Flaws exposed in social care Green Paper

Reactions continue to the Government Green Paper on the reform of adult social care services and funding, published on 14 July. A number of organisations have highlighted flaws in the thinking behind the Paper, or have exposed gaps and omissions in the document’s scope. Some of the key points that have been made are described below.

No reference to NHS continuing healthcare

Although NHS continuing healthcare is, by definition, a healthcare issue and not a social care one, concerns have been raised that the new social care funding system could result in some people having to pay for care who would, at present, receive free care from the NHS. Changes in the way that people are assessed and in the way that health and social care services interact that are outlined in the Paper could affect an individual’s entitlement to receive free care on the grounds of having a health condition. The Green Paper does not mention continuing care per se, but some people are worried by what they have read ‘between the lines’ – including the Chief Executive of the Royal College of Nursing, Dr Peter Carter. He comments: ‘The NHS is responsible for funding the nursing care of patients who have health needs, regardless of whether they are in hospital, a care home or their own home. We would fiercely oppose a system where responsibility for meeting the costs of nursing care was shifted onto the patient and subject to means-testing when it should be free on the NHS. We will be looking at the detail of the paper to see what could be included in the care package.’

No provision for accommodation costs

The Paper states that the funding options presented are only designed to cover the costs of ‘basic care’ and that accommodation costs such as rent or mortgage payments and care home fees will not be Government-funded, except in the case of people with extremely limited means. Despite this admission, numerous organisations and publications have pointed out that each of the proposed funding options – partnership, insurance and comprehensive – will involve most individuals paying out substantial sums of money to ensure they receive care when they need it. However, on top of this, they will still need to pay for their accommodation costs, which in the case of care homes, can be as much as or more than the cost of care itself. Many people would still need to sell their homes to pay for residential care – something the Government claims it wants to stamp out. The insurance funding option in particular, which involves paying out a lump sum of up to £20,000, has received criticism for this reason. The organisation Private Healthcare UK describes it as ‘like buying a new car and finding you then had to buy an engine, seats and four wheels.’ It also points out a second flaw in the insurance proposal – existing schemes of this type are very unpopular and only two insurance providers currently offer them.

No help for people who are struggling with care costs now

As our Managing Director, Colin Ball, comments in Cheselden’s official response to the Green Paper: ‘(It) ignores the fact that there are a significant number of chronically ill people paying for care that are “in the system” right now. These people’s assets and life savings are being stolen to pay for care they should be receiving free from the NHS.' Any funding reforms that are implemented as a result of the Green Paper will not come into force until 2014 at the earliest – meaning that there is no help available for the many people that are struggling with the cost of care at the present time, or who develop a need for care in the next five years. By then it is estimated that a further 400,000 people will require social care.

No provision for younger adults

A number of have raised concerns that all three of the Paper’s funding options are focused on the needs of elderly people, with those of younger disabled adults given scant consideration. The Government’s intention to fund basic care for everyone who needs it by abolishing Attendance Allowance – worth £3.7 billion – is seen as inadequate by Mencap’s chief executive Mark Goldring. He comments: ‘If Attendance Allowance is all they have to redistribute, that can't cover a quarter of the costs of those who don't get support at the moment and also pay for an extension of social care for those who are under 65.’ Leonard Cheshire spokesman Guy Parckar added: ‘More money is needed in the system. It's something that's so central that you need to fund it from taxation and national insurance.’ A group of charities campaigning for the rights of disabled adults and their carers has submitted a joint open letter to the Guardian on the subject – click here to read the letter and here for the related Guardian article.

Paper’s proposals will not abolish means-testing or ‘postcode lottery’

There have been angry reactions from several quarters to the Paper’s stated intentions to both remove means-testing from the social care funding system and to abolish the current ‘postcode lottery’ of care provision and standards. Central to the paper is the ethos that the Government will pay for a set proportion of basic care for everyone in England, regardless of their financial means. The individual is then responsible for funding the remainder through one of the three proposed options of partnership, insurance and comprehensive. However, the Paper states on several occasions that those people who have very low incomes will have all their care funded by the state – including accommodation costs (see above). This cannot happen without means-testing, so it can only be concluded that a means-testing element will be included in whatever funding system is eventually introduced for social care. Colin Ball comments in Cheselden’s official response to the Paper: ‘The Government claims to want to end means-testing for care fees, and yet it proposes that those on lower incomes will still have their full care costs covered. It suggests a sliding scale of individual contribution according to ability to pay. That is contradictory to the proposal of “ending means-testing”’. This issue has angered many people who feel that is unfair that those who have saved all their lives are then forced to use their assets to pay for care, whilst those who have not been as frugal are rewarded with free care.

Regarding the ‘postcode lottery’ issue, the Paper describes two options for setting and allocating funding levels – nationally by the Government or locally by councils. In both cases the Paper refers to varying levels of funding according to geographical location, because of local differences in the types of care needed and the costs involved. This has attracted criticism because the references are at odds with the Paper’s stated intention that in future, access to social care services and funding will be fair and consistent for everyone. The references to differing levels of funding and care availability could be said to perpetuate the ‘postcode lottery’ rather than abolish it. Says Colin: ‘Much more needs to be done if (the Government’s) aims of a “fair and consistent social care system for all” stand a chance of being met.’

You can read full and abridged versions of the Green Paper at the Government’s Care and Support website or a summary on Cheselden’s website.