Some thoughts on social care and the elderly

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It was the issue considered by many to have robbed Theresa May of a majority back in 2017 and it may well rob Boris Johnson of his when the next General Election comes (although he is presumably calculating that a short term loss of popularity won’t be sustained). The vexing question is concerning what to do about he rising cost of social care. People are living longer and with that comes the cost of providing care as they become frailer, particularly in the face of age related health conditions such as dementia. It has been widely reported that the Government are planning to increase National Insurance to foot the bill. 

In this article I want to encourage us to think through how we respond ethically to the issue by asking a couple of questions. The first question concerns the role of the state and of the private individual.  What responsibility do each have?  The social welfare model assumes that the Government has significant and extensive responsibilities for all aspects of our life.  From that perspective it is reasonable and indeed moral for the state to take ownership of businesses to ensure full employment and to run our schools, hospitals, railways etc as well as providing us with free wi-fi.  From the alternative end of the spectrum, a more libertarian, centre-right or traditional liberal view assumes that the State has limited responsibilities primarily related to defence of the realm and law and order. The one view assumes that the state is responsible for your welfare, the other that it is simply responsible for your protection. Most of us sit on a spectrum between those two views. 

I tend to lean towards the liberal/libertarian view preferring a small state as I think that is most likely to preserve individual freedoms. Along with that view comes an understanding of taxation.  From this view-point tax cuts are not a give away but simply returning to the tax-payer what is rightly theirs.  The Government does not have an absolute claim on the possessions of its citizens hence the long held principle of “no taxation without representation.”  The other viewpoint is that if the Government has such extensive responsibilities, then it should be free to raise the finances necessary by whatever means necessary.

My personal view is that increasing taxation tends to penalise the poorer in society, especially when targeted on the lower and basic rates of income tax.  I’m also unconvinced that raising taxes is effective at increasing revenue.  So, I’m cautious about increased taxes or new taxes.  In that respect, I think that an increase to National Insurance is probably one of the worst possible solutions. Although it is referred to as insurance, NI is in reality a tax and it falls heavily on the lower paid as it is due as soon as you are earning £702 per month or £8424 per year. Unlike genuine insurance policies you have no option but to contribute and no possibility of opting out and choosing a different scheme. Further, the charge is related to income rather than risk.

The other question concerns our responsibility to the elderly.  This is important because saying that The State does not have a specific responsibility in its own right does not mean that there isn’t a responsibility both from individuals and the wider community.

In Scripture we are told to honour our parents and Jesus in Matthew 7:11 picks up on this command to rebuke people who have found a cunning work around. They were declaring their estate to be “corban” or set aside for YHWH in order to get around supporting elderly relatives. Jesus is having none of that.

I think this challenges a contemporary assumption that support is all one way so that the parents are responsible for looking after their children but this does not have to be reciprocated in later life. Indeed, our society is more focused on what we can get out of the elderly. This has fed through to the nervousness surrounding social care.  We expect our parents to leave us as much as possible and the prospect of either a death tax to pay off costs or the family home being sold to pay for mum’s care is seen as untenable by many. 

Yet not only is the moral assumption there questionable but in practical terms it is rather anachronistic. There was a time when the family remained rooted in an area and the grand-children expected to live in the same home that their parents grew up in. Yet society is increasingly mobile. Furthermore, as people live longer, the assumption that the children are dependent on an inheritance to get by in life is questionable.  By the time that mum and dad pass away and the will is opened, their children may well have already bought their own house, put together some savings and supported the kids through Uni. They’ve probably retired themselves! 

In my opinion, any approach to social care needs to start from the assumptions that

  1. Children have a primary responsibility to ensure their elderly relatives are cared for.
  2. That a parent’s priority is to use their own savings and resources for their own well-being before worrying about their children’s inheritance.

So, whilst this may be unpopular in some quarters, my first concern is not about whether some people might lose out on a little of their inheritance but on what will enable us to take an appropriate level of responsibility for the care of the elderly in our communities.