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Shaping the future of care together
Funding options
Current system
In the current system, people who have the highest needs and lowest means get some help through the social care system, and some people get help through disability benefits. But many people, including some with high needs, get no help with paying for care at all. Twenty per cent of people will need care that costs less than £1,000 – but 20 per cent will need care that costs more than £50,000.
And someone who is in a care home for years could have costs of more than £100,000. If someone is in a care home and no one is living in their house, they are expected to use their savings and the value of their house to pay for care and accommodation, until they have used up almost all of them.
Possible funding options we have considered
In order to have an informed debate between these models, we need to have a sense of how much the different options might cost to people. But the precise costs will vary depending on how we design the options and decisions made about spending at the time. The figures that we show here indicate how much it might cost to run systems like these at the moment. They show the cost of care, but do not include accommodation because we would expect people to pay for their own food and lodging whether or not they were in a care home.
1. Pay for Yourself – In this system, everybody would be responsible for paying for their own basic care and support, when they needed it. They could take out insurance to cover some of these costs, or use their income and savings. There would be no support from the state, even for people with the lowest incomes and no savings. This is ruled out because it would leave many people without the care and support they need, and is fundamentally unfair because people cannot predict what care and support they will need.
2. Partnership – In this system, everyone who qualified for care and support from the state would be entitled to have a set proportion – for example, a quarter or a third – of their basic care and support costs paid for by the state. People who were less well-off would have more care and support paid for – for example, two-thirds – while the least well-off people would continue to get all their care and support for free. A 65-year-old in England will need care and support that costs on average £30,000 during their retirement, so someone who got the basic offer of a third or a quarter paid for might need to pay around £20,000 or £22,500. Many people would pay much less. And some people who needed high levels of care and support would pay far more than this, and would need to spend their savings and the value of their homes. This system would work for people of all ages.
3. Insurance – In this system, everyone would be entitled to have a share of their care and support costs met, just as in the Partnership model. But this system would go further to help people cover the additional costs of their care and support through insurance, if they wanted to. The state could play different roles to enable this. It could work more closely with the private insurance market, so that people could receive a certain level of income should they need care and support. Or the state could create its own insurance scheme. If people decided to pay into the scheme, they would get all their basic care and support free if they needed it.
People could pay in several different ways, in instalments or as a lump sum, before or after retirement, or after their death if they preferred. Once people had paid their contribution they would get their care and support free when they needed it.
As an indication of the costs, people might need to pay around £20,000 to £25,000 to be protected under a scheme of this sort, compared with the average cost of care for a 65-year-old which is £30,000. This system would work for people over retirement age.
However people paid, the insurance payment would help people to protect their wealth and the value of their homes. Whether they decided to pay during their working life, during their retirement or after they died, people would know that once they had made their contribution and paid for their accommodation, the costs of their care and support would not prevent the rest of their wealth being passed on to their children.
4. Comprehensive – In this system, everyone over retirement age who had the resources to do so would be required to pay into a state insurance scheme. Everyone who was able to pay would pay their contribution, and then everyone whose needs meant that they qualified for care and support from the state would get all of their basic care and support for free when they needed it.
It would be possible to vary how much people had to pay according to what they could afford. The size of people’s contribution could be set according to what savings or assets they had, so that the system was more affordable for people who were less well-off.
Alternatively, if people wanted to be able to know exactly how much they would have to pay, most people other than those with lower levels of savings or assets could be required to pay a single, set figure, so that people knew how much they would have to save for. As an indication of the costs, people might need to pay around £17,000 to £20,000 to be protected under a scheme of this sort compared with the average cost of care for a 65-year-old which is £30,000. The cost would be less for people who were over 65 when the scheme was introduced.
However people paid, the insurance payment would help people to protect their wealth and the value of their homes. Whether they decided to pay during their working life, during their retirement or after they died, people would know that once they had made their contribution and paid for their accommodation, the costs of their care and support would not prevent the rest of their wealth being passed on to their children. We would also look at having a free care and support system for people of working age alongside this.
5. Tax-funded – In this system, people would pay tax throughout their lives, which would be used to pay for all the people who currently need care. When, in turn, people needed care themselves, they would get all their basic care free. This system would work for people of all ages. This is ruled out because it places a heavy burden on people of working age.
The funding options are flawed in that they seem to start from where the money will come from instead of what is an essential requirement, what it costs, who can provide it at that cost. The next step is contracting services to bodies who can provide the basic requirements within a given framework, then setting the national or regional cost that can be charged for that service. (this of course needs to be at a level that is sustainable for those who provide this). Then the real cost can be calculated and this can be funded by any of the measures suggested such as Insurance or Taxation. It will be significantly lower than current costings especially if current allocations are included. For those who want an enhanced service then that should be funded at their own cost but every provider should have to provide a Quota of basic funded care to qualify for registration.
