First thoughts on Dilnot.
The Dilnot report on social care funding comes out today. This is an essential part of the complex changes needed to make Hospital care and End of life care work, and of removing a great deal of the fear from old age . Here is Dilnot on BBC Radio 4 Today.
Everyone knows that we need Dilnot. That is why there is agreement to work across parties to make this work.
This is an interesting challenge to the press. – Where is the conflict? What can be said to make this an “interesting” story from the media point of view.
I would suggest that what the press can and should be doing is taking up the challenge of showing people clearly why something that many members of the public will not instinctively take to is in fact in their very best interests.
The press need to help with the process of driving whatever modifications are needed, but also they need to help us to “love Dilnot”.
My own journey towards “the Dilnot solution” began around 12 years ago, when I began to be a full time carer for my mother. A very respectable conservative voting friend took me on one side and advised me to “lose” her limited assets, so that they would not be swallowed up in care costs if mum eventually went into care.
His position showed me that the manifest unfairness of the means tested system we still have are so great that the “respectable” and “prudent” line of action is to take steps to evade payment.
When I looked at this more closely I could see that he was the tip of a very big iceberg of overpriced rented properties for the elderly, and clever financial advisers that are all based on the premise of getting rid of your money before you have to pay care costs.
The cost of all this activity becomes apparent when you see what it is like within a cash starved care industry, where the quality of care is often very far from being what anyone wants. We are also seeing (if we look carefully enough) the cost of this evasion in the quality of life being lived by that elderly lady living out the end of her life in a house several doors down the road from you.
Dilnot is not perfect, any more than its predecessor, the White Paper on Social care produced by Labour in 2010 is perfect. It is the product of the government that we as voters have empowered. It is something that may change a little over time, but if it does not, then I think that we can live with it.
I have not yet read the report, but from hearing Dilnot’s very clear interview on Radio 4 Today I would suggest a number of key things that Dilnot is getting right.
Raising the Means tested threshold.
Raising this from the ridiculous £23,000 to £100,000, is something that the Joseph Rowntree Foundation has been campaigning for, over many years. This is a realistic aspiration for people to have this level of “wealth” to pass on to their children. Some people will fall below this, but it will no longer be “respectable” to try and fall below this more generous figure. (questions- how does this work with couples?)
Capping the contribution
I was pleased to hear Dilnot say this should be at £35,000 . (We have been hearing a lot about £50,000 – not sure where the pressure for this figure is coming from).
Capping the contribution from the individual does two things. It immediately takes away the fear of unlimited costs, and it makes it possible for the insurance industry to offer some kind of sensible packages to cover this known risk.
This is actually very similar to the proposals I put forward about 7 years ago now.
Recognising costs at home and in care
An anomaly in the existing system is that you can do what I in fact did with mum. You can spend years caring at home. Reach the point where it is no longer possible to buy in enough help to make that viable, and then end up spending £100,000 on residential care costs. Dilnot’s cap applies to Care in the home and care in a residential home.
(questions – how do we set the minimum needs thresholds for care provision, – how does this work with the localism agenda)
With all the talk of Care costs, it is important to know what is covered and what is not. The fear is that you get a shift to disguised care costs, being called hotel costs, as has happened in Scotland. Dilnot addresses this by setting a cap on Hotel costs, at £7,000 which is the minimum income anyone would get from the state.
(questions – is this going to satisfy care providers – what about people who want “a luxury care home” – Will some homes be able to opt out, and will that then put pressure on families to pay “top ups”)
Is it fair to pay out for people who do not need help
Dilnot does mean that rich people will get state help with their care costs. Some will see that us unfair. Dilnot was quick to point out that this works on the same basis as the NHS. If we are worried about fairness then that is what the tax system is there to do.
Today is only the start of discussion. It is also perhaps the start of a better way of doing politics, and a better way of making our society work for us.
Will it make care any better?
The first tweet I saw on Dilnot is the question will Dilnot make the quality of care better. My answer is yes it can. At present the care funding system is so problematic that most of us just simply avoid thinking about a problem that we cannot deal with and will not go away. The Dilnot framework gives us something we can work with to create a care system that we all "own". We will all have a vested interest in making the whole system work better for us.
Lets do it.
Let’s use the opportunity.