CARE for the elderly has moved from being a major issue to a very urgent one. After Boris Johnson accused care homes of not following procedures during the coronavirus outbreak, he desperately needs to show that he is going to deliver positive change in care for the elderly.
He did, after all, make a General Election pledge to build a social care system that ‘would give every person the dignity and security which they deserve’, and the Covid-19 situation has demonstrated that the issue cannot be put off any longer.
Two days ago former government adviser Sir Andrew Dilnot put forward a plea for to revive his plans which would see that no household pays more than £45,000 for looking after the elderly. He still argues that the current system is unfair, but that is stating the obvious.
The issue of care for the elderly came up at a fringe meeting at the Conservative party conference last year. I spoke at this meeting and explained how my native Guernsey had dealt with this issue, and received a great deal of support from the mixture of party supporters and charity representatives. To my surprise, none of them had heard of Guernsey’s successful scheme.
Yet the answer to the nation’s social care crisis lies right on our doorstep.
At present residential and nursing home costs for the UK’s elderly are charged in an unfair way. Those who for one reason or another have no savings have their care home and nursing costs paid by their local authorities.
Those who do have savings are required to use them to pay for their care costs. They may even have to sell their homes which they had hoped to pass on to their families. This policy discourages savings and encourages irresponsible spending.
Yet since 2003 Guernsey has had a Long Term Care Benefit ( LTCB) scheme which provides for the costs of long term residential/nursing care.
Guernsey adult citizens simply pay an additional social security (national insurance) contribution of 1.9 per cent on top of their normal contributions. This entitles them to all types of residential care, whether it is standard residential, elderly mental infirmity or nursing. All they have to do is to pay their state pensions towards the costs, with the government funding the difference.
No one has to sell their home, their assets or give up any savings. There is no means testing. There are some variations: for example if a person wants to stay in a higher standard home, he or she has to fund the extra cost.
Guernsey is ahead of the game and is now bringing about cohesion in care for the elderly, whether it is care in people’s own homes or care in a residential home. The government is aware that providing care in people’s own homes is generally more cost-effective than are care homes. More and more home care services are becoming available at no cost to those concerned.
The scheme has of course had some teething problems. Guernsey has a mixture of state-run and private residential care and nursing homes. Some of the private homes do not participate in the scheme or participate only partly. One reason is that they believe the scheme’s levels of support for the different types of care should be increased. This is not a problem at present as there are sufficient care beds to meet demand, but further capacity will be needed in the future, particularly in dementia care and nursing.
However, these are all issues which are part of a review of the scheme being undertaken by the Guernsey government.
Demographic changes and improvements in medical diagnosis and treatments have had some impact on the original projections (made in 2001) and consequently the sustainability of the Long Term Care Fund, so an increase in contributions and/or more Guernsey government funding is possible. The citizens of Guernsey, having seen how effective the scheme is, are likely to back paying increased contributions rather than have limitations such as means testing put into the equation.
It is remarkable that the UK government, who have been investigating long term care issues for years, have simply paid no notice to the success of the Guernsey scheme. It is far better than anything proposed in the UK so far.
Guernsey did indeed face some opposition when proposals to set it up were put to the Island States (Parliament), and no doubt in the UK there would be objections to the proposed costs, which could be in the region of up to another 1-2 per cent on national insurance costs. These contributions could be much less if reasonable government funding was put in, but delay in dealing with this issue will only make it worse.
I put all these points in a letter to Boris Johnson shortly after he became Prime Minister. I got the standard non-committal response, but now is the time to take it from the bottom of the pending tray to the top of the one marked ‘Urgent Priority’.