This will ensure a basic standard of acceptable care and enhanced services for those willing to pay for it - no different to buying a hotel you can afford or staying in a hostel so that you can use the cash elsewhere. Basics covered but luxuries are extra.
For example care homes can vary in cost for clients by 5 or 6 hundred pounds for exactly the same care depending on state funding or private funding. Setting a bar would mean the funds of private clients would potentially last much longer. Similarly Councils should be restricted in providing services to commissioning from external bodies as they can provide the same services much more efficiently. Salaries paid by councils and diversion of other services to support their in house provision hide significant costs in providing in house services stopping this would free up funding.
Personal views I know but after 33 years in health and social care perhaps worth considering.
Many years ago the government of the day introduced a National Insurance scheme. this was sold to my parents and later genrations as being a scheme to provide health care and pensions and would look after them (and us) from the cradle to the grave. now it doesnt appear to cover the elderly care that is required. If this scheme had been offered by an insurance company the government of the day (today) would have been shouting and screaming about misselling and demanding compensation for the people who had been fooled and mislead. If the payments into the National Insurance had been ring fenced in the first place and not just used as general taxation there would have been ample funds available. Now however it seems that we need a new "Insurance" scheme that will also, no doubt, disappear into the genral taxation funds never to be found again. Unfortunately the present government cannot be trusted and this debate should be left until after the next election.
The comprehensive is unfair on people who have worked hard and saved it is again slanted towards helping people who havent worked or saved. I think the fairest way would be to dedcut the insurance payment from peoples estate....so if I die owing the governement they take the £25,000 from the value of any property I have on my death. That way while alive I can afford to live in my own home without fear of it being taken away from me to pay for my health needs.
My initial response was similar to Tony's: what is national insurance if it isn't state insurance? However, I do understand that much has changed since it was first introduced, and any government would have a hard time making things fit.
What I am concerned about is that many people's pensions will not provide nearly as much as income as they thought they would. Who will have enought money to contribute 2/3rds of their care costs?
Any funding system, other than general taxation, will be complicated, expensive to administer, confusing for the public, and perceived as unfair for some people. It would create an industry of accountants helping people minimise their payments. It would also offer a "cash-cow" for future Governments who wanted to raise income. Therefore general taxation is the only real option for the sustainable and fair funding of care into the 21st Century. The Government simply has to bite the bullet.
My husband and I took early retirement, and moved into a bungalow to make things easier for my arthritic joints - I am 62. We have spent a lot of money improving the property, and now have very limited savings of roughly £10,000. Where are we going to find the £20,000 each if this proposal goes ahead? I know people who live in housing association properties with no savings at all - presumably they will get free care whilst we will have to sell our home to pay for our care (which we have worked hard for) instead of leaving it for our children. We get no state help whatsoever, as we saved for a company pension, and also both have a state pension. We can't even claim pension credits - and we can't afford to take out a burial plan! Thank God we don't have a mortgage - council tax of £125 per month is enough to find!! A "short stay in Switzerland" may soon start to look quite appealing!
Perhaps the answer is the comprehensive scheme with a "bonus" scheme attached. Whereby those who contribute and don't then utilise the full amount paid in are entitled to a percentage back.
One of the ways the government could ease pressure on the funding, offer people better choice and help them enjoy their lives to the full is:
If the government changed the policy to allow expatraites to take their care package to the country of their origin for a limited period every year. This could allow them to enjoy the assets they have built or inherited in the country of origin while receiving support from the UK government to pay for their basic care. this would also ease pressue on the NHS and other support services. The govenment should not shy away from this idea as it makes an awful lot of economic sense. Personalisation is the vehicle through which this can be implemented.
My answer would be to offer an option between the two extremes ie “Pay for yourself” and “Comprehensive”. A straw poll amongst my 3 former class mates - all middle-class women and home owners in work or of means, and all age 58 – was that they would not consider optional insurance schemes or round-sum payments. They reasoned that they had made almost no use of state services (education or health) and felt that comprehensive care in old age was their due under current taxation levels, and that the distribution of their estates was no concern of the state. In other words, they had given no thought to the lottery that we all face and I believe I was the only one who had had a relative die after years of high care and support needs, entailing the sale of her house.
