You’d have thought that after that experience she would have gone away and made sure that the issue was properly tackled. The UK has a major problem over an aging population in which the number of people that are going to need care in the next decades is seriously out of proportion with the number of people in the working population available to pay for it. It has an even worse problem finding the staff. Any half way responsible government would realise that this may be a hard problem but it urgently needs solving.
Instead she has kicked the can down the road and let the problems accumulate. She’s been good at announcing policy reviews and small changes but she has been weak and confused about the central problem of funding. The result is that up and down the country local authorities are reporting that they are running out of money to provide care.
The impact of this on the ground is very serious. People who need care are facing some pretty dreadful choices. If they wish to stay in their own home they can apply to get themselves assessed and, if they meet the criteria, they are supposed to get help with installing specialist equipment and with vital tasks like getting washing done or meals on the table. The tests for getting that service provided by the local authority are getting harder and harder to pass as local authorities struggle to balance their books under the assault of ten years of real terms funding cuts. So more people are having to pay for services out of their own income or savings. The rules around how much they pay are obscure and difficult and that complexity alone is resulting in large numbers of old people trying hard not to access help that they really need in order to avoid being “a burden” on their relatives or to preserve some kind of safety net of savings. If a person decides to enter a care home then the quality of what is on offer from government funded care homes can be very low because the funding simply isn’t enough to cover the basics. Private care costs for something a bit better can be as high as £1,000 a week for a high needs service and the problems of funding that out of personal savings quickly escalate.
Then there is the impact on the NHS. People who can’t be looked after in their own home after a fall or an illness end up occupying hospital beds for long periods of time. Council run care homes are often full so that people who are ready to be discharged can’t get into one and the cost of looking after them falls on the NHS. Increasing numbers of beds are being blocked and the NHS is trying to deal with this by paying for people to go home with a NHS funded care package. That may be cheaper than a hospital bed but it is still very expensive and the increasing expenditure on temporary care at home is one of the key factors pushing our badly under funded health service to the limit.
Whenever these points are made to Conservatives they respond by telling us all with great gravitas that hard choices have to be made in government, that there isn’t a secret money tree and that everything has to be paid for. Then they proceed to act with gross irresponsibility about public funding. So the inheritance tax threshold for a couple with a house has now been raised to £900,000 and will go up to a neat £1 million next year. That is very nice and very welcome if you are fortunate enough to receive that size of windfall. It is also excessively and unaffordably generous. The most practical place to look for a way of funding the cost of care is inheritance tax.
We can’t have it both ways. It isn’t possible to fund care for the elderly and tell the elderly that they can pass large amounts of wealth over to their children without any tax burden. There is no incentive to hard work for the next generation if they can inherit much larger quantities of free money than they can earn by decades of their own efforts.
Care costs vary enormously from individual to individual. If we simply rely on the private market to deal with the gaps in the publicly funded care system then some families will find themselves shelling out for decades to support four grandparents that need decades of expensive care home provision whilst others will be fortunate enough to have relatives who remain well and die from a sudden heart attack. That sort of chance unfairness is something that society ought to be trying to avoid.
We need the community to even out the cost of care and we need government to accept responsibility for providing a reasonable level of care service for all. A quality care system can only be realistically funded from much higher inheritance tax. I suspect that most Conservatives know that. I also suspect that they know the bulk of their members will vote down any attempt to raise inheritance tax. That is why Theresa May has failed to tackle the problem and why she is likely to continue to dodge around the issue without solving it, despite the fact that she knows the problem is getting worse by the day.
Oh, and there is one other small problem with care that she is dodging because of ideological problems with facing up to reality. Immigration. You can’t provide a care service without staff. You can’t look after increasing numbers of old people without increasing numbers of young people in the workforce. The demographics of the UK mean that it has to have a certain level of immigration if it is going to be able to staff its care homes. In Germany Chancellor Merkle dealt with that by being welcoming to over a million young and active Syrian refugees. Theresa May is refusing to be so brave and far sighted and instead she is increasing the problem by creating an unwelcome atmosphere for immigrants.
In an unequal world it is, of course, necessary and wise to have controls over borders and to manage immigration. There is a big difference between successful management and sterile political obsession. This week a 6 year old boy who was born in this country, has a British father and a mother living in the UK had his passport cancelled whilst on holiday in Belgium and was told he couldn’t come home.
I leave you to judge whether that counts as sensible management of a practical policy. Personally I just hope that 6 year old gets home quickly, grows up wanting to work in the UK care system and doesn’t minding paying huge amounts of income tax to keep me looked after in my old age.