Burnhams Tax on Cash ISAS and Death tax

MaizieD

Politically unpalatable to whom, Tuliptree?

To the government in the sense that they would be relentlessly and unceasingly hammered by the usual rags

But think about how that could be achieved? Buying back care homes etc would be extortionate. Seizing them would be totalitarian.

Aveline

But think about how that could be achieved? Buying back care homes etc would be extortionate. Seizing them would be totalitarian.

Well of course that’s the problem. They won’t be thinking at all of buying back and even less so of ‘seizing’ . It would all be about contracting places with the ‘owners’ of the care homes and the cost of those places -as is done now for council funded residents but on a much bigger scale.

The difference is that much of the general population would like to see social care free at the point of need and integrated with NHS health services- both on the left and the right and in the middle- whether the usual rags hammer social care proposals or not?

A key issue is to work out the way to fund it- of course that will get hammered by right wing media- what's new? That need not stop the government.

Once that has been established the next step is to control the profiteering social care home market to become ethical. Thats a tough principle for any party to disagree with and keep their voters onside. That is will the voters think that private care provider profits come before the benefit of elderly social care for the electorate? I doubt that.

There are relatively straight forward ways to do that- as the NHS does currently- preferred procurement and commissioning control- with state funds.

I suspect a large majority of the population, right wing or left wing or centrist, who become eligible for care home social care will avail themselves of it. The market and bed occupancy challenges will dictate the largest market share is state funded National Care patients. Thats huge procurement and commissioning power. The Care Quality Commission will only give a licence to operate to ethical providers. The current private providers decide to change their provider model or get out of the market.

AB seeks cross party consensus- he will get it from Lib dems- to a degree from KB/Conservative Party because of electorate self interest. Kemi B can dig her heels in and make undermining statements- but she is on a pretty sticky wicket currently as her party declines in by election vote share.

Whilst the Labour Party is government it can usher in reform anyway. I did say earlier that electorate support will play a factor and whether Labour remain in government for a second term is key- if not back to square one. AB has been upfront that this is one of his biggest priorities- time will tell whether he brings enough of the electorate with him on this big issue to gain a second term. Other parties may read the room and pledge to continue with reform anyway in an ideal world?

Aveline

But think about how that could be achieved? Buying back care homes etc would be extortionate. Seizing them would be totalitarian.

No not seizing....controlling the market and controlling regulation of care homes. Not totalitarian at all. It occurs in exactly the same way currently when the NHS procures and commissions health care services.

In effect Tuliptree, making the already vast income of private equity firms even greater … and more reliable, as it will be coming from government a.k.a. the tax payer.

Private equity care home owners must be rubbing their hands in anticipation and glee!

Yes but Lemon - nearly all care homes are private so the balance is completely different than with the NHS. With the NHS they buy limited procedures/ diagnostics from private providers and it’s a small part of NHS expenditure ( although growing I believe).

Precisely Tuliptree👏

I doubt the care homes are rubbing their hands in glee- they are more likely to be calculating risk on their profit margins.

I agree Tuliptree that the NHS procures limited procedures ( for a variety of reasons) diagnostics from private providers- with the accent on limited. What the NHS procures will be at a state agreed price.

It would be difficult to run a care home and balance the books with limited beds occupied- they need to have a high occupancy rate to survive. Ultra luxury homes with great facilities may attract those who elect to self fund even if state provide social care free. But I doubt run of the mill care homes will attract sufficient self funders in such circumstances?

Having said all that I'm not here to defend - just presenting my personal views how it might work 🤷‍♀️

I really do want reform of social care ( as so many do) and wish I didn’t feel so negative about the chance of a successful system being implemented. I think also we need to consider the social care system for people living in their own homes. We know how failures in that provision lead to people staying in hospital longer or going into residential care when with better community provision they could have returned home ( in many cases via step down care in a local community/rehabilitation unit)
And thst leads into the role and provision of community health care- GPs, DNs, Physios And that leads onto the interface between hospital and community care ( what interface and asks hollowly) . Recently a friend couldn’t get aids at home provided for her husband following a fall because his fracture was only discovered after discharge and the hospital didn’t have a system for updating the discharge letter sent to the GP.