I suggest that at retirement age, we “opt in” or “ opt out” of a government comprehensive insurance scheme, covering not only social care but accommodation, and maybe certain advanced acute care options too – they are all interdependent and any separation is artificial. If we “opt out” and go for “Pay for yourself”, then we would have to show evidence that we were of sufficient means to pay into a private insurance scheme or to throw the burden onto our families who would, in turn, have to demonstrate the financial means and adopt legal liability to care for us in every particular. My friends could then decide, in conjunction with their families and independent financial advisers, whether the family ties were strong enough to take such a strain. The default position would be the comprehensive insurance scheme, secured by a charge over the principal asset of the estate ie preferably paid on death and at the value that the actuarial risk dictated at the date of death. Only the state has sufficient statistical information to calculate the sort of actuarial risks that need to be covered, and how these risks will vary as medical science advances or retreats (which it may well do with the rise of antibiotic-resistance and pandemic virus infections). Quoting a round sum of £20,000 is just a hostage to fortune!
No. Just because a burden is heavy isn't a good enough reason to rule option 5 out. DON'T make assumptions for the 'working person' - I'm one. 5 IS the honest fair option. Good services cost. Involving private companies at any stage is giving away public money to shareholders. They cherry pick the easy, leaving public services to do the hard expensive stuff less the money given away for the quick wins. Then if the companies don't manage the public services have to pick up the wreckage. The 'project' / quick win / hands off mentality from Thatcher onwards has left public services stricken. Fund them and then TAKE responsibility for the hard bit - making sure they deliver. PLEASE learn from previous project based / private based initiatives (utilities, public transport, PFI, LSC; learndirect etc) and put the £ into your public services and then manage and evaluate properly - ie. ask the people who receive the services. Everyone could pay the same tax % - e.g. 30%. Having a good income isn't a crime and doesn't give other people rights to it - you work hard for it. If everyone pays the same proportion it feels fair. Anything else is envy. Anything that talks about basic services is just setting up work for legals and interpreters. People who need care just get lost in the grey areas.
I cant understand why people save for their old age then dont want to use it to pay for their care because it is in some ways 'unfair'. I expect my Dad to pay for care if he needs it from his savings as I am not willing or able to care for him myself, so yes I wont inherit his money if this happens but it is HIS money, not mine and in my opinion why should the taxpayer fund his care when he has money saved up. If I ever need care I will sell my house to pay for it if needs be. There needs to be a safety net for those who havent been able to save (say people who have been carers or on low income or disabled), those whose savings have run out, and even for those who abuse the benefits system (as you will never stop this happening) but everyone else should pay if they need care until their money falls beneath a certain level. In my opinion all that needs debating is what that level should be, which I do think seems too low at the moment and leaves so little for people to pay for the niceties of life and so is perceived as unfair. If the level was say £100,000 instead of £23,000 it may be more acceptable to contribute above that. There should also be a national system to allow people to stay in their owned homes with a charge put against them to pay the care costs when they no longer need the home, not these equity release schemes which are generally rubbish. I am against further insurance schemes (especially through the private sector) or charges on retirement, as we pay tax and NI all our working lives already. Also what happens when people know they will have a care need because they already have an incurable health problem with a deterorating prognosis like Parkinsons Disease - will they get insurance at the same rate? I reckon by the time I have worked my 46 years to retirement at 68 I will have paid about £500,000 in tax and NI, more than covering my care and I am still happy to sell my house to pay if needs be.
In conclusion, individuals pay for care until their personal wealth drops to £100,000 say and then fund the remainder of their care through exisiting tax/NI system.
Of course there needs to be reform of the present care and support system. It is failing fast and something must be done before it is too late. Here lies a problem. Asking people what they want, is half the story. What they don't want, is to pay for it. Costs of £30,000
[or even £10,00 ] a year being bandied about, the mind boggles! Instead of going off at a tangent to seek new challenges, why not stop and explore what went wrong with this present system. If we don't, then a few years down the line, we will be back to the same problem which exists today, but with even a greater elderly population to support and care for. A ‘questioning approach’ is
essential. However, the appropriate questions need to be asked. IS THE COST OF PROVIDING CARE TODAY VALUE FOR MONEY? I would think the Providers of Care, having read the preliminary guidelines, are
gleefully jumping up and down on the spot, clapping/rubbing their hands. Without a doubt, they have their requests for increased fees already in the pipeline, but NOT
ONE THING WILL CHANGE FOR THE BETTER.
Care Home fees today are often in far excess of £500 per week. For that, we could have a weeks holiday with board, in a hotel of our own choice. My fear is when the Health Service ceases, one of the large Care
Home Providers will be ‘invited’ to take it over, THEN WE WILL BE IN TROUBLE. There are several ways to improve services even at this late stage, but I believe plans were made a very long time ago, and the aim now is to continue pushing the idea to get the public into accepting it!
Its the middle income-earners that any of those proposed changes hit hardest. We pay for those who can't, while proportunatly the higher earners don't pay as much.
Do it through the tax system - but make tax more fair.
