Monday, 22 May 2017

Care

My wife Maureen has now very late stage Alzheimer's type dementia. She showed the first signs of it in 2004 and is now completely bed bound and incapable of eating unassisted. She also has the other symptoms of the late stage of the disease which I need not spell out here but which will be familiar to those who also have knowledge of it.

It is not an experience that I would wish on anyone but, here is the thing, the one way in which it has barely affected us is financially.

That is partly because we live in a big house. It has four bedrooms and two bathrooms, so our own former bedroom has been capable of being turned into what is in effect a hospital room and the bathroom close to it into a wet floor room with a disabled shower. Few are so lucky.

Maureen requires 24/7 care, which I provide from 6pm to 7am, Although, since she now largely sleeps during that period, that is not the task it once was. Outwith that, we receive a "Self Directed Payment" from the local authority as part of Scotland's free personal care regime introduced by Holyrood's first Labour/Lib Dem administration. That pays, more or less, for the monthly cost of the carers who are in the house all of the time I am routinely not there. The only time we have to seriously dip into our own money is if I want a night out or a holiday and, even then, Maureen's own personal income, a teacher's pension, a PIP and now a state pension more than covers the cost of that.

We are very fortunate in that regard to be living in Scotland. In England we would be paying for all of this care from our own pockets. We are not poor people, far from it, but I doubt we could afford that. Out of income at least.

There has been much controversy about the Tories plan to address the funding of social care in England and Wales, not least because of the shambolic way in which it has been handled. But in one respect it is undoubtedly right. In the interest of inter generational fairness, never mind the willingness, possibly even the ability, of general taxpayers to stump up, the ever increasing costs involved in providing social care should not be funded from general taxation, direct or indirect.

For, in a UK context, between 2015 and 2020, over a period when the general population is expected to rise 3%, the numbers aged over 65 are expected to increase by 12% (1.1 million); the numbers aged over 85 by 18% (300,000); and the number of centenarians by 40% (7,000). And while it might be nice this will consist largely of elderly golfers "shooting their age" we have to be realistic as to what this actually means. Over the age of 84, the prevalence of dementia is more than 25%. And medical progress in this area is slow. Believe me, that is something I am also well informed about. Not least because Maureen's brother, Professor Michael O'Donovan, is one of the UK's leading medical experts in the field.

Anyway.
A form of inheritance tax is the fairest way to address this issue.

I personalise this only because it is a good way to outline the general point.  You see, Maureen and I are baby boomers. Only very much at the margins have we enjoyed inherited wealth but we both received a free university education. She then benefited from a very generous teacher's final salary pension while I enjoyed the "golden years" of Legal Aid. She, now aged 64, has a "triple locked" full state pension while I will in time enjoy a private pension significantly subsidised by being able to claim higher rate tax relief against my earlier contributions. Oh, and we own a big house with a negligible mortgage due to be paid off entirely well before my own retirement. We are very comfortably off. The point is however that for people of our generation, particularly perhaps those retired from a lifetime career in the professions or in the corporate or public sector, we are far from untypical.

And, in normal circumstance, we might both have anticipated living to a ripe old age. But if we did, there would inevitably come a point when we needed some help.

So who should pay for that? Those struggling to raise a deposit to buy a first home? Those having to pay off a student loan? Those claiming tax credits while paying income tax?

No, the obvious answer is that, through taxation, we should. Those who of us who have had such a fortunate period of time in which to have lived,  We baby boomers, who are only where we are because we enjoyed all these advantages outlined above and yet are being told such advantages are increasingly "unaffordable" for those who come after us.  And if that taxation only kicks in when we're gone we won't even notice it. Because we'd be gone.

So a levy on assets of the deceased is the fairest way for these costs be met. But here's what isn't fair about the current Tory proposals.  For liability for that taxation to be based on a lottery whereby those with a slow decline become liable to pay this tax while those who are taken quickly will not be. The risk should be, to coin a phrase from a different debate, "pooled and shared".

Now, in a Scottish context, the last stroke of good fortune Maureen and I have enjoyed is that we have benefited from free personal care before the money ran out. (And, as always, a bit because we were middle class, articulate, and knew our rights),

But when free personal care was introduced by the Labour/Lib-Dem coalition it is an open secret that our then Health Minister, Susan Deacon, opposed it. Not because she didn't see its merits but because she could see that, given the demographic changes I highlight above, in time, and within the limited revenue raising powers of the Scottish Parliament then prevailing, it was, in the long term, unaffordable. Even now, if people understood their rights properly, it would collapse overnight,

But the revenue raising powers of the Scottish Parliament have moved on since then. There is no reason now that Holyrood could not address this issue before the current policy hits a financial wall. Social care, free personal care, or whatever you want to call it, could be paid for a blanket inheritance tax, levied not just on those unfortunate enough to suffer a lingering departure but on all of those who die widowed and beyond a certain age.

The Nats won't confront this as they won't confront any difficult choice for fear of shaving off any part of their fragile Yes coalition. But Ruth Davidson and Willie Rennie are serious politicians. As are many of the Greens once you get beyond their yes Nicola, no Nicola leader. As will Scottish Labour (hopefully) be again at some point later this year.

So here is a proposal. Let's ignore the Nats and get together to try and work out the detail of a long term viable solution on this matter.  I'd happily write a scoping paper. I do have some experience to draw on.







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