Professor June Andrews is a renowned dementia expert. In 1992, she was appointed head of the Royal College of Nursing in Scotland before returning to practice as a Director of Nursing in the NHS.
She has also been a senior civil servant in the Scottish Government, leading the Centre for Change and Innovation to foster improvement in delivery of health care. She is a Fellow of the Royal College of Nursing, the world’s largest nursing union and professional body and, as professor emeritus, advises the Dementia Services Development Trust.
The first few months of the pandemic showed us what we already knew: we are facing a crisis in care for our growing elderly population.
With preparation for the anticipated influx of Covid patients to hospitals came a tipping out of elderly patients who no longer required medical treatment into care homes; some of those elderly patients were positive and the virus ran amok, claiming many lives.
A degree of buck-passing followed, with much condemnation of the concept of private care homes run for profit. But, June Andrews says, for-profit care homes only exist because the NHS removed itself from the care of older people by shutting geriatric hospitals, and then councils partially removed themselves from care of older people by ceding much of the responsibility to the private sector. Now, the public sector cannot afford to bring all care homes back under its control.
Ever since the Second World War, we have been encouraged to believe the NHS will look after us from cradle to grave. The problem, Andrews says, is that the growing number of elderly people with dementia or other chronic illnesses makes this ideal economically unsustainable.
“Policies that move in the direction of more free care are very popular and welcomed by lots of people when they are announced, but the assumption is it’s going to come from somewhere that is not going to hit any of us financially, and that’s just not possible,” she says.
Her radical suggestion is the introduction of filial responsibility legislation, where families are required by law to take responsibility for their own, with health and social services only stepping in when that proves impossible.
Under the current system, those individuals who have the resources to pay for their own care are expected to do so, even if that means selling their home. But, at the moment, if the parent can’t pay, the children don’t have to. As a result, Andrews says, some families take control of their parents’ assets so they can receive free care (and the assets remain within the family).
“Look-back” by local authorities tracks when parents have transferred assets such as property or capital to avoid paying for care. There is no limit to how far back they can look, and in recent years they have done this even more actively and further back. Yet Andrews claims it is still possible to ring-fence your home and your assets.
“You even get lawyers who are selling people the idea of putting their parents’ property into a trust because then it doesn’t count as something that belongs to the parent. It belongs to the family trust if you do it early enough,” she says. “What the local authority is looking for is evidence that you did this, deliberately, to avoid paying for care.”