Saturday, 10 June 2017


Chris Grayling is Secretary of State for Transport. So he can perhaps be forgiven for not understanding the details of the current means-test applied to people who go into a care home. Perhaps less forgivable is not understanding the detail of a key proposal in the Conservative Manifesto on which he was re-elected on 9 June. But he got both wrong on Question Time on BBC One on the day after the election. Here is what he said and why it is wrong.

"The irony is there was never such a thing as a dementia tax."

That is true, though not ironic. But some people with dementia face - and will face - paying more for their care than others as they tend to need care for a lot longer than those with other illnesses in later life.

"The package compares quite favourably with the situation at the moment." 

It doesn't. As I shall explain.

"Most people don't understand that the situation today is that if you go into residential care and you have no other financial means your house has to be sold there and then..."

That is wrong for three reasons.

First, if the person's need is primarily medical then the NHS will pay the whole bill without a means-test. A cash-strapped NHS will try to get out of doing so but it is the law that it should.  

Secondly, many people do not have to contribute to their care from the value of their home. If their spouse, partner or a relative aged 60 or more still lives in their home its value is exempt and no contribution has to be made from its value. That is also true if their child aged under 18 or a relative who is disabled lives there. There are other exemptions.

Thirdly, a person needing care who has to use the value of their home towards their care costs does not have to sell their home 'there and then' or indeed at any time while they are alive. Some choose to do so - I have estimated that number at around 19,000 a year - but no-one has to. Since 2001 they can ask for a deferred payment agreement and pay it from their estate when they die. Until 2015 the debt clocked up interest free. In April 2015 the right to a deferred payment scheme was put into statute and interest is charged on the debt as it accrues, currently at the maximum rate of 1.35% a year - to rise to 1.65% from July. The local authority may make some other charges of a few hundred pounds to set up the agreement.

"...and the money is spent down to the last £23,000. That's the situation today."

Once the person in the care home and the value of their own home is taken into account then its value is used up as the bill accrues. But very few people will spend it all down to the limit which is in fact £23,250. ONS says the average house price in England is £233,000 and the average cost of a residential care home in England is around £700 a week or £36,400 a year (Laing Buisson 2017). It would take five years nine months to use up all the value of the average home down to £23,500. Most people in a care home live two years or so. So very few will end up with only £23,250 left.

"And it's been the case for the last ten, twenty, thirty years in this country."

It has not. The paragraphs above take us back to 2001. Before that another legal provision enabled people simply not to pay their care bill. Until 2015 the local authority still had to provide the care and could take the money owed - again interest free - after they died. 

"What was brought forward in the Conservative Manifesto actually took less from people than the current system."

Perhaps the biggest fib of all.

The Manifesto plan is better in one respect only. It raises the £23,250 to £100,000. So anyone living in an average priced house in England would lose all its value bar £100,000 after three years eight months. That is far longer than most people live in a care home so for most it would make no difference from the present system. But for those who live longer than that time it would enable their heirs to inherit more. So it takes less in that limited way.

However, it would make another major change which was not explicitly stated in the Manifesto but which both Conservative Campaign Headquarters (CCHQ) and a Conservative MP Chris Philp confirmed to me was the case. 

The plans would remove the exemption for the family home if a spouse, partner or elderly relative was still living there. So the value of the home would be taken into account in far more cases than at present. The home would not be sold to pay the bill until after the other person had also died. But its value would eventually be used. So the Conservative plans would take far more from many people than the present system.

They would also take more from people who got their care at home rather than moving into a care home. For the first time the value of their own house would be taken into account while they - and of course their spouse etc - lived there. That was a new provision and would cost those people who owned their own home a lot more than the present rules. 

What about the proposals for a cap on the total cost anyone would have to pay?

The cap was not, of course, mentioned in the Manifesto. Plans to have one were leaked to the press early in May before the Manifesto's launch on 17th. But it was not in the Manifesto and Ministers where wheeled out on the day it was launched to justify the lack of a cap in it. However, the outcry about the so-called dementia tax (and Grayling was right that there wasn't one) was so great that by the time the Welsh version of the Manifesto was launched five days later Theresa May announced "We will have an upper limit, absolute limit, on the amount people will pay for care."

That was not mentioned in the Wales version of the Manifesto either. And no-one would say how much that cap would be but, we were told, it would be part of the consultation in a Green Paper after the election.

If the cap followed the plans of Andrew Dilnot - which were specifically rejected in the Manifesto as they "mostly benefited a small number of wealthier people"- it would not be an absolute cap. The reasons are complex but the cap of £72,000 proposed by the last Coalition government would have been effectively double that for most and the few who reached it would still have to pay a board and lodging charge of £230 a week (£11,960 a year) for life. My blog on the £72,000 cap explains the arithmetic.

However, Theresa May's phrase of an 'absolute cap' was repeated to me by Chris Philp in my Money Box interview on the Manifesto. I put to him that a Dilnot cap would not be a cap at all as it would leave an unlimited liability.

"Not an unlimited liability...there will be an absolute cap and the Prime Minister made that clear…the Prime Minister Theresa May was extraordinarily clear there will be an absolute cap that will cover all of those liabilities." 

That part of the interview starts at 8'20" into the programme.

Chris Grayling concluded his remarks on Question Time by saying

"We've got to learn lessons about how that came across, how it was launched, about the communication of it."

Indeed. That is the truest thing he said.

The rules here and the Conservative Manifesto plans apply to England. Care is a devolved matter in Scotland, Wales, and Northern Ireland where the rules are similar but different in detail.

There is an interesting analysis of the Manifesto plans on paying for care by the BBC's Nick Triggle

10 June 2017
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