Also making the care system actually "caring" would be handy - as there is so much waste in NHS systems but so much penny-pinching in private companies providing care.
My instinctive preference is for the `comprehensive' funding scheme. It seems to offer a better balance between the principles enshrined in health and social and the practicalites of its affordability. However, I would prefer a single set figure to be agreed.
I agree with Margaret that the comprehensive option is flawed and those who work hard, save and try hard will subsidise those who don't - for whatever reason. I believe the insurance model is the best but would NI payments reduce if people had to take out this additional insurance which is surely funding what the NI should fund? For young people today it's clear that savings and pensions are going to be worthless when retirement comes and this has created a very disallusioned society.
I worked for 25 years, paying tax and NI until I had to 'retire' early due to a progressive and disabling condition. It is true that I have received state benefits for several years, but I regard this as my right after the contributions I paid in to the welfare state.
Any system for funding care will have to take into account those with progressive conditions, as these people may well have saved during their working lives. Yet most will have quite serious financial burdens to bear as a direct result of their disabilities : in my own case, the costs of mobility aids from private companies which I cannot expect the government to bear; equally I do expect my savings to be ring-fenced to take this into account. Someone else has suggested a figure of £100,000 to be the limit below which savings will be protected - this seems reasonable. There are also the possibilities opened up by radical new treatments which N.I.C.E. will not countenance (or will not approve for maybe years) and which must therefore be privately financed.
Proposed solutions must include the flexibility to look at individual cases, particularly where people are disabled or seriously ill, so that their needs and commitments can be paid for - from personal savings if necessary, up to a limit - but their care is provided. At present the social services in England are totally inadequate to meet this task, mainly due to underfunding; this has led to their unofficial policy of placing the disabled towards the bottom of their priorities, simply because their resources are fully stretched dealing with the remainder of their mandate.
Any Green Paper must look at existing systems, and research why they are failing, before adding new layers of what will amount to bureaucracy onto them. This will have to start with social services (the highest priority for reform), then the benefits, pensions and taxation systems. If this is not done properly, any proposed changes will not only fail, they will fail 'chaotically' leaving potentially a worse mess than before.
This whole issue seems to be the result of the government misselling NI as insurance rather than extra income tax. I would propose a system of genuine insurance. When you turn 18 (or when the system comes in) your payment level (as a percentage of income) is set and then rises with inflation.
This money is ring fenced for all the care needs those who were born in the same financial year as you have, from 18-death. This includes NHS treatment.
As stakeholders in your pot of money you can vote on what is paid for and what is not. Anything extra you pay for.
Compulsory insurance is fair, but as you will have noticed, in Germany last year the insurers with whom the public must insure themselves suddenly declared they didn't have enough money, they'd go bust, leaving Germany with no social care, so the government, held to ransome, gave them the money they asked for, and it was a lot.
I definitely like the 'insurance' option, like partnership but with optional state insurance. There is no 'right' way of rewarding the hardworking without also punishing the disabled or carers, and no way of being generous which does not allow freeloading, so this 'moral' point cannot be addressed. But it is important to allow for different temperaments: some people are very nervous and want the chance to make provision, others are very individualistic and resent being made to pay taxes.
I think the insurance option is proably best so long as it can be paid after one's death. I've managed to save the grand sum of 25000.00
for my retirement (due to poor health I've never been able to earn a lot) so I would be very unhappy if I was expected to pay a premium of 20-25,000.00 out of this. At least if it was paid from my estate there would be something left for my legatees to inherit. But I feel, like many people, that it is very unfair that those who've made no effort to provide for themselves (not including people who are unable to work due to disability or carer commitments of course) get free care while the rest of us must pay.
Interestingly one of the ideas put forward in the Green Paper is the notion that it is only fair that everybody (who meets the criteria in terms of need) should be entitled to receive at least a basic minimum of such care without charge.
Under the old arrangements, (pre the 2003 guidance), many local authorities including my own worked on a system whereby those receiving 5 hours or less care per week or attendance at a day centre could do so free of charge.
They also used to work on a basic protected income level for all those still subject to charge which was set at £140 per week, to take account of basic Income Support plus the average additional living expenses disabled people generally face. This, of course, interestingly also equates roughly with the current level set for the over 60’s in the latest guidance after allowing for inflation since 2003/4.
One argument used on introducing the new “fairer” charging scheme here was also that too many people were being allocated 5 hours or less care simply because of this break point on charging, and so the new charging system would mean that those who needed more care would not now be deterred from seeking extra hours if needed on the basis it would no longer increase the actual cost of their contributions.
To date though I have not been able to establish just how many (if any) of those previously on 5 hours and/or attending day centres have now actually had their care packages increased since the new system came in? But I am betting it is almost zero.
