Andrew Dilnot is a man with whom I have had differences of opinion. But his recommendations on care seem to have some merit to them. As the Guardian notes:
Although the centrepiece of Dilnot's report will be a recommended cap of about £35,000 on individual liability for care costs, which would require underwriting by the government, other proposals will seek to make it easier for people to draw on their assets without having to sell their home during their lifetime.
Dilnot said the proposals would cost the state about £1.7bn a year.
I stress, I have not read the full proposal so I am not in a position to make completely informed comment, but what it seems to be saying is that we need a courageous state — a theme I will be returning to often over the coming months - which has the willingness to act as the agent to ensure that an effective solution to the problem of care in old age is available to everyone in this country irrespective of their means and without the real fear that arises for many old people when faced with the prospect of having to sell their home at the time that they first consider the need for support.
I'm not interested in someone's ability to pass their wealth to another generation: inheritance tax should deal with that anyway. I am interested in the fear that selling a property creates for the living. Dilnot seems to have got his emphasis right on this issue.
If that is what he is saying, he is right to say that we do need a courageous state ( even if he does not use the term). A courageous state is one that is willing to take on these big issues that affect us all and which have for too long have been ducked by politicians of all parties.
Dilnot rightly points out that there is no solution to this problem without a proactive state functioning at central and local government levels. That will be anathema to the Tories but they commissioned this report, and they should stand by it. And if it turns out that it has merit, then Labour should push the point hard: any weakness by the Tories on this issue should be revealed.
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“Dilnot rightly points out that there is no solution to this problem without a proactive state functioning at central and local government levels. That will be anathema to the Tories but they commissioned this report, and they should stand by it. And if it turns out that it has merit, then Labour should push the point hard: any weakness by the Tories on this issue should be revealed.”
Although it’s been anathema to the Tories, in the form stated, since the 70s – remember that they’ve been screwing us via the state at central and local government level highly proactively since 1979 – it shouldn’t be forgotten that it’s been so for Labour as well since the 90s. That’s what the New Labour Project entailed, after all, and inequality increased under Blair and Co. as you rightly point out elsewhere. Convincing Labour politicians of the necessity or desirability of going down the road suggested and in the progressive form intended; well, I think you’ve got a job on there, Richard, as they say up here in sunny Manchester. Sisyphus probably had a more favourable prospect.
I’ll take the job on, none tj wilhe less
“an effective solution to the problem of care in old age is available to everyone in this country irrespective of their means”
1) Can you please explain what you mean by an ‘effective solution to the problem of care…’? I have never met anyone who has a definitive understanding of this concept for everybody.
The needs, wants and preferences of every senior citizen are unsurprisingly unique to the individual. They have an inalienable right to control their own lives.
Can they stay in their own homes? If not, what kind of residential care do they want? Should they be in the city near family, transport and other facilities or in the countryside where there are less transport, facilities etc but plenty of peace and quiet? Should it be a secular facility (as anything provided by the state must be), or one with an overt religious affiliation? Do they want their own cooking facilities? How do they change homes as their wants change? Can they have something with a few more luxuries, a nice view, exercise and social facilities etc?
2) When you say ‘irrespective of means’, are you seriously suggesting the state funds the old age care for millionaires? In the list of pressing needs for limited resources, I can’t see this as a particularly high priority, but accept this is just my personal opinion.
1) I mean that care is available to all old people who need it irrespective of means. A solution that does not provide that is not a solution. But let’s not pretend that this can be tailor-made to every individual and every individual circumstance: we would all like the state to also give us a free holiday in the Bahamas every year, and that’s not going to happen so your criteria is a strawman put up to deliberately obstruct progress in which does actually shown no consideration for the needs of real people at all. If an individual has the means to make all the choices that you desire, that’s great. Most haven’t. So whilst I’m seeking the highest possible standard of care I also accept that the market will not be being able to provide the choices that you desire for everyone because the excess capacity to do so will not be available and that means that the state has an inevitable and appropriate role to play in the provision of the services.
2) Yes I am suggesting that the state provide old-age care to millionaires, but I’m also suggesting that they should pay significantly more inheritance tax and I see no problem with that. That is a perfectly efficient way of dealing with this situation. It is what a courageous state should do, having the courage to provide services that the person needs during their lifetime and then taxing their estate when they have no further use for it
“But let’s not pretend that this can be tailor-made to every individual and every individual circumstance:”
OK, so what does it look like?
Is it centred in the cities? Would you ever put a care home in a country village with limited amenities, some distance from a hospital with little public transport?
Is religion allowed? We know what happens when public sector staff who casually offer to pray for clients! Big no no.
Should residents be allowed to move, something they may want to do if their family relocate or if they simply aren’t happy where they are?
How much ‘indepedence’ should be allowed?
What exercise and social facilties should be provided?
Most importantly, who decides this?
As I said before, you are clearly intent upon creating a strawman to defeat an honourable objective.
