I’m not sure if there was an episode of ‘Yes, Minister’ which revolved round the issue of care for the elderly. If not, and there is ever a revival, then the script will not take much writing. The PM will outline her brilliant plan to startle her own core voters with a freshly conceived policy which challenges their vested interests. Sir Humphrey will raise an eyebrow and reply: “Courageous, Prime Minister”. And off we go.
It is probably fair to say that Mrs May’s manifesto plans were more widely condemned than understood. It is also true that, if implemented, they would have been redistributive on a spectacular scale, albeit later in the life cycle than could be more useful.
The average house price in Mrs May’s Maidenhead constituency is £505,000. In less leafy parts of the country it is a quarter of that. Under her manifesto plan, the person requiring care would be left with £100,000 to pass on; those with high value properties would stand to pay most, by far.
So while the policy had flaws, as was acknowledged with record-breaking speed, they fell on the side of “soaking the (relatively) rich” rather than “attacking the poor”. However, the relatively rich have children and grandchildren, so there was a large body of opinion to offend and alarm.
The Tory manifesto, under the optimistic heading “A Renewed Contract Between the Generations”, stated: “We will introduce a single capital floor, set at £100,000, more than four times the current means test threshold.” It is understandable why, in a room full of bright Tory advisers, that could sound like a saleable offer; reaching out to those of modest means who might become “winners”.
And would the potential “losers” not vote Tory anyway, when faced with the Corbynite alternative?
It took a single weekend for even that assumption to prove risky. The high command was appalled by what it heard from the focus groups. Sir Humphrey would not have been surprised.
If the policy reflected a personal, egalitarian commitment to addressing a vexed issue, Mrs May might also have reasoned that putting her solution in the manifesto was the best way of pre-empting a Tory rebellion once it came to legislation. Instead, instant rebellion pre-empted the policy.
The great U-turn will become a text-book example of why initiatives of any complexity, involving winners and losers, cannot be launched during an election campaign. Paying for elderly care cries out for a radical political solution but launching that debate amidst the chase for votes was a lot cause.
When campaigning resumes, it will probably be confirmed that kicking the issue into touch was well worth the embarrassment caused. By promising to consult on a “cap”, Mrs May has reverted to where matters stood prior to the manifesto’s publication. When the election is over the same questions will remain.
One beneficial aspect of this episode is that it has brought Andrew Dilnot back on to the public stage. Dilnot chaired a commission on funding care and support in England back in 2012. It would be a mistake to think that his conclusions do not have relevance in Scotland where much of this policy area is devolved.
The fact that, in some respects, things are done differently here does not disguise the fact that the basic challenges are exactly the same.
Free personal care, which was introduced in 2002, is creaking at the seams, particularly in the face of hugely disproportionate cuts inflicted on local authorities. Earlier this month, Age Scotland warned of a “theoretical rather than a realistic entitlement” as councils struggle to match increasing demand to reduced budgets.
Dilnot’s commission concluded that individuals should pay the first £35,000 of their care if they have more than £100,000 of assets, regardless of where that care is delivered. Once that sum had been paid, the public purse would take responsibility for all other costs on a non means-tested basis.
The beauty of Dilnot’s approach lies in its relative simplicity where, at present, complexity and anomalies reign. Not insignificantly, he has just retired as chairman of the UK Statistics Authority and it is by applying a statistical approach, rather than an emotional one, that a sense of proportion is achieved.
On average, each of us will require social care worth £20,000 during our lifetime. One in five will die without requiring any such support. However, ten per cent of the population will attract much higher costs, perhaps running into hundreds of thousands of pounds.
Thus, the reasons for opposing Theresa May’s plans were founded less in rationality than in fear. While only ten per cent of the population might face these very high costs, capable of wiping out property values and savings, a far higher proportion – including all these children and grandchildren – fear that it might happen to them; that it is their savings or inheritance which will be whittled away.
The obvious solution is to insure against that risk, just as we insure against other catastrophic misfortunes which might befall us but probably won’t. Where government is involved, “insurance” is branded “taxation” which has a very different connotation, particularly at election times. High-minded appeals to vote for “a penny on income tax” generally fail, not least because there is no clear idea of where the money goes. So there must be clarity. Using Dilnot’s approach, the actual scale of the challenge appears less than perceived (because perception is based on fear of worst outcomes). A solution is affordable, based on a ring-fenced proportion of public expenditure (i.e. tax) but people have to know that what they are paying for is really insurance.
The National Health Service was founded by the post-war Labour government under the motto “In Place of Fear” – fear of sickness where treatment was unaffordable. Once again there is fear in the land, largely brought about by the successes of the NHS. It is time again to ask people to pay insurance, tell them what they are paying for and thus remove the basis of that fear.
When polling day has passed, these are principles to which all parties should sign up, throughout the UK, for this is an imperative that demands leadership and consensus, without much need for division.