leadership), she can be regarded as authoritarian.  We should learn from history the dangers of “strong” leadership.  There are enough tyrannical leaders around in the 21st century wider world – as there were in the 20th century.

Liberalism is messy – but it offers a better bet to voters than authoritarianism.  Authoritarian leaders find it hard to change course and to learn from criticism; or they change their mind and alter course, opportunistically, and claim they were consistent all the time.  (Remember George Orwell’s 1984.)  Mrs May herself was supposedly in favour of a ‘EU Remain’ vote in the 2016 UK referendum.  But now she is stridently hostile to the EU.  Her position is weak – one against 27!

17th century England and Wales suffered authoritarian rule under Charles I, the Commonwealth (led by Oliver Cromwell) and Charles II – the details varied. The poet John Milton who supported the Commonwealth (not uncritically); and he suffered for this after the Restoration of Charles II.  He went on to write his great verse epic, Paradise Lost.

Interpretations of PL are diverse; and there is controversy among scholars, not so much about the value, but about the arguments.  Is it religious and theological?  Yes.  Is it allegorical?  Maybe, to an extent.  Does it directly reflect the breakdown of the command of the Commonwealth over ordinary people?  Perhaps not.  Is Milton’s God authoritarian?  Milton does not think so – quite the opposite.  Is Satan authoritarian?  Yes he is, while pretending to be democratic.

One idea about PL is that Milton demonstrates in it a circular rather than a linear view of human history.  Consistent with a linear view is the belief (or hope) that humans as a whole are engaged in progress.*  Do not people of a liberal disposition embrace this idea?  The circular model fits in with the idea of repeated falls and rises in history.  Given Milton’s Christian beliefs, human history commenced with the Fall of the rebellious angels from heaven, followed by the Fall of Adam and Eve.

We should recall that Milton believed in mankind’s free will.  So all citizens have to take some responsibility for the politics of their country.

So perhaps the UK is now in a period of decline and fall long and drawn out.  Separation from the EU will probably hasten this.

 

*See: Weston, P (1987), John Milton: Paradise Lost, London: Penguin – pages 25-6.