Mary Dejevsky

Damian Green’s social care model breaches a sacred tenet of the NHS – and a good thing, too

The central proposal in Damian Green’s recent paper on social care is that care provision should be treated like pensions. In ‘Fixing the care crisis’, he argues that everyone should be entitled to ‘a decent standard of care’ funded by the state – in the same way as they are entitled to a state pension – but could then choose to ‘top up’ from their own resources to add what he calls ‘bells and whistles’.

The benefits from such a system, as he sees it – and I agree – could be manifold. It should eliminate the patent injustice, according to which cancer care is fully state-funded while dementia care is not, and many other chronic conditions, such as MS and Parkinson’s fall somewhere (often disputed) in between. Removing the social care funding responsibility from local authorities should also remove the disincentive to build adapted housing for elderly people and care homes. (They are reluctant to give planning permits to new developments, apparently, because the pound signs for care costs flash before their eyes.)

Most of all, though, it could encourage those who can afford it to contribute more to the care system, quite willingly, because they would be getting ‘something for something’.  Under the present, frankly confiscatory, system, those with assets over £23,000 must not only fund their own care, but may actually get nothing for something, as they may be charged higher fees to cross-subsidise those funded by the local authority. What sort of a perverse message does this send about saving for retirement and general prudence? Any ‘nudge’ is in precisely the wrong direction.

What Damian Green does not point out anywhere in his paper, however, is that ‘topping up’ could be equally useful elsewhere in public services, but most of all in the NHS.

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Written by
Mary Dejevsky
Mary Dejevsky is a writer, broadcaster, and former foreign correspondent in Moscow, Paris and Washington.

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