It is very obvious that vast numbers of facilities will be needed to meet need, and there are thousands of care homes at present. That will still be the case. They will exist through out the country. of course there will be the means to move. Of course they will meet differing needs. Of course they can be near people’s homes, as most are now. If they are state run, what is religion got to do with it? Only the private sector hides these homes in the middle of nowhere for cost reasons – again the state should not.
And as for independence, within my experience of these places ( and I have some) independence is encouraged wherever possible: indeed, it provides staff who want to work in a thriving, caring environment, with the incentive to care, and it’s also my experience that the vast majority of people working spaces want to do just that.
So please stop being so utterly negative just because you think the state cannot provide.
A courageous state can provide for all its old people
I was just giving examples of some of the factors some users find important, but there are others. These are real things some people find important. They are not strawmen. The fact there are some homes in the isolated rural areas are not just about cost (although that can be part of it). There are plenty of people who want to live in such places out of choice. Peace and quiet etc.
The point is: the wants of users are so diverse and changing that it is humanly impossible for the planning system to come even close to meeting and keeping up with them them. If there is a human being or even group of human beings capable of doing it, I have never heard of them.
And that is the sole and entire purpose of having care homes – to meet the wants of the users.
There is no other way to do it but through trial and error. The state should simply pay, accredit and monitor, that’s all.
And what is abundantly clear is that the private sector cannot meet this need
So you’re completely wrong
The state has to accept responsibility and deliver
“The state has to accept responsibility and deliver”
How are they going to do that then? I work with commissioners in Adult Services and have not met any individual or group with sufficient knowledge to plan it to the level of detail you think is possible, whether within private or public sectors. Who do you know has sufficient knowledge of the constantly changing wants of millions of unique individuals? Please, name names.
Constant trial and error is the only way we can do it. As soon as you think you’ve cracked it, there is a new generation of users who want something different.
Ultimately, it is the user who rules.
The reason we need the private sector is that it pushes the trial and error thing out to beyond the walls of the Town Hall. Different providers with different ideas – all with a bit of glimpse of the total picture. Religious organisations and secular charities can have a go. Big corporates can have a go. Small business can have a go. It opens it up.
The one thing we don’t need is monopolies in this.
Oh absolute rubbish!
You’re saying only Southern Cross can do this
And people who work for the state can’t innovate
I’m happy for there to be private contractors – of course – but like it or not they’re merely agents for the state, regulation and control on their finances needs to be much tighter and the funding should give more control
The fact is people supply these services – and it’s people I believe in – and you don’t
Of course the state sector can do this and do the trial and error too
Have a little confidence in yourself. Try being a member of the Courageous State even
I said:
“Different providers with different ideas — all with a bit of glimpse of the total picture. Religious organisations and secular charities can have a go. Big corporates can have a go. Small business can have a go. It opens it up.”
You said:
“You’re saying only Southern Cross can do this”
Do you really think your reply is a remotely fair interpretation of what I said?
“And people who work for the state can’t innovate”
Where did I say that? All I said was with trial and error we need the pool as big as possible, and to get away from the enemy of innovation, monopolies. If the state does get involved as a provider, it should not be as a monopoly.
“The fact is people supply these services — and it’s people I believe in — and you don’t”
How do you draw that conclusion from my suggestion that we need to open things up?
And to say that people supply these services — well yes, it is a service so the time, effort and expertise of people is important. But it is not the only thing involved in providing care. Facilities, systems etc all go into it.
I think my comments were entirely fair
The truth is that the state can innovate
And I did not argue it should be the sole supplier
But on the other hand I also argue that the state has to ensure that continuity of supply is vital – and the market is not good at that since failure is integral to it – which is why it’s scope for involvement is limited
Sorry to harp on, but how is it you can equate:
“Different providers with different ideas — all with a bit of glimpse of the total picture. Religious organisations and secular charities can have a go. Big corporates can have a go. Small business can have a go. It opens it up”
With
“You’re saying only Southern Cross can do this”
I don’t have that opinion, didn’t imply it, and didn’t even mention Southern Cross.
And say your comment is entirely fair? I am curious to know how you drew the conclusion from what I said.
“But on the other hand I also argue that the state has to ensure that continuity of supply is vital — and the market is not good at that since failure is integral to it — which is why it’s scope for involvement is limited”.
Not sure I understand. Failure (ie trial and error) is integral to the system regardless of whether it is public or private sector provision. Either way, we will always be getting bits of it wrong, sometimes. That’s a given. It is humanly impossible to get it 100% right all the time. I asked you for names of who knows how to get it 100% right all the time and unsurprisingly, you didn’t mention anybody. I am not sure they exist.
The difference is: when the private sector fails, it leads to closure (or at least changing of hands). When the public sector fails, it stays open and the failure continues.
I’m sorry – your last comment is so crass it’s not worth debating
Your assumption that the public sector is unaccountable is absurd: it is in almost every case more accountable than the private sector, including for failure
“Yes I am suggesting that the state provide old-age care to millionaires”
What, against their will if necessary?
“I’m sorry — your last comment is so crass it’s not worth debating”
Richard, I work in the public sector. The speed with which failure – big and small – gets closed down is nothing short of glacial.