Hi manfrom
I think this is part of the trouble in getting this idea across.
The need for the National Care service is I think to set the standards, so that people can have a very clear expectation of the level of care that they will be able to receive.
At the moment the effect of the post code lottery is that no one has a clue. You expect that there will be some support if you are left at home with limited mobility etc, but each authority is interpreting this differently.
There is now some clarity with continuing care - but this relates only to the most high level care needs, where there is a very blurred line between what is health and what is social care needs.
In terms of provision, I think you are quite right that local delivery of the service can often be the best option. I would actively want to ensure that much more of the care is being delivered by small scale social enterprise. - and there is no reason why that can't happen.
So what we would be looking at is Clear national guidlines,and systems for monitoring delivery, and then local authorities commissioning the services from a wide range of different providers including voluntary, private sector, and social enterprise.
The part that interests me most in all of this is the funding issue. We are still at the point where social care is means tested. If you have over £23,000 then you effectively pay what I at times like to call the "dementia tax". which basically means you pay as much as it takes until you die or your capital falls below £23,000. There has been some modification to this now so that if you have a spouse living in your house, the house will not have to be sold for this purpose. - but this still does not go far enough.
I think in many ways this is a woman's issue. It is usually going to be a woman who faces the last years of their life alone, and is likely to have a smaller pension than the husband. Having seen how all of this affected my mother, and affected my family in looking after her it is something that frankly frightens me.
Having scuppered my career - and pension because of 8 years of caring for my mother, What I really do not want is the prospect of paying out tens of thousands of pounds for my care when I am older.
It is the unpredictability of this which is the problem. We can anticipate expenses like putting a child through university, or paying for a wedding, or helping a child buy their first home. - but we do not have any way of knowing how much our old age is going to cost.
A paper I wrote on all this about 5 years, which I believe may have influences the thinking behind the National Care Service, is called "spreading the risk". I did not think at that time that this government had accepted that they should help middle income people to prepare for their old age and still have the possibility of passing on an inheritance to their children. I think it is entirely to their credit that they have understood this. (Fot the record on this I joined the Labour party at the point when my MP showed very clearly that he understood this and would be actively campaigning for it)
What I was asking for, and I think what the national care service will give us, is a way of everyone accepting that old age will cost, and all entering into a national agreement to pay the costs, sharing the risk through what is effectively another form of national insurance (but with a different payment method.
When I speak to the increasing numbers of my friends who are now hitting the "aged parent stage" It seems to me that people are going to elaborate and often quite costly lengths to try and avoid the prospect of paying care costs.
My feeling is that we just need to accept that we have a truly scary demographic problem for the next 50 years, we haven't set aside the money as a country for it (in the way that the Swedish have done) - and it is ultimately going to make sense to choose to do this properly, and invest time, money, imagination and local committment in devising and delivering a decent care service.
As I indicated in my article, the conservatives simply do not see it this way. They have addressed the single issue of care in residential care, but the indications are that the insurance companies that they have been working with on this have cold feet. They think the £8,000 proposed premium won't cover it, and the voluntary schemes set up under Major certainly did not work.
Leaving the setting of provision levels to the local authority means that we get lost in complexity. No one see can who is getting what, and it is not until you are in this vulnerable position that you find that what you are being offered is simply not enough.