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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To think it’s not fair that we cut public services so that older adults pay less for care?

159 replies

Bristol2021 · 03/11/2023 13:58

I work in a local authority which is facing an unprecedented budget deficit, like most councils across the country. Most of the deficit is due to the government demanding that councils pay the ‘fair cost of care’ - demanding they negotiate with local care providers so that the same rate is charged to councils as to people paying out of pocket (who are not eligible for free care). This brings the cost to private payers down a bit, but raises the cost to most councils by £tens of millions. As a result all councils are having to cut hundreds or thousands of jobs, and cut back any services (things like arts and leisure, homelessness prevention, remaining children’s centres) to what is required by law, and lower standards of what’s left. This is all so that relatively affluent older adults pay less out of pocket for care. Those people still get the lifetime cap on care costs regardless of what they pay per week of care. This is the main reason so many councils are facing bankruptcy (with a few exceptions where there’s been serious financial mismanagement). It seems to me that most tax payers are going to see far worse public services, all so that some older adults can pass on more inheritance at the end of their lives. They’re not going to spend much on themselves once they’re dependant in care, so I find it unbelievable that the ‘injustice’ of paying more than a local authority (who are a bulk purchaser) for a care package is being used to justify driving councils to bankruptcy and decimating services for everyone else. Do people not realise this is happening, or do people just care more about their inheritance than they do about schools, rubbish collection, roads, child protection, public health..?

OP posts:
StarTrek6 · 04/11/2023 05:57

grottyb · 03/11/2023 16:41

I don't think it's ethical that the taxpayer is funding privately owned facilities in this way.

It’s like paying £££ to landlords though as so much social housing has been paid off. Or for childcare.

If there was squillions to be made in care homes we'd be awash with them. Care Homes are closing whcih doesn't suggest there's much profit.

grottyb · 04/11/2023 06:27

I don’t think anyone has said that they shouldn’t pay. What they have said is that they shouldn’t be expected to pay for their own care and additionally to subsidise residents who are council-funded.

In reality how much are private paying care home people paying to subsidise the LA places? My understanding is it’s not a significant figure.

And why is it any different to paying for dentistry or eye care costs or childcare costs?

And as I said I don’t believe private places would suddenly get cheaper if council-funded places were fully funded? Why do you?

grottyb · 04/11/2023 06:43

I haven’t disputed that there is a subsidy, I just don’t think it’s anything like the council/taxpayers pay 10% of the costs & the self funders cover 90% of the council places. Tax payers do pay for care which seems to be misconstrued on this thread.

I don’t believe self funded places would be cheaper if LA increased their funding.
And I don’t understand why it’s ok to have subsidies in other areas eg childcare & dentistry but it’s unacceptable in re care homes?

Cosyblankets · 04/11/2023 07:15

Flev · 03/11/2023 14:51

Right now Councils are paying way less than it actually costs to provide care. That's why providers are handing contracts back to local authorities - they simply cannot afford to deliver them and are at risk of going bust themselves. It's why salaries in care are so low, backlogs so high (hence impacting on the NHS) and standards so hard to keep high. It's not about saving private payers money, it's about making sure it is actually possible to deliver the services for council-funded individuals.

I'm currently supporting a relative who is paying upwards of £3500 a month for care in their own home. 2 carers 4 times a day. This is via their local council but self funded.

Cosyblankets · 04/11/2023 07:21

VerityUnreasonble · 03/11/2023 18:47

To be in a care home (certainly of funded by the LA) you would expect someone to have a level of need which means they need support available all the time, or close to. If you can manage at home with 4 visits a day from carers that's all the LA will fund.

There are 168 hours in a week, so at 1kish that's under £6 per hour for care / food / laundry / accommodation / heating / cleaning.

A room in a house share near me costs around £100 - 175, including bills. So that takes it down to about £5 per hour for care.

Take off say £10 a day for food, another say £20 a week for cleaning, £5 for laundry. That's £4.50 per hour for care.

Also need to pay a proportion of the cost for care home manager, deputy, kitchen staff, care taker etc. let's say a total of 2k per week? So for a home with 40 residents that's another £50.

So we are now down to £4.20 per hour for the actual carers. Carer's probably actually get £9-12 per hour but will cost the company a bit more than that for training, pensions, payroll etc.

There are other costs I've not included I'm sure.

So one person's 1k actually probably pays for maybe 1/3rd of a carer per hour? If that?

I don't know if that's good value but if you pay for care at home you are probably paying around £30 an hour for the care you receive, so would get maybe 24 hours, 3.5 hours a day for the same care costs.

I see where you're going with the figures but the care home will have a ratio of staff to residents. It's not one to one.

Quisquam · 04/11/2023 07:48

In reality how much are private paying care home people paying to subsidise the LA places? My understanding is it’s not a significant figure.