LemonJam

Having said all that I'm not here to defend - just presenting my personal views how it might work 🤷‍♀️

And I’m enjoying the discussion

I absolutely agree we need to expand domiciliary social care services and integrate them with NHS domiciliary services- same principles. Having such similar control ( or procurement influence if thats a better description) will so help NHS bed blocking- an integrated National Care Service welcome bonus 🤗

We do currently have NHS GP, DN, OT and Physio community services- provision and capacity will need to be reviewed and dovetail with integrated community social care services- which are delivered closest to the patient largely by care assistants.

Harping back to a much earlier job and post- the tradition in NHS elderly care and rehabilitation services was to have separate health care assistants supporting the separate health professionals- ie nursing care assistants, phsyio care assistant working with the physios in physio department- OT assistants working with the OTs in O department etc- yet the patients had holistic needs- 7 days a week. OT, SALT and Physio departments and services closed down at weekends- nursing not.

So we integrated the nursing care assistant and all other care assistant roles. We structured multi disciplinary training to integrated with NVQ modules. A multi disciplinal elderly healthcare assistant was born. It was fairly revolutionary at the time- the various care assistants were not happy at first and sceptical- but fairly quickly came to love it and the skills and greater autonomy they developed.

It would be wonderful to have such holistic, skilled MDT care assistants in the community delivery elderly domiciliary care via a National Care service liaising closely with and following the care plans designed by DNs, GPs, OTs, SALTs, Physiotherapists etc.

Such opportunities excite me- it almost prompts me to come out of semi retirement to get involved in my area.

Aveline

So everything should all be nationalised? How best to address this situation? I won't hold my breath.

I don't think anyone is suggesting that everything should be nationalised. IMO essential services should be - housing, education, health, water, transport, energy and so on. Things that we all rely on for the basics.

I would also like to see statutory control of things like rent, linking it to wages, and for a way to be found to stop state support of underpaying employers, without disadvantaging the workers.

It seems wrong to me that people are forced onto benefits when they are working, and also that two people could do the same number of hours at the same work, but take home different amounts depending on their circumstances.

Sorry - I wrote that then got distracted, and when I posted the thread had moved on.

The key to bed blocking is respite care and a much more comprehensive care at home provision.
At present only a small % of the elderly are in residential care, there is no reason for this to rise if home care is improved. Residential care is very expensive to provide, not just staffing but property as well, if that can be avoided costs can be controlled.
A live in carer or full time day carer can be provided for much less than residential care, several families I know have done just that, saving the need for any residential care.

David49

The key to bed blocking is respite care and a much more comprehensive care at home provision.
At present only a small % of the elderly are in residential care, there is no reason for this to rise if home care is improved. Residential care is very expensive to provide, not just staffing but property as well, if that can be avoided costs can be controlled.
A live in carer or full time day carer can be provided for much less than residential care, several families I know have done just that, saving the need for any residential care.

I knew a few people who had live in carers and I also know a lady who provided this service. I considered it for my Mum too.

Trouble is you might not get a person who you gel with or who is only in it for the money.

Most work two weeks on, two weeks off and you might get a good one for the first fortnight and a poor one the second week. A lovely titled lady I knew was in that position and she hated the second woman as she was bossy and encouraged her to go to bed in the day so she could play on her phone and eat her biscuits! She never liked it when myself and another neighbour visited her either. It was an uncomfortable atmosphere.

We costed it and by the time you have paid for the care and paid for their food with extra heating, washing etc it wasn’t a viable proposition.

Live in care is not all it's cracked up to be and virtually the same cost. I know .... we tried both for my late OH.
Rotating carers, time off during the day, days off, scrabbling to get replacements, difficult personalities, varying competence, dietary challenges ... I could go on. In the end he opted for nursing home which we selected with care.

I am not sure I agree that the key to bed blocking is respite care. In the main beds are blocked following acute admissions (often following a fall) when someone is not well enough to safely return home.

People are living longer, it stands to reason that it doesn't necessarily mean better.
A fall is sometimes the catalyst to a precarious independent life no longer being possible.