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16Th April 1997 at 10 JO A.M Printed (by Authority) by CORRIE Ltd., 48 Bucks Road, Douglas, Isle of Man. REPORT OF PROCEEDINGS OF TYNWALD COURT Douglas, Wednesday, 16th April 1997 at 10 JO a.m. Present: term support of those requiring residential and nursing The President of Tynwald (the Hon Sir Charles home care. The original resolution called upon us to report Kerruish OBE LLD (he) CP). In the Council: The Lord at the March 1996 sitting. That was not possible due to the Bishop (the Rt Rev Noël Debroy Jones), the extent of the task and the amount of information that the Attorney-General (Mr J M Kerruish Q C), Mr B Barton, department’s working party had to sift and interpret. The Hon C M Christian, Messrs D F K Delaney and E G Lowey, size of the report which has been circulated to hon. His Honour A C Luft CBE, Hon E J Mann, Messrs members is, I think, indicative of the work needed to fulfil J N Radcliffe and G H Waft, with Mr T A Bawden, the terms of the resolution. I do not intend to go into the Clerk of the Council. report in detail, but to deal with a few key issues and to summarise the options. In the Keys: The Speaker (the Hon N Q Cringle) The first issue that we should bear in mind is the (Rushen); Mr L I Singer and Hon A R Bell (Ramsey); worsening dependency ratio. Projections of future working Hon R E Quine OBE (Ayre); Mr J D Q Cannan (Michael); age and pension populations can be given with some Hon H Hannan (Peel); Mr W A Gilbey (Glenfaba); confidence, but it is not the case with the future population Mr S C Rodan (Garff); Hon D North (Middle); requiring long-term care that we can give equally confident Mr P Karran, Hon R K Corkill and Mr J R Kniveton figures. In particular we do not know whether voluntary (Onchan); Messrs J R Houghton and E A Crowe (Douglas carers will continue to look after aged and infirm relatives, North); Hon D C Cretney and Mr A C Duggan (Douglas in many cases spouses or parents, in the same way as they South); Mr R P Braidwood and Mrs B J Cannell (Douglas have done in the past. Increasing trends of single East); Messrs J P Shimmin and A F Downie (Douglas parenthood and women working full-time are going to West); Hon J A Brown (Castletown); Hon D J Gelling reduce capacity for family care at home and increase (Malew and Santon); Sir Miles Walker CBE LLD (he), demands for long-term residential care, but we cannot and Mrs P M Crowe (Rushen); with Prof T StJ N Bates, forecast the extent of this with any certainty. Clerk of Tynwald. Another key issue is one of cost. Even on the most conservative of assumptions costs of long-term care in the Island are projected to double by the year 2032 in real terms on the basis of the present funding arrangements The Lord Bishop took the prayers. without any further enhancements to current provision. I would emphasise that, as far as we can establish, there RESIDENTIAL NURSING HOME CARE — is no country in the developed world which is DHSS REPORT — MOTION CARRIED contemplating removing from the individual the obligation to meet long-term care costs. The charging principle, with The President: Hon. members, we resume our state support on a means-tested basis for those unable to consideration of the order paper at item 24 and I call upon meet their charges, is well established across a wide- the Minister for Health and Social Security. ranging community. Other countries with similar problems Mrs Christian: Mr President, once more into the are very concerned about future funding and are allocating breach. I beg to move: more resources to help more elderly people stay in their own homes for longer. That the report of the Department of Health and One issue which may be regarded by some as an Social Security on the options (and costings) for the long­ unacceptable one but one to which I feel it is appropriate term support of those requiring residential and nursing to draw attention is the question of establishing a regime home care be received and the Department be invited to here which is very different from those of our neighbours develop the proposals in para 1 130 and report by the so that we would have a net migration into the Isle of Man. October 1997 sitting. That of course may be controlled under another area in terms of residential control. But whilst people may say The motion standing in my name arises from a resolution that we should not have a problem in this connection, we of this hon. Court from October 1995 asking that the already do find ourselves in some difficulties. We pay department examines the options and costings for the long­ supplementary benefit to a number of people who have Residential Nursing Home Care — DHSS Report — Motion Carried T390 TYNWALD COURT, WEDNESDAY, 16th APRIL 1997 retired to the Island and are now in residential elderly folk. However, there is not much information accommodation. What can we say to people who come available to allow us to cost this option and I suspect that and present themselves to us without resources? We cannot there is a trend in any case away from this particular turn them away; we are, in fact, left with funding their situation. The indications are in other countries that there care. is an increasing reluctance, because of the changing social Having indicated some of the key concerns I would just conditions, for families to continue to be prepared to take like briefly to go through the options which are set out in on these responsibilities. the report. The first is to maintain the status quo. Now, We could pay all nursing and residential home and care some might argue that that is not an option at all, but the costs across social and NHS long-term care but provide department puts it forward on the basis of those concerns that hotel costs, if they may be defined as such, are paid that I have outlined in terms of changing demographic by the resident. This is an even more expensive option position, increasing dependency and emerging costs. than the ones I have outlined earlier. Total costs, including The department also has looked at option 2, the position social security benefits, would have been £11.4 million in where government would fund the element of nursing costs 1996, projected to rise to £25.4 million in 2031. but other care costs would continue to be borne by We have looked at facilitating the funding of long-term residents. Again here we have to consider the costings for care by increased pension contributions, necessitating a general revenue. If that had been the basis on which we change in tax treatment. Again it is very difficult to produce currently worked, costings in the past year would have any costings for this. been £6.1 million and projected to rise to £12.3 million in We have looked at encouraging the development of 2031. equity release schemes. Again, costings are very difficult We have also looked at the position of increasing capital to obtain. tariffs to a level adequate to allow for the value of an The department was not asked to come forward with a average family home to be disregarded either by linking recommendation but to produce options for the Court to such an increase to indemnity assurance or otherwise. It is consider. However, the department recognises that the difficult to provide costings for this option at the present present funding arrangements are a cause of concern to because of insufficient available data, but that, of course, I some, particularly in relation to the home, and the will come back to later. department’s favoured response to these options is to ease We could introduce tax relief for indemnity insurance the capital tariff in supplementary benefit for nursing and and or perhaps increase tax relief for care costs. This option, residential homes cases. This could be done in a number we believe, has very limited scope. Within the proposals of ways and there is an infinite number of variables, but that we have seen being put forward in other areas it is capital disregard could be increased. Our capital disregard less than attractive for anyone to take out such cover, is of course higher than it is in the United Kingdom but I bearing in mind that not everybody will require long-term care in their old age. do not wish particularly to dwell on what they do there, We have looked at the situation where we would pay but consider what we need to do for our people. Apart for all nursing and residential home charges, less any social from altering the capital disregard by increasing it, the security benefits, with an allowance for personal expenses capital tariff could be eased. At the moment we have a continuing for those below supplementary benefit notional tariff on capital: £1 for every £250 of capital. We requirement levels. The total cost, including social security could of course vary that in any way which the Court saw benefits, would have been £11.7 million in 1996, projected fit, reducing it, for example, to £1 in £500 or even a higher to rise to £25.4 million per year in 2031, again, I stress, at ratio.
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