I went to a talk by the Director of Adult Social Care. He talked about this. Iirc, he said the LA wouldn’t pay more than £650 a week, while self funders were paying £1,000 - £1,200. He said the real cost of the council funded places was probably in the middle. So, if the average of £650 and £1200 is £925 a week, then the self funders are imo subsidising LA places significantly.

I don’t know anything about the figures for childcare and dentistry, but are people paying £275 per week to subsidise other people? We have a private dentist; if we are lucky, we don’t pay £275 in a year for 4 checkups. Even a while filling is £120! However our dentist doesn’t do NHS, so we don’t subsidise anyone.

WrongSwanson · 04/11/2023 07:59

Quisquam · 04/11/2023 07:48

In reality how much are private paying care home people paying to subsidise the LA places? My understanding is it’s not a significant figure.

I went to a talk by the Director of Adult Social Care. He talked about this. Iirc, he said the LA wouldn’t pay more than £650 a week, while self funders were paying £1,000 - £1,200. He said the real cost of the council funded places was probably in the middle. So, if the average of £650 and £1200 is £925 a week, then the self funders are imo subsidising LA places significantly.

I don’t know anything about the figures for childcare and dentistry, but are people paying £275 per week to subsidise other people? We have a private dentist; if we are lucky, we don’t pay £275 in a year for 4 checkups. Even a while filling is £120! However our dentist doesn’t do NHS, so we don’t subsidise anyone.

Yes these are broadly the numbers I have heard (from care providers themselves)

So on top of paying for their own care very people are paying approx £15k /annum over the odds.

And I don't agree with it in dentistry/childcare either. But it's particularly unpleasant in this instance where we are talking about very ill and vulnerable individuals.

grottyb · 04/11/2023 08:03

@Quisquam can you link anything? I remember reading something a few yrs ago in the Times or FT but can’t remember the detail except it certainly said the majority of the funding came from LAs

I don’t know anything about the figures for childcare and dentistry, but are people paying £275 per week to subsidise other people?

My point was there is a subsidy, so your argument is that it’s ok if it’s a low subsidy?

I paid just under 2k a month for one childcare place. Certainly childcare providers cannot cover everything based on the rates the gov provide for the free hours.

grottyb · 04/11/2023 08:06

And I don't agree with it in dentistry/childcare either. But it's particularly unpleasant in this instance where we are talking about very ill and vulnerable individuals.

So you agree with me, it’s not unusual? That was my point….

I would argue those that qualify for funded dentistry & free childcare are often also very vulnerable tbh.

WrongSwanson · 04/11/2023 08:11

grottyb · 04/11/2023 08:06

And I don't agree with it in dentistry/childcare either. But it's particularly unpleasant in this instance where we are talking about very ill and vulnerable individuals.

So you agree with me, it’s not unusual? That was my point….

I would argue those that qualify for funded dentistry & free childcare are often also very vulnerable tbh.

Something not being unusual doesn't make it ok. And in this instance the scale of the numbers an individual is being asked to subside by make it very distinguishable and exploitative

Why don't you tell me why you think it is ok?

Headsett · 04/11/2023 08:13

Governments have had decades to prepare and plan for the increase in the elderly population along with them living longer and with more co-morbidities, no one has though, and especially not the Tories in the past decade. The solution would probably be an overhaul in adult social care but it'll never happen, throwing money at a broken system seems to be the way things will continue to go.

grottyb · 04/11/2023 08:22

Something not being unusual doesn't make it ok.

I was simply making the point that private payers subsidise a lot of costs. I don’t think it’s inherently only unfair in the context of looking at care homes.

And in this instance the scale of the numbers an individual is being asked to subside by make it very distinguishable and exploitative

Without actual statistical data I can’t tell if the subsidies are proportionate to other examples.

Why don't you tell me why you think it is ok?

Why do you think it’s ok to increase taxation to cover the costs?

grottyb · 04/11/2023 08:24

Governments have had decades to prepare and plan for the increase in the elderly population along with them living longer and with more co-morbidities, no one has though, and especially not the Tories in the past decade.

This is true but I think it’s because the public don’t want to have the debate either.

Headsett · 04/11/2023 08:31

grottyb · 04/11/2023 08:24

Governments have had decades to prepare and plan for the increase in the elderly population along with them living longer and with more co-morbidities, no one has though, and especially not the Tories in the past decade.

This is true but I think it’s because the public don’t want to have the debate either.

Also very true!

