Action to address care crisis cannot wait any longer

by Dr. Ros Altmann

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Elderly people are suffering due to council and care company cost-cutting

All parts of the system are failing and Government has not yet offered solutions

Tax incentives to help families save for care costs are needed as £72,000 cap is too high for affordable insurance

Care ISAs, Family Care Plans and Workplace Savings free of Inheritance Tax

Use auto-enrolment and new free Guidance to kick-start care savings

There is no money set aside for care:  Even though demographic trends clearly signal a dramatic rise in the numbers of older people needing long-term care, there is almost no money set aside to pay for the care they will require.  Millions of baby boomers are currently reaching their 60s and will need care in the coming twenty years or so, yet the Government has not planned for this huge looming cost. Estimates suggest that around half the population over age 65 will need to spend at least £20,000 on later life care, and one in ten will spend over £100,000.

Long-term care funding is one of the least understood parts of the health and care system.  In fact, many people mistakenly believe that the Government will pay their care costs.  But social care is the responsibility of local authorities, not the free NHS.  The difference between social care and healthcare is not easy to define, but as an example, someone with cancer is likely to qualify for healthcare funding with care provided at taxpayers’ expense, while someone with dementia may not be considered to have a ‘health’ need and gets no help from public funds at all. 

Cash-strapped councils and indebted care companies are desperate to cut costs but this cuts quality too.  Local authority budgets have been squeezed and councils have slashed their social care spending by 26% in the past four years.  This affects all aspects of the care system.  Whether it is funding for care homes, where local authorities are not paying the full costs of care and are forcing private payers to subsidise publicly funded residents, or homecare, where councils have cut the time for home visits to only 15 minutes in many cases, the system is not being funded properly.  Private care companies are often highly indebted, both care home operators and homecare providers, so there is constant cost-cutting pressure.  This affects the quality of care provided and also the conditions in which staff must operate.  Zero hours contracts and low pay are endemic, often with no pay for travel time or training, which leads to a transient workforce and lack of adequate care. 

Healthcare and social care must be integrated.  Until the Government properly integrates social care with healthcare and insists on higher standards across the industry, the current crisis will only worsen.  This should be a major political issue, but it is not receiving sufficient attention.  The public is not being adequately informed of the problems and possible solutions, leaving families struggling to cope and elderly people at risk in a system that is failing on all fronts.

Families will need to prepare for some costs, but they need help.  In Scotland some social care is provided free by the government.  Elsewhere local authority care funding is subject to one of the strictest means-tests.  Most people will receive no help from the state until they have used up the bulk of their assets, causing significant distress to many families and leaving the majority of families to find huge sums at short notice.

Politicians have talked about this problem for years, but there is still no solution in sight.  Despite knowing that numbers needing care will rise inexorably, policymakers have not set aside public money, or encouraged private provision to pay for care.  The quality of care has suffered, many companies offering care are highly indebted and there is a crisis in the sector. 

Products for care funding are inadequate.  There are some products already on the market to help people pay for care.  These include Immediate Needs Annuities, Equity Release and local authority deferred payment plans, but each has advantages and disadvantages and they only help at the point of need, rather than allowing people to make plans in advance. 

The £72,000 cap is not a solution. The latest proposal designed to stop people losing their life savings or their home to pay for care is the £72,000 cap to be introduced from April 2016.  The state is supposed to step in once the cap is reached, to ensure nobody has to face catastrophic care costs, but most people will actually have to spend more like £140,000 on care before they receive any state help because the cap excludes. 

• £12,000 a year board and lodging costs for a care home
• Any money spent on care before your council assesses your needs as severe
• money spent on a higher-fee care home or more homecare in excess of the local authority basic minimum
• Any spending before April 2016
• Even after state funding begins, the £12,000pa for board and lodging elements of care home accommodation will not be paid by the council

Insurance up to the cap is not a viable solution.  Insurance companies have told the Government that they can’t develop an insurance solution to cover care costs up to the cap.  If insurance is not a realistic option, then other avenues must be urgently explored.  New products and approaches, together with new Government incentives, are urgently needed.

Encouraging saving for care and integrating health with social care could help.  In addition to a better integration of health and social care (the current distinction seems arbitrary and manifestly unfair) it is also important to help people prepare in advance for care spending if it is needed. I believe a savings solution will have to be part of the mix. 

How could a savings solution work?
Extra tax breaks are needed to encourage long-term care saving.  This is justifiable because the cost to society of failing to ensure money is set aside for future social care needs will put intolerable burdens on the NHS, on younger generations and on older people.  Urgent action is needed to head off a disaster that is clearly on the horizon.

Tax free pension withdrawal if used for care:  The new pension freedoms could encourage people to set aside money for later life care.  Now that the annuity requirement has been removed, and there is no 55% death tax, pension funds could help cover care costs.  Many people reaching retirement have tens of thousands of pounds in their pension funds but if they use this to buy an annuity, they will have no money to pay for care.  Allowing people to withdraw money from their pension fund without paying income tax, if it is to pay for care, would encourage them to retain some funds in the tax free pension wrapper for longer, just in case it is needed.  If they don’t spend it on care, it will pass free of inheritance tax to the next generation as the 55% pensions death tax has been abolished.

Care ISAs – IHT free: The Government could introduce a separate annual allowance for ISAs that are specifically earmarked to pay for care.  Launching such ‘Care ISAs’ would itself help people realise the need to save for care. 

Family Care Savings Plans – IHT free:  Another possibility is for families to save collectively for the care needs of their loved ones.  For example, parents, siblings or children might join together to build up a fund in case one of them needs care.  The probability is that one in four people will need care, but nobody knows in advance which one.  Tax breaks to incentivise this kind of saving, perhaps allowing them to be passed on free of inheritance tax, would help.  There is a role for insurance with such savings plans – which might also include some ‘catastrophe insurance’ to pay out if more than the expected number in any family or group actually need care.

Auto-enrolment to encouraged workplace care saving plans: Alongside auto-enrolment, it might also be helpful to ensure that employers are encouraged to offer the option for people to save in a workplace savings plan that is set aside specifically for care.  This could be part of a flexible benefits package, which receive an employer contribution.

Use Pensions Guidance to provide information and education:  It will be important to ensure that the Government’s ‘Pension wise’ guidance tells people about planning for care.

So, the message to the Government is that our care system is in crisis, there is no money set aside either publicly or privately to fund later life care adequately, and the time to address this crisis is now.  Social care in this country is failing, radical action is long overdue.