A number of my correspondents over the last few weeks have demanded to know why the Government did not lay before the voters detailed proposals to address the growing problems with social care.
Those proposals are overdue, they were promised earlier this year. My hunch is that the paralysis caused by the BREXIT impasse and stalemate in Parliament took its toll on a number of aspects of policy which in ordinary circumstances would have secured greater attention and urgency.
Even had the proposals been ready, it would have been foolish indeed to have sprung them on us during an election. As the polling guru Lynton Crosby says “you can’t fatten the pig on market day”. Measures to address the problems with social care are bound to be controversial and the level of analysis and rational discussion appropriate to them does not lend itself to electioneering.
Theresa May tried exactly that in the 2017 election with her own proposals for social care, and to her great cost. I was no fan of those proposals, but it was equally clear to me that many of those who were dismayed by them, had little understanding of what they actually were.
Like so many things, in the end the issue of social care comes down to two questions:
How much, and who pays?
When we are ill, we expect the NHS to treat us and for the taxpayer to settle the entire bill, (costing some £134 billion over the next year).
When we are ill and infirm to the extent that we need help everyday life however, we are expected to pay for it ourselves if we can afford to.
Do we want to ‘nationalise’ another aspect of our life by having taxpayers take responsibility by footing the bill for social care in entirety (with obvious consequences for taxation)?
Certainly, we cannot go on as we are now, spending too little on it and with the services available stretched beyond their limits.
My personal opinion is that the system ought to retain a balance between individuals and the state.
I was always taught to save for a ‘rainy day’. If you require social care, isn’t that a rainy day?
Over the years we have had a series of enquiries into the policy and Parliament broadly accepted the results of the commission led by the economist Andrew Dilnot in 2011. We legislated to implement Dilnot’s plan from 2021 onwards (giving more time for the public finances to recover because Dilnot’s proposals were expensive).
Basically the Dilnot deal was this: social care would remain means-tested with the expectation that, if you could afford it, you would be liable for the first £80,000 of your care costs, and thereafter the taxpayer would meet the bills. The advantage of this design is that would create an insurance market for those who want to protect themselves from that first £80,000 liability. Currently no market exists because the liability for insurers is unlimited, but by creating a cap to liability at £80,000 you give insurers an aiming point for which they can design financial products.
I never understood why Theresa May re-opened the issue in the 2017 election. We had the Dilnot plan and we should have stuck to it.