Dr Ros Altmann Andrew Dilnot, chairman of the independent Commission on Funding of Care and Support, is best known as a former BBC journalist and presenter of the Radio 4 programme More Or Less. He is also an economist, principal of St Hugh’s College, Oxford, and was director of the Institute for Fiscal Studies. What he and his two fellow commissioners propose is likely to change the way future generations are cared for. In advance of the report’s publication in July, Saga director-general Dr Ros Altmann asks him some vital questions in her exclusive interview.
Ros Altmann: Let’s start with one of the thorniest questions. Is it right that people should sell their homes to pay for care?
Andrew Dilnot: I don’t think it is unreasonable to expect people to pay something towards the cost of their care. After all, it seems to be accepted that we may use our house to pay for part of our pension needs. What does seem unfortunate is the possibility of people losing everything because they end up being one of the less fortunate people with very high care needs. So we need to think about how we can share that responsibility between the individual and the state. To get a balance people think is fair.
Saga likes the idea of capping the contribution anyone could pay – say, around £100,000.
That’s one of the ideas we are looking at. It’s interesting that Saga is keen on it. A scheme like that would be one way of balancing responsibility between individual and state.
What is your review focusing on?
The funding side is the core of our work. We are interested in the ways that provision of care and its funding are inter-related. We’ve narrowed down the range of options we’re looking at, but we haven’t taken the most narrow way of looking at things.
How about increasing tax?
We have been explicitly asked to suggest where funding could come from. My own view is that the system we have at the moment is as ungenerous as it could be – I can’t imagine less state funding. We have simply a means-tested regime. In our call for evidence we made it plain we thought there would need to be increased resources. I’ve not come across anyone who thinks the current eligibility threshold is too generous. So there’s an expectation that whatever happens next there will need to be more state funding.
How about changes that don’t directly involve funding?
We want to see if we can come up with recommendations that will facilitate greater innovation and development in the sorts of environments in which people find themselves cared for. I hope, for example, that our recommendations might make further development of things such as extra-care housing more plausible than it is at the moment.
How have you found working on the Commission?
My overwhelming feeling has been one of real enjoyment. I’ve loved being involved in public policy again. There are some issues which matter very much to a lot of people and if you can make a difference to those, even a small difference, that can be a very big change. I’ve loved having a chance to think about an issue that has dogged administrations for more than 15 years and, despite various inquiries, nothing much has happened.
Is that because it is such a challenge?
I think it’s tricky. More and more people are receiving and needing care, so the costs are rising pretty fast and that puts enormous pressure on systems. This is an area that’s extremely emotive, too. How well we look after one another when we are in that kind of need is a badge of what sort of society we are. I also think it’s tricky because it wasn’t thought about much at the founding of the welfare state. We thought very hard about the health service and we thought pretty hard about pensions but care didn’t get the focus it needs.
Of course, society has changed radically since then.
It’s changed in some important ways. We’re living longer and healthcare is much more effective, so more of us end up needing care. But that’s not something to be depressed about. People talk about the burden of ageing – the burden of care. We’re often much too negative about it. It’s something to celebrate, as long as we can find ways of looking after one another and looking after ourselves.You and I are likely to live for 10 or 15 years longer than a generation before, but alongside that we have to recognise the physical frailty that may come with it and think about organising our lives for that, for what we are facing.
So are there lessons to learn from the pensions crisis?
I’m wary of using the word “crisis” . One lesson I think we can learn is that, as people live longer, they need to save more. It’s an important part of helping them prepare for what in many cases is a happy retirement. Similarly, people need to prepare for care. But they probably find it more congenial to think about their retirement than their care needs. We get positive images of retirement but not of care, partly because we tend to focus on the most acute care needs towards the end of life.
One of the things I think we’ll be wanting to emphasise is that simply thinking about moving into more appropriate accommodation before you need to can be a part of what might be thought of as your care journey. If we can start people thinking and preparing a bit more, then we can concentrate on some of the more positive aspects of adjusting to growing older.
Even if you don’t describe it as a crisis, it certainly is a challenge.
The figures show that. The most rapid increase proportionately in age-related public spending in the next 20 years will be on care. Last year 1.2% of national income was spent on it. In 20 years it will be 1.7% – almost a 50% increase. And consider that in 1911 there were 60,000 people aged over 85 and now it is one and a half million. But older people aren’t hopeless incompetents – just ask Saga members. They are extremely talented people, who are capable of change and adaptation.
You have spoken of a partnership approach between the state and the individual. What part do you think should be picked up by the state?
If I answered that I would be telling you what is in our report before it has been announced. But I can tell you we’ve already narrowed down the options. Some say the state should pay for everything – we have a free national health service, so we should have free provision of care as well. We’ve ruled that out because it wouldn’t last and it’s really important that people can believe that the system we introduce is going to last.
Nor does it seem reasonable to stay where we are, leaving it to the private sector apart from the means-tested regime. That’s not sensible because the private sector is not picking it up. The financial services industry can’t really provide cover in this area because the uncertainty is too great. So what we are looking for is something between those two. Something which, by changing what the state does, makes it easier for the private financial sector.
If you could recommend only one thing, what would it be?
Read our report. It’s really good.
We’ll all be doing that. There will be a lot of interest.
I hope there will be. I’d love people to have a more positive attitude towards the provision of care. To get everyone, including policymakers and the media, to stop thinking this is a terrible burden and reflect instead that it’s fabulous and exciting that people are living into their eighties, nineties and even hundreds, and having independent, fulfilling lives.