Oh Philip what have(n’t) you done

Zip, diddly squat, bugger all. That's what this budget has delivered for health and social care. Nothing meaningful that will move the needle with efforts focussed on basically sticking plasters to fix a broken leg.

Once again efforts have fiddled round the edges, focussed on trying to win the youth vote yet, doing nothing to keep and grow their core vote; ironically it should help the former. Maybe it's because there is nothing in the tin?

Stamp duty savings for first time buyers, (Yawn) great but they need somewhere to move to first.

Money to help build more houses, (Yawn) given the levels of under occupation and that home ownership levels have stayed flat over the last few years, will it really help “home owners” and do the big house builders really need more cash? 

So where can we start?

More money for the NHS? it probably needs it just to stand still. It is a vote winner but lets stop people getting to A&E first.

More money for primary care facilities and services– a good and noble step, maybe part of the solution, but not THE solution – GPs will attest they can be counselors not medical professionals in many cases. Whilst much of the estate needs replacement we need to go further back.

More funding for social care – great idea and in my mind a logical step but that is focussed on a narrow band of people and not the masses. Most won't qualify and so the solution has to focus on enabling people to help themselves; using the resources they do have, namely housing equity or pension incomes to fund their own future - the very tenement of the original right to buy policies that got us here.

The only real affordable solution for government has to be focussed on keeping people independent and in a home of their own through better accommodation choices, creation of communities and genuine community services, not 15 minute visits. 

Support people to avoid them needing any of the former or reducing what they do need significantly through better community services and crucially a regulated and developed housing system for older people. You will stop people getting to A&E and free up cash to help those in the social care system that genuinely need it. 

Prevention not cure.

Look at other areas at severe extremes. Advances in cancer detection that prevents people needing treatment all the way to the catches I put on the kitchen cupboards to stop the kids eating the dishwasher tablets. Stop the problem don’t fix the result.

Look at what was done with the Fire Service. Rather than focusing efforts on putting out fires, they switched their focus on stopping them in the first place - remember the fire triangle from school? well the same applies to social care and especially older age only in reverse. 

If you provide all three people can stay out of A&E but fail to do one and it falls apart and guess where they are going to end up?

Clearly this comes with a cost, but there are avenues to explore. Some more contentious than others, but desperate times will require decisive action and brave leadership. 

Madness as they say is doing the same thing over and over and expecting a different result.

So what would this Phil do?

If you are reading this then you may already know I am a huge advocate of the role that retirement communities and downsizer homes will have to play in the solution. That it offers so much opportunity to rewrite the rule book by offering an alternative choice which in my view people will grab with both hands.

So I am trying to do just that - more developments, more operators, more investors.

But lets leave that to the side and put some other bigger picture ideas out there. The ones that might move the needle.

The favourite of the retirement builders is stamp duty. What about stamp duty exemption for those downsizing but only for apartments whose value is below a threshold. Let’s say ￡300,000. Those above it can probably afford it, below this and it might be sufficient to deter.

Removing blanket affordable contributions for specialist housing. Make your affordable at least match your demographics and if you are worried about affordability for the local market then look at other options like discounted sales or shared ownership – and don’t be afraid to accept offsite contributions, affordable tenures are hard to work in market led schemes because of the costs of running, you might only create division in the community. 

If you do take CIL at least offer the operator the ability to take it in house or make sure the money goes into services – provision of community facilities and libraries in a retirement community in exchange for no CIL now there’s an idea ….

What about social care - remove barriers for people self funding care through top ups if they want to. If you are 90 and bedbound and want to use your income to occupy a better room why not, you are unlikely to be using it for a holiday anytime soon.

Still to safe?

What about council tax, well how about doubling it for houses over a set band, or raising the threshold for those that get exemption at the bottom and double everyone's. You immediately double the income available for social care potentially. If you are in a half million pound house claiming to be on the breadline then maybe you should consider a move….

Now we are talking, but still small steps.

What about adding a penny to income tax for those over 50 and 2p for those over 60 but ring fence it for health and social care. Bolder, but not far enough?

Given the almost holy nature of the NHS, the acceptance that changing the whole system is to big to do, then we need to rethink funding. Dilnot was along the right lines and I would still advocate its principle; but if we were really brave we should think about starting over.

Should we start again?

Scrap National insurance. It’s archaic and frankly now a side tax, just roll it up. Why not be brave and put it all on income tax, adjust the bands so those at the bottom are at least no worse off, but those at the top and crucially those over retirement who are still earning significant incomes will still be required to make contributions.

Ring fence it, adjust banding for age, allocate it to health, just do something rather than fail to address the issues we are facing.

You might not agree with all of this but maybe some. Either way we need a step change in approach given we are facing a step change in just about every other area of our lives. Politicians are supposed to do what is right, and lead the country in the right direction, not just focus their efforts on being career politicians.

It’s time for ‘Box Office Phil” to step up - Be brave Philip, that’s what politician are supposed to do!