‘No death tax!” the chancellor, Philip Hammond, proclaimed before the election campaign began. But here comes exactly that – and a very good thing too, as the Tory manifesto recoups the cost of care from property after death. Social care is in crisis, leaving half a million frail old people with no care at all, while others get notoriously perfunctory 15-minute home visits or often squalid residential care.

Tory manifesto: more elderly people will have to pay for own social care Read more

Who should pay? Those with the money. On retiring, 80% of pensioners own their home. There are many old people sitting on mountainous property wealth generated by multiple bubbles, an unearned bonanza that has never been taxed. Now the beneficiaries need care, it is entirely right that their windfall wealth should pay for it. They won’t be forced to sell up, just to have the money taken from their estate after death, with a guaranteed floor of £100,000. So full marks to Theresa May and Hammond for not burdening the working young yet again, when that insane house-price inflation locks them out of home ownership.

Enough wealth has been sucked up from young to old, helped by David Cameron cynically courting the votes of older people with the enormously expensive triple-lock pension, while keeping Gordon Brown’s own extravagant winter-fuel bribe. Only a Conservative leader confident of a walloping great majority would dare challenge the privileges of the largely Conservative-voting old. Good for May.

But – and this is a big but – she does this in the most Conservative way possible. Each individual will be left on their own to pay their way. The lottery of life and death will see some families paying a fortune and losing all but the last £100,000 of their inheritance, while those who drop dead suddenly pay nothing. The NHS is a system designed to remove the cost of illness from the individual and pool the risk among all taxpayers. The same should happen with a national social care service, so everyone pays the same and no one is stripped bare.

The Labour plan in 2010, devised by then health secretary Andy Burnham, did just that. The idea was that everyone with assets – the majority – would pay in a fixed capital sum on retiring, or have it attached to the value of their property, only to be paid after their death. The sum might be around £30,000, the state paying in for those without assets. After that, all care would be free for all. The unlucky who suffered for a decade or more, using every last penny of the family’s wealth, would be protected. Everyone would know exactly what they would pay, pooling risk so no one is ruined by care costs. But to Conservatives, that smacks of socialism.

Will May’s system raise enough? Just before the election, the Commons communities and local government committee delivered a devastating report, finding care homes collapsing as some councils paid as little as £2.24 an hour for a residential bed – we would shudder at what kind of crude warehousing that buys. Staff pay and conditions are so abysmal that 48% of care workers leave in their first year, as do 36% of nurses working in nursing homes.

How much will the average person pay for social care under Conservative proposals? It costs around £150,000 for four years in residential care on the outskirts of London, or £109,000 in Lancashire. Someone who needs 14 hours of care a week at home could pay £45,000 in London over that period and £34,000 in Lancashire. Under the Conservative proposals, anyone with assets worth over £100,000 will pay – but the payment can be deferred until after death and deducted from their estate. Averages are tricky, but the situation is getting worse. The number of people in England and Wales dying from dementia are expected to almost quadruple to 160,000 by 2040. Philip Inman



Underlying all this lurks a fantasy politics. May has obstinately refused the NHS any extra money, pretending it has had a mythical £10bn despite the Institute for Fiscal Studies and every health economist proving that is untrue.

Her idea is that investing in social care will ease pressure on the NHS, with fewer A&E admissions as more frail people are cared for at home. But even a cursory glance at the facts will have told her that’s unlikely at the costings currently proposed. Social care will soak up the money just to stay standing, to stop further services and care homes collapsing, just to keep up with the galloping needs of the ageing population.

The National Audit Office shot holes in the idea that NHS and social care integration will deliver cuts in cost or hospital activity: an international study by the University of York found that integration schemes don’t necessarily cut hospital admissions. The latest attempt was the Better Care Fund, which pooled council and NHS money. It promised to save by cutting A&E admissions by 106,000, but instead they rose by 87,000.

Here’s the problem: both NHS and social care are suffering savage squeezes. Both hoped funds from the other would ease their own crisis – but putting together two turkeys doesn’t make a phoenix. Of course it makes sense to follow through plans to bring the two together locally – but only if both receive the funds they need.

But there’s nothing more for the NHS, which is not a “bottomless pit”: it just needs the scale of funds per capita of an ageing population that it had 10 years ago. The UK is a low spender, falling down the league tables compared with similar countries. And both the NHS and social care are easily affordable.

Plenty of wealth is available, and at least May takes the first bold step in recognising where the money is: among the majority of the older generation who have done so well out of a housing boom. Their income has grown and even richer pensioners inexplicably pay no national insurance. Poorer pensioners need that help, but others don’t.

However, the past seven years of growing intergenerational injustice has also seen tax credits and child benefit for working families shrink, and wages for May’s “just about managing” falling behind inflation. There is nothing in her manifesto to redress that.