We should use Winter Fuel Payments to fund social care reform

Asking the better off to sacrifice a £300-a-year benefit, could save the same people tens of thousands of pounds in care bills.

Care is a lottery and I have published a report, Delivering Dilnot: paying for elderly care, to explain how we might eradicate this lottery. My aim with this CentreForum report is to start an adult conversation about how we pay for care reform. In brief, I am arguing that the money for Winter Fuel Payments should not just disappear into Treasury coffers, but be recycled back into the pockets of those who most need it: the poorest and frailest older people. Ultimately this is about asking the better off to sacrifice a £300-a-year benefit, so that many of the same people can save tens of thousands of pounds in the future. Not an unreasonable exchange.

To illustrate my point let me give you an example. The average price of a house in London is £365,000. Under the current system, someone with these assets faces losing up to 41 per cent of this figure in care costs. Were a cap of £60,000 introduced, this percentage could be cut in half.

In the coalition government’s Mid-Term Review there were some encouraging signs that sorting out care will be our legacy. As I anticipated, the government reaffirmed its commitment to the principles of Dilnot. But more telling, and encouraging, was the language used in the foreword of the review – which confirmed that an announcement on care reform will be made in the coming weeks.

Currently, the state will only start to pick up care costs once a person has less than £23,250 in savings and assets. But this means test for social care in England and Wales is one of the meanest in existence. By contrast, my proposals (based on recommendations from the Dilnot Commission) would raise this figure to £100,000. This change alone would make a huge difference to thousands across the country and would make social care more generous. But because this figure is not the more easily-understood ‘cap’, it rarely gets airtime in the media.

A cap will require new legislation and detailed implementation by local councils over the next few years, so if my proposal were adopted nothing would change until 2015 or 2016. This is an important point to make to those worried that this would affect them in the near future.

I also agree with many members of the public that the 440,000 pensioners who live abroad but who still receive the winter fuel payment should stop receiving the benefit. This is an anomaly in the system that is clearly unfair. But this move would save £100m – nowhere near enough money to sort out our broken care system.

Of course, I would like to pretend there is some pain free way in which the reforms could be paid for, but so far no-one has come up a workable solution. If the Treasury does come up with such a proposal then I will be the first person to applaud it.

The next few weeks will reveal whether this coalition government has the political will and determination that Labour never had to put this issue right. I believe that it does, and I am hopeful we will finally be able to deliver peace of mind to families up and down the country.

Actor Tony Robinson (C) joins campaigners protesting in support of social care opposite Parliament. Photograph: Getty Images.

Paul Burstow is Liberal Democrat MP for Sutton and Cheam and the former care services minister

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear