Green Paper on social care reform published

The Government has published its long-awaited Green Paper on the reform of the adult social care system in England. Entitled ‘Shaping the future of care together’, the Paper was published on 14 July 2009. It marks the start of a four month consultation process during which the Government aims to get as much input as possible from the general public on how the social care system should be structured, operated and funded in future. The Paper is introduced by the Prime Minister, who summarises the Government’s aims for reform: ‘As a country we need a new National Care Service that is fairer, simpler and more affordable for everyone – a service underpinned by national rights and entitlements but also personalised to individual needs, where everyone can get the best possible care whatever their particular circumstances and where carers themselves also receive the support they need.’

Why the system needs to change

• The current means-testing system is widely considered to be unfair with some people being forced to spend their life savings and sell their houses to pay for care, whilst others who have never worked or not bothered to save receive free support.


• Britain’s ageing population means that by 2026 there will be more than 1.7 million more people needing care in England alone. The working-age population is shrinking in proportion to the growth of the retired-age population and an intolerable burden will fall on taxpayers as well as the state if the current system is not reformed.


• There is a ‘postcode lottery’ of care in England, with both the quality and quantity of care varying dramatically in different areas of the country. There needs to be more consistency to ensure a fair system and equal access to services for everyone.


• Existing resources are sometimes being inefficiently or poorly used, for example by duplication of services. And increasingly, local authorities can only afford to fund care for people who are the least well-off or who have the highest level of need – leaving many people who need support without any funding help.

A National Care Service – the future of social care in England

The concept of a National Care Service is defined as a social care system that is fair, simple and affordable. Likely to comprise some of the most fundamental reforms ever made to the care and support system, the new Service will provide support for disabled adults of all ages as well as elderly people. The Green Paper outlines six expectations that people have from a National Care Service:

1. Prevention services – to provide care and support early enough to stop higher levels of care being required later on


2. National assessment – to ensure that everyone’s needs are assessed in the same way, no matter where they live


3. A joined-up service – enabling health and social services to work along the benefits agency and housing services to provide a co-ordinated, comprehensive support service that is not duplicated


4. Information and advice – access for all to information on how the care system works and what can be expected from it


5. Personalised care and support – giving people more control over their care and an increased say in how their personal care budget is spent


6. Fair funding – ensuring that money is spent wisely and entitling everyone to some level of funding from the state.

It describes three key changes that need to take place to enable the National Care Service to work as planned:

1. More joined-up working between the NHS and the new National Care Service (comprising health and social services, the benefits agency and housing services) to reduce costs and improve outcomes


2. Local authorities to provide a wider range of services in care and support that are appropriate to the needs of residents in their area


3. Better quality amongst the care workforce and greater innovation in the ways that care is provided, for example, telecare.

Who should fund the National Care Service and who should qualify for help?

In 2008, the Government undertook a six month engagement programme to gather the public’s thoughts on social care funding reform. The programme’s findings form the basis of the Green Paper. One of the key areas that the programme looked at was who should be responsible for funding social care and how it should be decided that a person qualifies for funding.

Most people considered that funding responsibility should be shared in some way between individuals and the state, although some felt that care costs should always be borne by the state and some that an individual should be wholly responsible for funding their own care.

The following options were considered for deciding a person’s eligibility for funding resources:

• Where a person lives. Although many people thought that local authorities should be allowed a degree of flexibility as to whose care they will fund, it was also considered that basing eligibility for care wholly on where a person lives is not fair.


• When people develop a need for care and support. Opinion was divided as to whether less funding should be made available for older people, who have had the chance to anticipate and save for their care needs, and more funding given to younger disabled people who have not had the chance to save.


• A person’s ability to pay. Again people differed in their opinions, although it was generally considered that the state should fund the full cost of care for those with very limited resources. However, it was seen as unfair that those who could afford to pay for their own care should have to lose all their assets and savings before receiving any help from the state.

Funding options

The Green Paper makes it clear that simply redistributing or streamlining the current public spend on social care will not solve the problems caused by England’s ageing population and the spiralling costs of care. Society as a whole must be prepared to spend more on funding social care for others as well as themselves.