On the other hand, I am willing to bet, a pound to the Chief Exec’s and Council Leader’s new six figure salaries, that many have since decided they simply can not afford to continue to receive even the meagre 5 hours of care they previously received, simply because they now have to pay on average of £30 to £35 per week from their very limited means in order to get the help they so clearly desperately need given the pressure of LA’s to only provide such help to those who absolutely do.
An easy, workable and fair solution to all of this unquestioned unfairness and stupidity seems glaringly obvious; or at least it does to me.
Provide parity of protected income between both the under and over 60’s and allow a standard rate of £30 per week to cover “disability related expenses” (i.e. heat clothes special diets etc.)
The result would be that all those on I.S./ESA levels of income and/or savings would then automatically receive the care package they need free of charge, and only those who are actually able to afford to contribute towards their care would have to do so.
Not only would this be demonstrably fairer and more equitable, given all will benefit from exactly the same basic allowances, the reduced administration cost incurred by excluding this specific group from the charging regime would also save millions.
The £4 million grabbed from those on income support in Hertfordshire back in 2006/7 actually cost nearly 1 million to cover the increased cost of the new systems extra assessments and arrangements for collection of contributions, not to mention the immense extra burden it placed on those same disabled people to keep track of and prove every penny of their actual disability expenses let alone getting them approved.
And to put the tin lid on all this, they then have the absolute gaul to show the extra income from us as an “efficiency” saving in their annual accounts thus not even acknowledging the considerable extra contribution the very poorest disabled people are now contributing to the Counties Coffers.
Oh and before I forget, I actually worked out the impact adopting this option would have had for tax payers, when the system was first introduced, and presented this to the Council at time in a presentation to the full council.
It actually amounted to a cost of only £5 extra per household per year on Council Tax to have saved the poorest 2,500 disabled people in the county losing an average of £25 per week from their already sparse incomes at the time. This has of course now risen to an obscene average of £30 to £35 per week now.
A simple solution that is fair and equitable, efficient and easy to administer and what is more appropriate even meets one of the declared key aims of the Green Paper to boot.
So was it adopted back then? Of course not!
Question is will they, i.e. LA’s and/or the Government and/or the other main political parties listen now especially when, just maybe, at least a million or more votes of disabled citizens and their many friends, relations and carers just might hang in the balance this time around?
Only time will tell.
Most of this is nonsense. We are failing to address the underlying issues and that is, the state should set out clearly the range of care costs for the nation and then decide how and what they can afford to provide. We already pay National Insurance, so any supplementary payment is just paying twice, but it becomes less transparent. The problem is that social care needs grow according to the funds that are not available and the govenment always wants more. Everyone should have entitlement to basic care provision regardless of their ability to pay or and the care provision should be based on personal needs (Condition), not ability to pay.
Lets just get back to basics and address the real issues about where taxes come from and where they actually go!
I AGREE WHOLE HEARTEDLY WITH DAVID LOCKWOOD'S OBSERVATION. HOWEVER, THERE REMAINS A NEED TO COUPLE THEM TO RECTIFYING WHAT WENT WRONG WITH THE PRESENT SYSTEM. OBVIOUSLY THE POLITICIANS WORK FOR THE ACHIEVEMENT
OF THEIR OWN AGENDA, WITHOUT A CONSIDERATION FOR THE BETTERMENT OF OTHERS. A SECOND CONCERN, WITH ALL THE 'MONIES' THROWN AT EDUCATION AT THE HIGHEST OF LEVELS [?], SURELY WE HAVE THOSE BRIGHT ENOUGH TO SOLVE THE PROBLEMS WHICH HAVE ARISEN?
THE PRESENT APPROACH TO 'PROBLEM SOLVING' APPEARS TO BE 'BLOW IT ALL UP AND START AGAIN'. THIS APPROACH WILL PROVE IN-EFFECTIVE IN BOTH OUTCOME AND COST.
LET US NOT FORGET, THE COST OF CARE IS NOT DETERMINED BY WHAT CARE IS GIVEN. NEITHER IS IT DETERMINED BY THOSE WHOM PAY FOR IT. COSTS ARE BASED UPON WHAT MAY BE REQUIRED/WHAT MAY BE AVAILABLE/AND OTHER CONSIDERED FACTORS, WHETHER VALID OR NOT. TO GIVE EXAMPLES, THEY WOULD INCLUDE:
WORKING UNDERSTAFFED, WAGES SAVED =
GREATER PROFIT. MANAGER'S NOT IN POST = INEFFECTIVE PROGRAMMES OF CARE + WAGES SAVED. WHERE CRITERIA ESTABLISHED FOR 1 TO 1 RELATIONSHIPS ARE NOT MET = WAGES SAVED. . . AND SO ON. ALL ASPECTS OF A CARE ENVIRONMENT COULD BE QUOTED.GETTING BACK TO BASICS AS SUGGESTED BY DAVID IN RESPECT OF WHERE TAXES COME FROM AND WHERE THEY GO, IS AS APPROPRIATE AS THE COST OF CARE AND THE 'VALUE FOR MONEY'.
