Once again, Polly Toynbee puts her profound knowledge of the shortcomings of social services to good use (People are dying while waiting for welfare. Inheritance issues of the wealthy are not a priority, November 22). Policy reform must focus first on the weak care sector, where low pay, staffing issues and inadequate training bring people my age – as they watch how their friends and neighbors are treated – to cross our fingers and hope to be able to at least avoid institutional care.
Secondly, there is a need to recognize the particular injustice that arises from not viewing dementia as a disease, depriving its patients of a response fully funded by the NHS. Informal and family care can do a lot, but it is dementia that makes unbearable demands.
If attention is paid to these two issues, the costs will of course increase. It is reasonable to expect that people who have accumulated substantial assets will contribute to these costs. But since it is difficult to anticipate acute care needs in advance, the means-tested system can in this sense be seen as an arbitrary and unpredictable tax on the unlucky within this group. There are other ways to raise resources from the wealthy, including improving and extending inheritance taxes and imposing a wealth tax.
Emeritus Professor of Social Policy, University of Newcastle
Thank you, Polly Toynbee, for distinguishing between the urgent need for better social care funding and the not unreasonable aspiration to try to end the lottery of how care needs can affect assets potential assets.
Andrew Dilnot proposed the introduction of a lifetime maximum personal contribution to childcare costs; in September last year, the Tories said they would set that amount at £86,000 (although they have now delayed its introduction until October 2025). This would be a huge bonus for the wealthier beneficiaries, whose assets can be worth 10 times that figure and more. In contrast, someone whose only fixed asset is a modest house in the provinces could still spend well over 50% of their potential wealth.
Dilnot also recommended raising the means-tested threshold, above which people are responsible for the full cost of their care, from the current £23,250 to £100,000. If this were to be implemented without the maximum lifetime limit, it would greatly favor less wealthy beneficiaries.
It is a policy that should appeal more to Labor than to the Tories. But until the dire state of social services is addressed by a substantial increase in public funding, even a fairer and less regressive approach to inheritance issues is unlikely to be an affordable priority.
Helping a parent in Ireland put me in close contact with their Fair Deal program to support those in need of full time care. Beneficiaries must contribute 80% of their annual income, plus 22.5% of the value of their home and other assets, towards the cost of their care. The Irish State Health Service Executive (HSE) pays the rest.
Various expenses incurred are deducted from assessed income and the first €36,000 of anyone’s assets are not taken into account. Thus, the poorest families are protected. Even for the wealthy, it may be worth taking the deal as the HSE is charged less per resident month than private clients.
The Fair Deal gives clarity and certainty to the person in need of care and their relatives, as well as to the care sector, by supporting investment, recruitment and career development. I suggest all UK politicians give it an urgent look.