Care provision should be free, not for profit

Care for older people should not be dependent upon a cruel postcode lottery or private provision. Eddie Ford looks at the Dilnot report into the current state of care for the elderly

Old age should be something to look forward to - a time of greater relaxation with friends and loved ones, perhaps to pursue interests and activities so far neglected. In reality however, for many it is something to be dreaded. After a lifetime of wage-slavery, joyless and soul-destroying labour, their ‘reward’ is to be forced into impoverishment and denied a dignified life. And often suffering the added humiliation of having to forego their home, which they were hoping or expecting to leave to their children, just in order to receive any sort of care at all. Screwed from the cradle to the grave, you could say.

But now we have yet another government-commissioned report, published on July 4 - this time under the auspices of Andrew Dilnot CBE, a former director of the Institute for Fiscal Studies.[1] Last year, this commission on the funding of care and support was charged with recommending a system of social care for the elderly in England that was “fair” and “sustainable” - the projection being that over-65s are expected to reach 12 million by the mid-2020s. Currently, one in three women and one in four men are likely to need long-term care, with nursing/residential care costs ranging between £25,000 and £60,000 a year - but some estimate that for about 1% of the population that cost could climb up to £400,000, whilst one in 10 will have to pay £150,000 or more. Under the present means-tested system, any individual with savings or assets in excess of £23,250 (which naturally includes the value of the house) has to fork out the total bill for residential/nursing care costs. Therefore punishing you for doing the supposedly right and responsible thing - that is, working hard for the bosses and saving your money, instead of frittering it away on booze, fags, Spanish holidays and video games. That will teach you to be prudent. Perversely, but inevitably, this created an incentive to give away your hard earned money - in some way or another - as fast as possible, so as to keep you under the £23,250 cut-off point. To some extent, this meant that the less money you had, the (potentially) better off you were. Not that this is a source of joy.

In contemporary Britain the ‘care’ older people often get is nothing short of criminal - exposed to a regime of routine neglect or worse. Something that a BBC Panorama documentary highlighted in April 2009, when it sent undercover investigators to work as carers in prominent companies like Domiciliary Care, Carewatch and Care UK - all, of course, aiming to make fat profits from the old age ‘industry’. Needless to say, though you would think that such work demands a certain level of expertise, the training given to the staff by these viciously exploitative companies was barely above that need to work in a burger bar - with a salary to match. Hardly surprising, then, that the ‘clients’ at these institutions were regularly mistreated, whatever the subjective intentions of the staff.

Then more recently, we had the distressing example of the Elmer Sands nursing home in Bognor Regis, the manager of which was struck off the nursing register last month for regarding it as “no better than a kennel” (which is doubtlessly unfair to kennel-owners).[2] Or the government inquiry last week, which found, to no great astonishment, that nearly 100,000 people are not having their end-of-life care needs met - and that the whole system was based on a ‘postcode lottery’, with, for example, Tower Hamlets spending five times more than Cornwall on palliative care. An extra cruel twist is that the privately owned care home you are in could go bust - like Southern Cross possibly, which runs 751 such establishments and now finds itself on the “brink of collapse”. Leaving you terrified about what the future might bring, facing a traumatic upheaval or even potential homelessness[3] - though, of course, the Association of Directors of Adult Social Services, whose members buy places in Southern Cross PLC homes, were more concerned that unless the firm acted quickly there was a real danger it would lose its “market share”.[4]

The upshot is that old age for so many effectively means being thrown onto the scrapheap - abandonment in a degrading and frightening environment, to be increasingly patronised, or even treated like a downright idiot, just because of your years: a reflection of our undeniably ageist society and culture, which has become virtually institutionalised. All this was further confirmed by a report published on June 29, Age of opportunity: transforming the lives of older people in poverty, by the Centre for Social Justice[5] - and a follow-up to its publication last year, The forgotten age. The CSJ was, of course, established in 2004 by the former Tory leader, Iain Duncan Smith, its remit being to seek “effective solutions to the poverty that blights parts of Britain” - so one could hardly accuse the CSJ of being a bunch of wild, leftwing subversives. In what makes for generally grim reading, the report talks about a “lost generation” of one million-plus pensioners left in isolation and loneliness - getting no state support whatsoever, despite having very limited financial resources. Not to mention the six million unpaid carers, which by the CSJ’s calculations “saves” the state nearly £90 billion a year. Very cheap labour indeed - not that the report dwells on this point.