MotherOfCatBoy · 04/11/2023 08:40

I tend to fall on the “shouldn’t subsidise” side of this but it is complicated.
I think one of the elements that inflames it the most is the profit motive. I think privatisation is one of the root problems here (as it is in nearly all other public services). It’s effectively another mouth to feed, all the time, and ends up in the hands of hedge funds and investors. Although it’s true some care homes are closing now, with the energy crisis and cost of living, for a good couple of decades they’ve been making very nice profits indeed. I think that’s wrong. A pp suggested an overhaul with LA provision - I think that’s the way to go, like cottage hospitals.
Which means, of course, More Tax. But it would feel fairer because the tax should be redistributive and progressive, if higher than now, and it wouldn’t be as acute as the clear differences experienced by a small number of individuals (at population level) who rightly I think feel they are being exploited.

WrongSwanson · 04/11/2023 08:48

grottyb · 04/11/2023 08:22

Something not being unusual doesn't make it ok.

I was simply making the point that private payers subsidise a lot of costs. I don’t think it’s inherently only unfair in the context of looking at care homes.

And in this instance the scale of the numbers an individual is being asked to subside by make it very distinguishable and exploitative

Without actual statistical data I can’t tell if the subsidies are proportionate to other examples.

Why don't you tell me why you think it is ok?

Why do you think it’s ok to increase taxation to cover the costs?

I've explained multiple times, so have others. You haven't explained why you think it is ok

Zebedee55 · 04/11/2023 08:49

There is nothing wrong with people self funding, if they can. What is wrong is that they are propping up "council funded" residents, because councils can't/won't pay enough.

Self funding residents should only be expected to pay for their own care.

I've worked for a couple of local councils, and I know how much money they waste.

Dodgy investments and virtue signalling wastes money that could be better spent.🙄

grottyb · 04/11/2023 08:54

I've explained multiple times, so have others

No you haven’t explained why taxes should be increased for it?

You haven't explained why you think it is ok

I literally have said multiple times that we do it for lots of things so I don’t see the issue with it in the lens of singularly looking at care homes. I said upthread a relative paid thousands for care in the home out of their pocket because it was a better provision. I didn’t find it inherently unfair because others get it free!

grottyb · 04/11/2023 08:56

I've worked for a couple of local councils, and I know how much money they waste.

I would agree with this! Total mismanagement of money & lots of ineptitude.

Zebedee55 · 04/11/2023 09:08

grottyb · 04/11/2023 08:56

I've worked for a couple of local councils, and I know how much money they waste.

I would agree with this! Total mismanagement of money & lots of ineptitude.

Yep. Government cuts don't help, but many councils are hopeless with their budgets.😗

Theeyeballsinthesky · 04/11/2023 09:16

Well let’s be honest having a bunch of elected party political councillors with no required skills beyond the ability to get elected by a few hundred people in their ward in charge of council budgets of multiple millions is a bonkers way to run anything

some councillors are great & do have seriously high skills but they are generally outweighed by the pompous and over confident councillors who have been re-elected for years and who ignore advice from council officers on why doing “x y z would be a terrible idea” particularly if it conflicts with a party mandate sent from on high

WrongSwanson · 04/11/2023 09:21

grottyb · 04/11/2023 08:54

I've explained multiple times, so have others

No you haven’t explained why taxes should be increased for it?

You haven't explained why you think it is ok

I literally have said multiple times that we do it for lots of things so I don’t see the issue with it in the lens of singularly looking at care homes. I said upthread a relative paid thousands for care in the home out of their pocket because it was a better provision. I didn’t find it inherently unfair because others get it free!

Because taxation is the fair way to fund the welfare state, not making other ill individuals pay over the odds

I have no issue with people paying for their care, it's paying over the odds to subsidize someone else's that's the issue.

And I don't think it's ok in the other instances either. General taxation is the way to fund the welfare state , not picking on specific individuals.

MojoMum · 04/11/2023 09:33

Theeyeballsinthesky · 04/11/2023 09:16

Well let’s be honest having a bunch of elected party political councillors with no required skills beyond the ability to get elected by a few hundred people in their ward in charge of council budgets of multiple millions is a bonkers way to run anything

some councillors are great & do have seriously high skills but they are generally outweighed by the pompous and over confident councillors who have been re-elected for years and who ignore advice from council officers on why doing “x y z would be a terrible idea” particularly if it conflicts with a party mandate sent from on high

Absolutely this 💯 Plus senior council management have often spent their whole lives working within LAs and don't have the skills or knowledge to run these departments. The amount of people that get promoted who are useless, but mange to talk a good talk is ridiculous.

grottyb · 04/11/2023 09:37

@MojoMum & @Theeyeballsinthesky agreed

grottyb · 04/11/2023 09:44

Because taxation is the fair way to fund the welfare state, not making other ill individuals pay over the odds

So you would increase income tax? Tbh I think the whole tax system needs an overhaul, there’s too much burden on income which isn’t practical with an ageing population.

Do you honestly believe if council places were fully funded costs for private residents would reduce?

And I don't think it's ok in the other instances either. General taxation is the way to fund the welfare state , not picking on specific individuals.

Could you imagine the outcry if childcare costs all came from taxation!

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