There are also the issues of fairness and consistency to address. The new system must be:

• Fair to everyone


• Easy to understand


• Affordable to all, regardless of their income


• Universal so that everyone who needs help with care costs gets it


• Personalised and flexible to enable people to live their lives the way they want.

The Paper examines five possible funding options for adult social care. Two of these – full funding by the individual and full funding by taxation – have been immediately ruled out as they are deemed to be unfair. The remaining three options are:

1. Partnership. Everyone receives a set proportion of their care costs from the state, say a third. They pay the rest themselves. Those with lower incomes would receive additional support. The scheme would work for people of all ages. However, people who end up having to pay very high care costs or need to live in a care home for a long time will still have to pay very large sums of money for care and may need to sell their homes or use their savings to do so.


2. Insurance. Again, everyone gets a proportion of their care costs met by the state. The remainder would be covered by a voluntary insurance policy, which could be offered by a private provider or operated by the Government. People could pay in instalments or in a lump sum before or after retirement, or after death. The full cost of their care would then be covered if needed. The scheme would work for people over retirement age and would enable people to keep their home and bequeath their other assets and savings to their children.


3. Comprehensive. Similar to the insurance scheme but compulsory rather than voluntary, this would work for people over retirement age. People would be required to pay premiums into a state-run insurance scheme or to make a lump sum payment of up to £20,000, which would guarantee free basic care for the rest of their lives. The amount an individual pays would depend on their financial circumstances. Again, the person’s home and other assets would be protected. This scheme would work alongside a free care and support system for people of working age.

It is likely that the funding method that is eventually chosen will in some way combine elements of at least two of these options. The Government considers that, as well as people being cared for, carers will benefit from the new funding system because the assessment process will be made simpler and more people will get access to funding.

Funding restrictions

The Green Paper points out that the proposed state funding will only cover a proportion of an individual’s basic care and support needs, i.e. the care that they have been assessed as needing. If someone wants additional care on top of basic care, they will have to fund it themselves. Neither will the state will contribute towards accommodation costs such as mortgage payments and care home accommodation fees, except for people that are on very low incomes. However, the Government does intend to introduce measures to help people meet these costs, such as deferred payments for accommodation in a care home, where the cost is recovered from the resident’s estate after their death.

Eradicating the ‘postcode lottery’

An important part of the new social care system will be to ensure that everyone in England can access high quality care wherever they live. People should not have to worry about not being able to access the same care services in a new area if they want to move house. However, it is also important to retain a degree of flexibility so that local authorities can tailor their services according to the needs of their local population. For example, a rural population with a high proportion of elderly people will need different types and levels of care services from an urban population that mostly comprises people of working age. The Green Paper aims to gather people’s opinions on two possible ways that the new social care system could be operated:

1. A part-national, part-local system. Under this system, the Government would decide what proportion of a person’s care it will fund. But local authorities would be able to decide how much an individual will actually receive, depending on local circumstances. This would reflect the fact that the costs of care and the requirements of individuals vary across the country. It would also allow local authorities the flexibility to develop new and innovative kinds of care and support. However, the downside is that where a person lives would still dictate the level of care funding available.


2. A fully national system. This would involve the Government deciding on the exact amount of funding that each person is entitled to. Funding amounts might be the same for every local authority or could still vary by locality. Local authorities would have no say in how much care funding an individual could receive and it would be hard for them to tailor their care budget to an individual’s circumstances. This system would also mean that all care would have to be funded by national taxation, unlike the current system where local authorities can top up their care funding from council tax funds if they wish.

Under either system, local authorities would still be responsible for all aspects of delivering and developing social care and support services.

Have your say on the future of adult social care in England

Consultation on the Green Paper is open until 13 November 2009. During this time, the Government will be running a series of events for stakeholders and members of the public where these issues can be discussed in detail. If you would like to get involved in these events, you can find out more at the Care and Support website. You can also download the full Green Paper from the website as well as a shorter version that summarises the main issues.

To read Cheselden’s reaction to the Green Paper, click here.