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20 June 2022

Why the Health and Social Care Bill won’t fix Britain’s care crisis

Caring for my dying father, I learned I wasn’t just nursing a man towards oblivion, but a socio-economic system.

By The Reluctant Carer

Perhaps my father was quiet, or perhaps I talked too much to really listen. Either way, I learned a lot about us both while studying his paperwork, sitting in the bedroom he could no longer get to as downstairs he watched old Westerns on a booming television. Over the four years I cared for him – alongside a cohort of professionals, my siblings and, when she wasn’t too frail herself, my mother – I came to understand that I wasn’t just nursing a man towards oblivion, but a socio-economic system. This was a palliative farewell to an entire way of life.

Dad, born in 1930, left school at 14 and held a unionised, well-pensioned job for four decades. He retired at 60. By 90, he was unable to hold a pen, sign a form or rise from his chair unassisted. It fell to me to wrangle the family finances, and I have the revulsion for mathematics and practicality that only a child of someone sensible and well-paid can afford.

Scowling at those documents in a house that was expensive to heat even in the glory days of the price cap, I could see that he secured the mortgage 45 years ago, in 1976, for just over four times his wage. The same house would cost you 15 times the average wage today.

These numbers held a particular potency for me at the time: I was 50 years old, had nowhere to live but with my parents, a below-average income and no pension, and I was watching any scant fantasies of inheritance ride over the horizon towards a care home. Now you might say I was a fool and a loser and you might be right, but I think something bigger is afoot here.

[See also: The NHS needs a cultural overhaul – this time let’s hope it happens]

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I am the youngest in my family and so was caring for elderly parents before most of my peers, but I know that few of them are in the kind of work, or the kind of accommodation, that would enable them to fund the care provisions my father was able to: a well-rated care provider of his own choosing, that enabled him to stay in his warm house, eating more or less what he wanted while still supporting his wife, and in the end, a good care home. My younger friends especially, members of generation rent, stand no chance.

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The government’s proposed health and social care bill, Build Back Better, offers respite for a particular demographic – those with money to defend. Under the current system, anyone with assets of more than £23,250 must pay their care costs in full, but from October 2023 some care costs will be capped at £86,000. This comes largely too late for my parent’s generation, but just in time to benefit the buy-to-let and right-to-buy beneficiaries of recent decades of deregulation.

For the less wealthy, it is hard to interpret this legislation as anything other than a divisive tool that will provoke further inequality. You can relieve wealthy homeowners of some of the costs of care, but someone still has to pay. Nor is the government doing anything to address who will do the work of caring – half a million people are currently awaiting care, thanks to staffing shortages caused by low pay and immigration restrictions. A recently implemented 3.1 per cent rise in the carer’s allowance, to £69.70 a week, has been completely eroded by inflation. Most carers end up having to reduce their work hours or quit their jobs in order to care for their friends or relatives.

Underlying the failure to address the care crisis is our collective, primal fear of growing old – a fear that makes it easier to avoid the issue than to deal with it, something that is helpful to neoliberalism or take-what-you-can-capitalism, or whatever we are calling it these days.

The systems and opportunities that sustained my parents – home ownership, robust pensions from long-term employment and mid 20th-century social mobility – are gone. The gladiatorial individualism that has replaced them feels – almost – understandable in response.

How much systemic meanness is propelled by fear of our own old age? To speak meaningfully to tomorrow might enable us to purposefully re-imagine today. One need not delve far back into history to know that welfare spending is transformative and social change is possible – so why don’t we do it? It is almost as if there was something powerful in the way.

The Reluctant Carer: Dispatches from the Edge of Life by The Reluctant Carer is published by Macmillan on 23 June, in hardback for £16.99.

[See also: How worried should we be about the new Covid wave?]

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