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If this process is allegedly about shaping the process TOGETHER why has the option of paying for care from taxation been excluded before the consulatation begins? The process is a sham and another government talking shop, a fig leaf to justify whatever solution has already been decreed.
Your 'funding options' all seem to assume that everyone of working age will have enough income to save some. What about all those people on working families tax credits who just have enough to pay for the basics ; those who were born disabled, or through disability are unable to work full time? People who become disabled through chronic illness often get the conditions on their 30's and 40's - and the current system like the one you are suggesting is not set up to help them.
THIS ISN;'T ABOUT HELPING DISABLED AND ILL PEOPLE, IT'S ALL ABOUT THIS GOVERNMENT TRYING TO0 FGRAB WHAT (i THINK) THEY SEE AS EASY MONEY FROM THE MOST VULNERABLE IN SOCIETY.
WHAT IFN PEOPLE COULDN'T GET INSURANCE, I'M SURE MANY WOULD STRUGGLE TO FIND THE MONEY TO PAY THE PREMIUMS. HOW LONG WOULD INSURANCE COMPANIES PAY OPUT TO THOSE WHO NEED THE MOST CARE.
MOST INSURANCE POLICIES OF THIS TYPE WON'T BE RESPONSIBLE FOR EXISTING CONDITIONS !
My mother has just gone into care
I wish she had insurance to pay for her care. She was widowed young, scrimped and saved where she could out of her meager income and now she will have to sell her little flat to pay for her care. She is brokenhearted at the thought of this. Other who spent have the same standard of care free - so there should be a must pay for all system for equity.
Where in this discussion of funding options are the needs of younger adults addressed? It isn't just the over 65s in care homes, you know--many young people never even had the chance to save for their future before ending up in care facilities or as recipients of home-based services. Speaking of which, the whole thing seems to be based on the idea that residential care homes are the way to go, when most older people would prefer to live with dignity in their own homes, with help from staff of their own choosing as needed. Which costs less than care homes too...
I smell the contributions of the care home industry in this document, waiting to get their hands on a growing gravy train. In case you wonder where this train is headed, many of the consultants who hang out around this government (and around the opposition, who offer no better solutions and have some even worse ideas!) come from the US, where the baseline cost for nursing home care is now around $5000 per month (app. £3000), more if you need anything more than "three hots and a cot".
A natural conclusion by this inept government, to take away the personal choice and enter into a postcode lottery. If you compare the cost of DLA and CA to the cost of Care Providers you will see who gives value for money and who reaps the profits.give it to local
The Govt should not have excluded the option of funding care through taxation. It should have been presented as one option for consultation, otherwise there's no point having a debate!
Many younger disabled people, such as myself, take the view that we don't choose to have care needs any more than we choose to have medical needs, and both are equally necessary for a half decent quality of life. If we are charged for care services this is, in fact a tax on disability, paid only by those least able to pay and least able to choose not to. None of us chooses to be or become disabled but under the options offered we would have to 'choose' and pay to have our needs met in a way which would give us anything approaching a normal life.
This part of the green paper is also distorted as it talks about people having to pay for food and lodging - yes, this applies to care in a care home but the current trend is to enable disabled people to have as normal and independent life as possible, which generally means supporting people to live in their own homes, following the principles of independent living to which the Govt appears to be committed. Older people don't usually go into a care home out of choice; they do so because the care services currently on offer are not sufficient to meet their needs, despite the fact that many disabled people with high levels of need are successfully supported to live in their own homes. If the national care service enables more older people to live in their own homes with sufficient support then it is to be welcomed.
If an insurance scheme is implemented, this should be a Government insurance scheme, as we don't want another misselling scandal. However, unlike National Insurance, a government care insurance scheme should be much more transparent in terms of the audit trail between payment of premiums and provision of care - ie all revenue from the insurance scheme should demonstrably go towards paying for care.
It is by no means clear how an insurance scheme would deal with the care needs of younger disabled people, particularly those who have very little opportunity to undertake paid work and therefore would be unable to pay a premium.
Given the significant differences in the situations faced by younger disabled people and older people, the funding systems should be different. Younger disabled people are financially in a very different situation to older people, particularly if they have been severely disabled since birth or childhood. The comprehensive option seems to provide for free care and support for people of working age, and is therefore the preferable option.
All models appear unfair to the generation of people who have worked all their lives, paid NI and tax etc and saving for their retirement, which is difficult in these times, and will only have saved enough to enjoy a relatively modest retirement.
I sense the models may build barriers for people who do not want to spend their savings on social care needs and opt out remaining vulnerable in difficult circumstances. What will happen in these circumstances where people need care but refuse to pay? Will they be fined!!
Understand that money is not in a ‘bottomless pot’ and responsible funding is called for.
The Government needs to set out a ‘cutting off point’ similar to the national pension model, whereby people who have paid NI for most of their working life, with the understanding that this would cover their care needs in old age, will not be subject to insurance agreements etc to pay for such care. Younger people, who have more time and options to take out insurances, could be covered by such models. However, how they will earn enough to pay for their own pension insurance, pay rent, mortgage, taxes etc is a scary thought. Shame the billions paid out to the banks, whilst they continue to award themselves ridiculous bonus, wasn’t put in this ‘pot’!
I am aware that with an ever growing elderly population the system needs to be reviewed. The new care system should be national, clear on what care or support is available and therefore funds should not devolved to local authorities to decide on levels of care provided.
I also think Benefits such as DLA & AA should be re-examined, for although for some these meet the cost of essential support services for others it improves their standard of living or adds to their savings, which although nice was not what these Benefits were intended for -they were brought out to prevent people having to move into a care home for the want of a little care. Unfortunately desperate situations required desperate measures.
Pat on 30th September states that the DLA and AA should be re-examined because for some it "improves their standard of living..which although nice was not what these Benefits were intended for". It would indeed be very nice if the DLA improved my standard of living, but for someone for whom the DLA and IB is the only income, by covering a few of the extra costs being disabled brings it actually affords me a small measure of independence and a quality of life that would disappear entirely if it was taken away. No amount of DLA compensates for the frustrations my disability brings me, but in providing me with a carer it does help me to do some of the things the non-disabled take for granted, like being taken to the cinema or to visit friends, which in fact the DLA does cover. It is a somewhat worrying attitude, if there are many people who, by inference, would rather the disabled were kept poor and grateful.
Income tax should be used to pay for care of the elderly.
Care homes should be state run like hospitals are, not for profit.
Inheritance tax is fine to take some money back from the wealthy.
As I understand it, the proposed changes have to be robust enough to last the next 50+ years. So let us first examine where we are now.
People already retired are living longer. Their income is decreasing in inflationary terms, due to the broken earnings/pensions link. Many have modest homes already paid for, but many also rent. In recent years a large number of home owners have used equity release to provide income for themselves and/or their families and this income is steadily eroding.
The young are finding jobs difficult to obtain, especially given the current economic situation, and generally salaries for them are relatively low. Even in employment job security is uncertain, and they will need housing for their families in due course. Many already cannot afford supporting pension provision, and personal savings are low. Some will lose their home when their parents die. They will all retire later in life than their parents, as they will have to work longer. Deposits for mortgages are difficult to obtain, and job insecurity leaves many in uncertainty.
Many people receive benefits through the system which greatly enhances their quality of life, as they can use these benefits to best support their individual needs. DLA and Attendance allowance are particularly useful in this respect, and in my opinion should continue to be paid directly to those who are successful in their justification for these benefits. Without these direct payments the effect on entitled individuals would be catastrophic and demeaning, and would remove much of their independence and dignity, also creating increasing mental stress.
In their (and my) opinion, Councils or other bodies are not capable of determining the best use of these benefits for individual needs.
Given the above, I have been considering the proposed funding options.
I agree that the 'Pay for Yourself' system should be ruled out. I also believe that the 'Insurance' system should also be ruled out. I do not believe generally that people could afford to pay into an insurance system, especially those reaching retirement age, and who have already paid NI for most of their working lives. In any event, why should people have any confidence in an Insurance scheme, given the way Insurance Companies have performed and behaved in the recent past.
The'Comprehensive' system might work like the current NI conts., but only for wage earners. I do not believe you can expect either workers or pensioners to provide lump sum payments any more. Just not practical.
The 'Tax-funded' system that you ruled out, should, in my opinion be put back in, as an option.
It has always placed a burden on people of working age, but could be expanded to other taxation elements as well as employees. What about those who have already paid throughout their working lives and can no longer afford to pay now. Why should they?
Which then raises an important point. How is the transition going to work from the exising system to any new system being introduced, particularly for people already retired or benefitting?
General taxation would be fairer as the cost would then be borne by all people who pay taxes. It would be difficult to save the large sums of money required to pay when retired or during working life. The burden of the other schemes seem to fall on the older people. Savings are needed to live on, supplement pensions, repair to property, replacements, new car etc. I think it would be difficult for people to pay out those sums of money which would increase with inflation. It would be be a disincentive for people to save knowing that most of it would go on insurance, they would be inclined to spend it before their
retirement. I don't think the other schemes would work. I think the board and lodging would come to more than living in your own home.