For the CSJ, a major housing “shake-up” is required - Britain is now faced by growing numbers of pensioners living in their own homes, but unable to meet basic repair and maintenance costs. The result, as they say, is “significant housing poverty among older home-owners, especially in the private sector” - meaning that “currently there are 3.2 million older householders living in non-decent private sector homes”. Iniquitously, the report argues, the poorest older householders face a “perfect storm” because of the gradual loss of grants for repairs to crumbling private homes, the failure of efforts to help the elderly release equity from their properties, inefficiencies in the grant system to help old people adapt their homes to cope with their disabilities, poor progress on home insulation, and so on. Age of opportunity states that there are 200,000 households in “fuel poverty” every winter.

So is it the Dilnot commission to the rescue of the elderly? No, of course not, even if some aspects of its proposals represent a limited advance over what we have now. Hence the report proposes to quadruple the means-tested threshold to £100,000, so as to “better reflect the rise in property prices seen over the last two decades”, which is not without logic, and also to place a cap of between £35,000 and £50,000 on the amount an individual has to stump up for their own care - after that the state would pick up the tab. The cap will apply whether a person is receiving support in his or her own house or living in a residential home, the commission maintaining that the new cap and the increased threshold will mean no-one will lose more than 30% of their savings/assets in order to pay for care. Though it should be immediately noted that the cap will not include so-called ‘hotel costs’ for food and accommodation, by far the largest component for most people - thus making the cap far less generous, or progressive, than it might first seem. In mitigation, or justification, the report argued that care homes should introduce a “standard charge” for such charges/costs at around £7,000 to £10,000 per year - though why or how this would happen was left unexplained; as if care/residential homes are philanthropic charities, as opposed to profit-making businesses.

The report also offered the hope that, with the state paying for the high-cost cases, or the ‘upper end’ of the market, then the private insurance industry would be duly “encouraged” to develop polices which would cover any care costs below the cap. Additionally, all local councils are to offer loans to home-owners to pay care costs. The commission wants to see its proposals implemented by 2014. In an upbeat conclusion, Andrew Dilnot admitted that the package of reforms recommended by the commission would add an initial £1.7 billion a year to government spending, rising to £3.6 billion by 2025 (currently just over £14 billion a year is spent by the government on social care). But he went on to state that this was equivalent to just 0.25% of total public spending and described it as a “price well worth paying” to take away the fear of having to sell your homes and spend almost all your savings on care when they get older.

Not a chance, and members of the commission are already sensing betrayal. In this age of austerity and vicious assaults on the living standards of the working class, even the Dilnot report’s totally inadequate recommendations - as far as communists are concerned - will be strangled at birth by this wretched penny-pinching coalition government. To this end, the health secretary, Andrew Lansley, hypocritically thanked Dilnot for his “immensely valuable contribution” - but immediately noted that such changes would require a “significant cost” and hence must be “balanced” against other “funding priorities”. Very prudent. Therefore, he declared, the Dilnot commission’s report was merely a “basis for engagement” and announced another process of “consultation” - or, as one government source told the BBC, the report has been “kicked into the medium-length grass”. Thanks, but no thanks. Nor is it exactly difficult to see which direction the government has in mind - towards some form of a compulsory private insurance scheme, with a figure like £17,000-£20,000 being bandied about.

Dot Gibson, general secretary of the National Pensioners Convention rightly slates the Dilnot report for really having “created more heat than light when it comes to the social care debate.” Nothing in its recommendations will end means testing, improve standards or prevent people from still having to sell their homes to pay for care. As everyone knows, the “current care system is in crisis”, yet, as she says, “these recommendations won’t go anywhere near putting that right.”[6]

Dilnot suggests that the old should be made to pay for the care of other older people - yet in every other part of the welfare system the costs are borne by society as a whole. Care for the elderly should be no different from the NHS - it should be free at the point of use and provided on the basis of need. Communists certainly reject all ‘solutions’ based on the private sector, which not only pursue profits as their main goal, but always degenerate into soulless - and very costly - nightmares in terms of the quality of care and human fulfilment. Domiciliary Care, Carewatch, Care UK, etc, prove that beyond doubt. For us, it is an obscenity to claim that society cannot afford to ensure that people’s winter years are satisfying, comfortable, stimulating and fully integrated with the rest of society. And if Cameron, Duncan Smith and Dilnot say that the capitalist system cannot afford to do this then our answer is simple. Their system should go.


  1. www.dilnotcommission.dh.gov.uk
  2. Daily Mail July 1.
  3. www.bbc.co.uk/news/business-13761790
  4. tinyurl.com/6et288e
  5. www.centreforsocialjustice.org.uk/default.asp
  6. www.maturetimes.co.uk/Dilnot-Commission-misses-golden-opportunity-to-bring-fairness-into-crisis-ridden-social-care-system