How the dementia tax would become a blueprint for the NHS

One of my earliest school memories is of a teacher whose oft-repeated mantra to pupils whining about the equity of any issue was, “life isn’t fair. The quicker you get used to it, the better”.

Perhaps that was easier to learn when raised in connection with something trivial; but the wider lesson stands whatever the circumstances. If the debate provoked by Theresa May’s new social care policy serves only to bring in to sharp focus the fact that life is a lottery, it will have achieved something.

But I suspect that its legacy will be much broader than that. What is being mooted over dementia seems to me likely to become the solution to what has become known as the crisis in funding in the NHS.

I am not suggesting it will be popular. The idea that you can have built something up all your life that you wish to pass on to your children, only to see its value whittled away by the need to pay for social care if you suffer from dementia, is objectionable to many.

But the harsh reality of it, as Will Hutton pointed out in the Observer over the weekend, is it means “the spoils of undeserved brute good luck will pay for the costs of undeserved brute bad luck – and the state gets resources it otherwise would not”.

Brute bad luck indeed. The hypothetical example of two families with identical houses is laid out by Libby Purves in the Times. The offspring of parents who die suddenly inherit everything, while “next door’s oldster lingers on for a decade needing care from the state”, and the children’s inheritance dwindles to a hundred grand. The unfairness of life is laid bare, but as Purves points out, “if you are wistfully hoping your parents drop dead quickly to make you richer, you don’t deserve anything.”

The trouble is that once you have accepted the premise, the question surely becomes why you single out one disease over another. As Jeremy Hughes of the Alzheimer’s Society wrote recently to the Times, “In the lottery of life, people with dementia remain the principal victims, forced to spend hundreds of thousands on care — unlike those who develop cancer.”

Dominic Lawson’s forthright response in today’s Daily Mail, arguing from tragic (and multiple) personal experience that families “laid waste by cancer” can hardly be called “the winners in the ‘lottery of life'”, is hard to dispute. But competitive diseasing and death, which would have a touch of the Monty Python about it were it not so tragic, can be looked at from the other side of the telescope. Far from being a reason not to introduce the solution mooted to address social care, the Hutton balance could surely be looked at more widely as a means of addressing more generally scarce resource.

Many will doubtless point out the cruelty if families that are ravaged by disease should find themselves stripped of their assets to pay for the care that is required to address it – a cruelty exacerbated, presumably, the more you have to lose. But if life’s a lottery, then it is hard to see how the right place to draw the line is at dementia, rather than generally at the affordability of care. It is unquestionnable that up to a point, alleviating suffering is easier, the wealthier you are. Undeserved brute luck is surely the point, either way.

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