It has been universally presented in the media that NHS and social care services are in a state of crisis – they are underfunded and need is continuing to grow on a background of our nation living longer.
As we approach another General Election, the main parties have published their manifestos with proposals for this sector featuring highly. The reason for this may well be as a reaction to the crisis however, it can only be positive that health and social care is at the forefront of concern.
The Labour Party manifesto promises big money with a pledge of over £30 billion in extra funding over the next five years through increasing income tax for the highest 5% of earners and by increasing tax on private medical insurance including £1 billion in the first year is proposed to address the immediate crisis.
Labour maintain that care services have become too privatised and that if elected, they would reverse this to return the NHS into expert public control not “putting profits before patients”. Part of their ‘National Care Service’ would also be to place a cap on personal contributions towards care costs, raising the asset threshold from £23,250 (below which people are entitled to state support currently) and provide free end of life care. A Labour government would seek to bring more social care services under the remit of the NHS which essentially would provide a potential shortcut to further integration between health and social care.
It can easily be envisaged that there may be downsides to bringing health and social care together with personal choice being compromised and many would argue that the NHS already does too much without having to handle social care too. The big question therefore is, can this be achieved, and can social care cope with such an overhaul at a time when both it and the NHS are so fragile and in this state of acute crisis? Labour’s response presumably would be that integration of health and social care together is exactly what both of them need to survive.
Currently, those receiving residential care may have the value of their home taken into account and for those receiving home care only savings and income are taken into account; this is what the Conservatives plan to change proposing that people with more than £100,000 in assets will have to pay for their own care out of the value of their own homes, rather than relying on local authorities to cover the costs; this would be deducted from the estate upon the person’s death.
This follows the recent announcement that the Conservatives would drop their previous pledge to put a cap on the amount individuals would be expected to contribute towards their own care. At present, approximately 75% of over 65s are homeowners and the average value of a property in England is over £150k meaning that a great many older people will be affected with no cap to protect them from the potential weight of their full care costs.
There is also the proposal to introduce £8 billion into the NHS over the next five years however, with no specification as how this will be raised.
The policy from the Liberal Democrats contains an immediate 1p rise on higher and additional rates of Income tax to raise another £6 billion additional funds which would then be reintegrated and spent only on NHS and social care services.
In the longer term and as a replacement for the 1p Income Tax rise, a development of a dedicated health and care tax possibly based on a reform of National Insurance Contributions is proposed.
Similarly to Labour’s proposals, their long term objective is to integrate health and social care into one service, pooling budgets in every area by 2020. The implementation of a cap on the cost of social care is also championed.
In conclusion, the choices are clear – Labour propose direct funding and a slow but steady attempt to reorganise health and social care, the Conservatives propose to claw back the costs of care from people’s estates who appear to be able to contribute more, albeit after they are deceased and the Liberal Democrats propose direct funding with a specified avenue of obtaining the extra revenue in order to do so and a move towards a more integrated system.
All in all, there are no right or wrong answers to the question of how much money is needed to sustain this national institution.
Author: Portia Woodhouse, WBW Solicitors
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