Dividing Lines: Getting old

The graph of doom.

In local government they call it “the graph of doom”. It is the chart with one steep downhill line showing budget resources and, soaring above it, another line showing the demand for services to look after an ageing population.

According to the latest census, one in six Britons is past retirement age. The number of pensioners will rise from roughly 12 million now to 16 million in 2050. The number of people aged over 100 (now around 12,000) will double over the next decade. As local authorities are responsible for adult social care, they won’t be doing anything else in the future unless the system changes.

What about the National Health Service?
It isn’t designed to provide long-term care for the elderly. Many people discover that only when they or their parents need urgent help. By some estimates, a third of all hospital beds are occupied by elderly patients. Long-term social care, arranged by councils, isn’t free for all. There’s a means test.

That’s the bit where I sell my house, right?
Under current rules, if you are worth more than £23,250 you pay. How much depends on the kind of care you need and where you live but the exposure is potentially unlimited. That often means cashing in equity.

Politicians should do something.
They are. The government is proposing a cap of £75,000 on the amount any one person would have to spend, starting in 2017. There will be a new, tapered means test starting at £123,000 – and so someone worth £50,000 still has to pay something, but less than someone worth £100,000. No one should pay a penny beyond the £75,000 cap.

Really?
No. In the small print, you are still liable for some “hotel costs” – the bed and board element of residential social care, the logic being that you’d still be paying for that sort of thing at home. But the state will now ease the burden for tens of thousands more pensioners.

If all these people are being let off the hook, where does the money come from?
The Treasury will need to find about £1bn extra per year. Some of this will be coming from additional employer National Insurance contributions. Most will be raised by freezing inheritance-tax thresholds, skimming more revenue over time from legacies of the dead.

Death taxes! Yuck!
Funny you should say that. It’s the very line that the Tories used in the 2010 general election campaign when attacking a Labour plan for universal social care, funded in part from inheritance taxes.

Oh, the irony.
That’s one word for it. That campaign poisoned relations between the Labour and Tory health teams, which made cross-party agreement impossible even though everyone agrees this is one of those big, long-term issues that demands collaboration. After the election, the coalition commissioned Andrew Dilnot, an eminent statistician, to come up with a plan. His report, published in July 2011, forms the basis of the coalition’s proposal. The government’s cap is a bit less generous than Dilnot recommended.

It took them 18 months to make that tweak?
It took them the best part of 18 months to summon up the courage to do much at all. There was a social care white paper last year that avoided the Dilnot route, which sounded a bit difficult and expensive to implement. Then the coalition parties realised that they needed some policy for the second half of the parliament. That became more urgent the clearer it got that fixing the national finances – formally declared Tough Issue Number One and the coalition’s stated raison d’être – wasn’t being tackled to anyone’s satisfaction. So Dilnot’s plan was fetched into Downing Street from the long grass.

And how’s that cross-party consensus coming along?
Labour has responded cautiously to the new coalition plan, with variations on the classic “too little, too late” holding rebuttal. Separately, Andy Burnham, the shadow health secretary, has devised a grand plan to integrate social care with the NHS. The idea, under the rubric of “whole-person care”, is to find ways to maximise the value that society gets from the huge health budget with a more strategic focus on promoting healthy, happy living – supporting the elderly to stay in their homes, for example. That, in theory, works better and costs less than the present inefficient process, which intervenes too late and ends up throwing money at random at the consequences of unhealthy lifestyles and poorly managed chronic conditions.

What does that mean in practice?
There’s a review to work out the details.

What about the money?
The right kind of interventions at the right time save money in the long term, as health and social care spending would go much further if the system wasn’t forced into making so many costly last-minute emergency interventions. Hospitals wouldn’t be turned into vast geriatric warehouses.

Long-term savings appear only in the long term. You’d need money upfront to fix social care, even just to match what the government is doing.
Yes, you would. And when Labour finally decides what its spending priorities are, there is a strong chance this will turn out to be one of them.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

This article first appeared in the 25 February 2013 issue of the New Statesman, The cheap food delusion

#Match4Lara
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#Match4Lara: Lara has found her match, but the search for mixed-race donors isn't over

A UK blood cancer charity has seen an "unprecedented spike" in donors from mixed race and ethnic minority backgrounds since the campaign started. 

Lara Casalotti, the 24-year-old known round the world for her family's race to find her a stem cell donor, has found her match. As long as all goes ahead as planned, she will undergo a transplant in March.

Casalotti was diagnosed with acute myeloid leukaemia in December, and doctors predicted that she would need a stem cell transplant by April. As I wrote a few weeks ago, her Thai-Italian heritage was a stumbling block, both thanks to biology (successful donors tend to fit your racial profile), and the fact that mixed-race people only make up around 3 per cent of international stem cell registries. The number of non-mixed minorities is also relatively low. 

That's why Casalotti's family launched a high profile campaign in the US, Thailand, Italy and the US to encourage more people - especially those from mixed or minority backgrounds - to register. It worked: the family estimates that upwards of 20,000 people have signed up through the campaign in less than a month.

Anthony Nolan, the blood cancer charity, also reported an "unprecedented spike" of donors from black, Asian, ethcnic minority or mixed race backgrounds. At certain points in the campaign over half of those signing up were from these groups, the highest proportion ever seen by the charity. 

Interestingly, it's not particularly likely that the campaign found Casalotti her match. Patient confidentiality regulations protect the nationality and identity of the donor, but Emily Rosselli from Anthony Nolan tells me that most patients don't find their donors through individual campaigns: 

 It’s usually unlikely that an individual finds their own match through their own campaign purely because there are tens of thousands of tissue types out there and hundreds of people around the world joining donor registers every day (which currently stand at 26 million).

Though we can't know for sure, it's more likely that Casalotti's campaign will help scores of people from these backgrounds in future, as it has (and may continue to) increased donations from much-needed groups. To that end, the Match4Lara campaign is continuing: the family has said that drives and events over the next few weeks will go ahead. 

You can sign up to the registry in your country via the Match4Lara website here.

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.