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Westlake Legal Group > The Welfare State

Jacob Rees-Mogg: Why I believe that the NHS should cover social care

Jacob-Rees Mogg is MP for North East Somerset.

A proposal to solve the social care issue was one of the reasons for the Conservatives’ dismal performance at the last election. There has long been a need to develop a system – but that it had such stark electoral consequences is a reminder of the sensitivity of any policy solutions, though bringing it forward it showed how serious the issue is.

The current system does not work. It is arbitrary. Families argue with the authorities as to what part of care is medical and what is social and diseases of old age, especially dementia, seem to be excluded, at least in part. This leaves some families with bills of tens of thousands of pounds each year, potentially for many years, while those with heart disease or cancer will see all the costs fall on the state. This principle of health provision free at the point of use is one of the main stays of the British welfare state. It provides security for all of us if certain types of illness hit, but leaves the failure to provide social care, that has crossed a narrow boundary from medical care, appear all the more unfair.

Not only is there an arbitrariness in the definition but the rules of who pays what are complex and problematic. Council budgets take the strain for social care but the NHS for medical, which leads to people spending too long in hospital. All the while, budgets are argued over and higher-cost hospital beds remain occupied by people who ought to be elsewhere – possibly, with a little support, even back in their own homes.

Once the bureaucracy has determined the fall of costs, the ways that these fall on individuals are equally complex. Quite rightly, an individual who shares a home will not normally be expected to see the value of the property taken into account. Yet, the frail, elderly parent who has been looked after by a child for ten years who then spends the last year of their life in a home could see the family property taken, whereas if the child had moved in it would not be. Complex charging rules inevitably lead to the system falling harshly on some and not on others, contributing to changes in behaviour.

It is, perhaps, easy to set out the problem but less so the solution. An ageing population and the growing complexities of care make the costs high and move from self-paying to government-paying increases demand. This is an iron law of economics – there is more demand for something that is free. So why is Warwick Lightfoot of Policy Exchange right to say that the state must take on this burden?

It is the role of the state to save and shelter us from the overwhelming problem. The cost of long-term social care is more than all but the super-rich can easily afford, and the risk of it falls indiscriminately. The majority of families will not be hit in this way, but some will be hit completely.

It is also a continuation of the NHS principle of care free at the point of use: any constituency MP will have helped constituents argue what proportion of care is NHS and free and what is social, so paid.

Additionally, the cost, though high, is affordable if it is a priority. Lightfoot’s paper suggests £11 billion, but there would be some savings from the NHS budget as beds are freed up, reducing the misallocation of resources. The ONS has recently revised up the nation’s GDP to £2.2 trillion so this is 0.5 per cent of national income, a significant but not disproportionate amount to provide for the needs of the most vulnerable elderly.

To prevent a spiralling of costs, it is important to keep an affordable element of co-payment: £5000 per year seems to strike the right balance. Families would still have an incentive to keep their elderly relations at home, avoiding the probably vast cost of all this care falling on the state. However, once this amount had been spent, the rest of the base cost would fall on taxpayers, although families would be free to buy extra services and the supply would continue to be from private operators as no one wants to go back to council-run nursing homes.

There are some things that ought to fall on central taxation, and it is anomalous that social care does not, especially when the individual cost is potentially ruinous. It has become a near 100 per cent wealth or inheritance tax that falls randomly on an unlucky few. It is, therefore, a risk that it makes sense to pool but, with no insurance available, it is an area where it is right and fair for the state to step in.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

Dean Godson: There are plenty of ideas on the centre-right. Here’s how it can create a new, decent, patriotric consensus.

Dean Godson is Director of Policy Exchange.

Where next? For the last two years, British politics has been stuck in paralysis. There has been a lot of noise and clamour, but no side seems capable of creating consensus and winning broad support. That is not to say that this is a dull time in our national debate – a deep ideological contest is under way for the future of our country. It will reverberate long after Brexit, in whatever form, is complete.

It is often said today that all the intellectual energy is on the Left. But is this true? There are no leaders of the quality of Clement Attlee on the Labour benches. There are no economists or thinkers of the ilk of Anthony Crosland. Thirty years after the fall of the Berlin Wall, we have people aspiring to power in this country who are proud to call themselves Marxists – including the Shadow Chancellor.

The problem is not that there is an absence of ideas on the centre-right. It is that they have yet to coalesce into a coherent vision of national renewal. Policy Exchange, for example, identified the plight of the “just about managing” classes in our country – the JAMs – in 2015. So many in the country would put themselves in this camp. But has enough really been done for them in the four years since? Do they think the state is on their side, or that the political class is fighting for them?

The election of a new Conservative Party leader is the moment – perhaps the last chance – to get this right. One of the greatest mistakes that the Tories could make is to play the only game that Jeremy Corbyn’s Labour Party is capable of – sectional, identity politics that sets different groups of voters against each other.

Last year, Policy Exchange organised a Conservative conference event with the title ‘Can the Conservatives win in Canterbury and in Middlesbrough at the same time?’ But you could ask the same question of Labour. As it stands, the UK risks being treated as if it exists in balkanised sub-electorates, each with niche interests and obsessions. The only way to electoral victory in this model is with temporarily cobbled together coalitions of rival groups.

Yet despite polarisation on Brexit and other issues, there is more agreement – and more consensus – among voters than often appears, and therefore more cause for optimism. This is not a jingoistic nation. Instead, there is a deep tissue of patriotism in the best sense of the word – a fidelity to constitution, citizenship and community – that has too often been dismissed out of hand. Policy Exchange’s polling on the Union revealed that a clear majority of people in the UK say their support for it has remained constant or has risen in recent years – 78 per cent in England, 60 per cent in Scotland, 69 per cent in Wales, 70 per cent in Northern Ireland.

There is also, among immigrant communities in the UK, a complete rejection of the gatekeeper politics that sees putatively “national” representative organisations claim to speak on behalf of millions without their consent, in the most damaging form of identity politics. Only 20 per cent of British Muslims, for example, saw themselves as represented by such organisations. Fifty-five per cent of British Muslims felt ‘very strongly’ that they belonged to Britain and 38 per cent ‘fairly strongly’ that they belonged to Britain; only seven per cent did not feel a strong sense of belonging to the UK.

Consensus can be found elsewhere. Our work on lawfare – the unfair hounding of British troops through the courts – has had huge cut-through with the British public, whose outcry on the issue has forced our political and legal establishment to wake up.

The same goes for housing, where our research was based on the simple proposition that the way to overcome opposition to building more homes – so-called Nimbyism – is to make sure they are designed in a way that fits the tastes of local communities and makes our country more beautiful. This is a vision with massive support.  Traditional terraces with tree-lined streets, for instance, are by far the most popular option for the design and style of new homes. They may be unfashionable among “starchitects” but they are supported by 48 per cent of the public, with some of the strongest support among working-class Ds and Es. And how many want housing developments or estates in a modern style? Just 28 per cent.  Our polling shows a clear majority favour traditional design over modern developments. In housing and more, the first job of the new Prime Minister is to come up with a coherent national narrative that restores our sense of direction as a country.

There is the chance for a new Unionism, not just making sure that the individual countries of Scotland, Wales, England and Northern Ireland breathe comfortably within the shared home of the United Kingdom, but also that the Union itself is to an extent reconceptualised – so that we build a union between young and old and address the challenge of generational justice. A union between newer arrivals in Britain and long-established communities, so that suspicions and enmities can be overcome. A union between those whose faith means so much for them, and others for whom faith is vestigial and whose values increasingly shape the public space.  In short, we need a new social contract for post-Brexit Britain.

Social care is one concrete policy example. It is increasingly plain to those involved in the care sector that the state should cover almost all of the costs of long-term complex social care, which can involve ruinous costs for individuals and families, particularly for those suffering from dementia in old age. It can lead to the forced sales of family homes and wipe out a lifetime of saving and hard work. This idea – effectively the completion of the Welfare State – was proposed in a recent Policy Exchange research paper and embraced, perhaps surprisingly for someone on the right of the Conservative Party, by Jacob Rees-Mogg, who argued in the foreword that “It is far better to pool risk and for the taxpayer, where appropriate, to step in and help those who would face ruinous costs on their own, making social care largely free at the point of use.” He is surely right.

Where else could the next Prime Minister discover a quiet majority? On the environment, perhaps, where there are strong arguments to reduce carbon emissions to net zero by 2050 – with support especially high among the young. On investment in R & D and industry, especially in the North East, which could become a leader in the high-value, green economy. Certainly, on protecting British troops from pernicious forms of lawfare, which has high levels of support because of the obvious injustices involved. On education, too, where our polling revealed that poor pupil behaviour is driving teachers from the profession and undermining children’s education – 72 per cent of teachers know a colleague who has “left the teaching profession because of bad behaviour”. On countering extremism online, 74 per cent think that the big internet companies should be more proactive in locating and deleting extremist content, with 66 per cent of people believing that the internet should be a regulated space.

There is more thinking to be done across all policy areas – People, Prosperity, Place and Patriotism, as Policy Exchange’s work is organised – as a new Prime Minister is chosen. With that in mind, we will be publishing a series of proposals under these themes in the forthcoming weeks, which will seek to answer the question: what do we want from the next Prime Minister? We will also be hosting a series of events, including one in partnership with ConservativeHome, on electoral politics, housing, the economy, education, energy and the environment, lawfare and the rise of China. Only by hunting out areas of existing consensus will the next Prime Minister be able to start bringing the country together and healing the divides of last few years.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com