As a person with MS who became disabled at any early age, and has struggled to join an employed community - albeit part-time - I do not understand how I can ever earn sufficient to fund the money required under this scheme to pay for my care. My husband can also only work part-time. These ideas seem like a punishment for my misfortune to develop a chronic illness.
Although a supporter of the Welfare State I recognise its 'unintended consequence' is the vast increase in dependency culture. Therefore we should strive to fund basic Care as broadly as possible ie through general taxation leaving individuals to decide themselves if and how they wish to pay for a higher standard.This need not bear too heavily on working families if taxes were increased on non-neccessities ie alcohol ,second homes and luxuary items.
If we have to change the system (and I'm not persuaded that we do)I would favour option 5. Isn't that what we pay our taxes and NIC for?
I am intrigued by this figure of £30,000 for the average cost of care. This would only pay for about 7 months in a nursing home wher I live and my father survived for 7 years.
I agree that the fact that something is expensive should not mean it is not met from the public purse. How much do you spend on education?
I am 30. I pay for health care, dentistry and perscriptions. I have been to hospital once in my adult life, for a broken hand; a visit which lasted all of 2 hours.
I have paid approximatly £28,000 in National Insurance Contributions to date. I have 30+ years of working life left so potentially will contribtute over £100,000 to my National Insurance over my working life.
How much more would you like me to pay if i require care at some point? And if don't req
higher taxation to provide care and support for those who need it should not be ruled out - that seems a political choice rather than a technical one so is offensive in this debating arena.
put up taxes, via paye or NI, and explain clearly to the population what it provides and you will be surprised at the reaction.
also carefullly monitor the profits of care home companies and make sure they are not making excessive profits through being essentially monopoly providers.
by the way i hope no one is suggesting that any of the insurance schemes be put out to profit making porivate insurance companies - that really would be an insult.
Benefits like winter fuel and Attendance Allowance need reviewing. As I understand it, if you are self-funding in a nursing setting, you get both. Those whose nursing care is paid for by Gov. do not get these benefits.
Should it not be the other way round?
I have been disabled for 40 years and now I'm old as well. Over the years I have received local authority care in a variety of counties on a number of occasions and the experience has been universally dismal. Although the authority leaflets and letters invariably promised to provide 'unified care' based on individual need' , the service I actually received was always based on what the authority thought I should need and this, in turn, depended entirely on the authority's budget. I never saw the same carer twice and, being overworked and underpaid, their attitude was at best generally disinterested or 'couldn't care less' and abusive or rude at worst. When to get up, eat, go to bed, have a bath all depended on the carer's schedule and more often than not involved visits cancelled or hours late. Although my needs are increasing with age, I have long since given up asking for local authority help or care and now have to rely on my family. Asking my family has been very very difficult, but my DLA at least allows me the dignity of re-imbursing them for some of the costs they incur as a result of looking after me. The government's guarantee to provide 'care and support equal to (the value of) any benefits taken away from individuals is utterly meaningless because, it once again removes their ability to deal with their needs in their own way. For me personally, no amount of 'government care and support' could even remotely compensate me for the modicum of dignity and choice my DLA allows me to retain and since I do not wish to involve local authorities in my care ever again, the promised 'compensation' wouldn't apply in any case.
Point 5.
Tax-funded.
Most people have already paid into this throughout their lives as National Insurance.
Increase National Insurance to cover care. It is an insurance policy, and unfortunatly no-one knows when or if they will need to make a claim, but they still pay their premiums.
If premiums have to rise, then so be it.
But dont ask people to pay twice, ask them to pay once at a realistic rate, then MANAGE the monies created in a proper manner.
Again, mis-management of National Insurance, the insurance policy that people paid into should not become a reason to ask people to pay twice.
A "heavy burden" of increased National Insurance contributions would then reflect in a care and support system that people could access if they needed to.
You have failed to manage the money contributed to pay for care and support, so you need some more. Taking it from the few unfortunates is wrong, taking it from everyone as an insurance is fair, because no-one knows when or if they will need to claim.
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5. Tax-funded – In this system, people would pay tax throughout their lives, which would be used to pay for all the people who currently need care.
Correct me if I am wrong, but I was under the impression that I had done just that for over fifty years.
If I had paid into an insurance for that time, and they decided to change the rules, I could take them to court.
What is the difference? Are you above the law? Now that we are in Europe, against the majorities will, can this be take to their court?
I am disgusted!..... I spent a long time in the forces for this country, just to be stabbed in the back by civil (and I use the word lightly) servants (again very lightly).