News

The 2010 Budget, released on 24 March, includes a number of changes that affect anyone who is means-tested for their ability to pay care home fees. In particular, the savings thresholds for people living in residential care have changed. You must now have at least £14,250 of capital before you can be asked to pay towards your care, an increase of £250. And the upper savings limited has been increased from £23,000 to £23,250. There are also changes to the way that some kinds of income and capital are treated during the means-testing process. For full details, you can read the Charging for Residential Accommodation Guide (CRAG) amendment 29. This can be downloaded from the Department of Health’s website, where you can also read the updated version of the full CRAG document. Or read our updated Care Homes Factsheet 7 which summarises the most important points.

From 1 April 2010, the weekly rates of NHS-funded Nursing Care for care home residents have increased by 2.25% to £108.70 standard rate and £149.60 higher rate. For more information on NHS-funded Nursing Care, please read our Factsheet 5.

The Budget has also made changes to the amount of most state benefits, such as Carer’s Allowance and Disability Living Allowance. On 1 April, a new benefit called Carer’s Credit was introduced. This entitles people that care for a dependent relative for 20-34 hours a week to claim National Insurance credits towards their state pension. We have updated our State Benefits Factsheet 8 to show the relevant changes made in the Budget.

To find out more about the Budget and the implications it could have on your personal finances, please visit the Treasury website or talk to your financial adviser.

A selection of reactions from politicians, charities and social care experts to the proposals put forward in Labour’s White Paper on social care, ‘Building the National Care Service’.

‘This is a very important day for securing decent care in later life. We welcome the government’s staged approach to reforming the care system, its commitment to give free care to those most in need and free care to those in residential settings after two years. These reforms comprise a significant reform agenda for the next parliament.’

Michelle Mitchell, charity director of Age Concern and Help the Aged

‘Free care for all is a historic commitment and signals a new frontier to the welfare state. Everyone needing care should be assured that their needs will be put first. The white paper is a landmark that heralds better care for generations to come.’

Stephen Burke, chief executive of the charity Counsel and Care

‘This is an ambitious plan and if all political parties work together it provides a real opportunity to turn around the social care crisis we currently face. However this will take time and we now need information of how the immediate funding shortfall is to be met.‘

Ruth Sutherland, Acting Chief Executive, The Alzheimer’s Society

‘We welcome a staged approach but this will only work if detailed proposals are set out without delay. While political consensus is vital, further deliberation could slow down the momentum for reform.’

Anna Dixon, acting chief executive of the King’s Fund

‘Social care in Britain has been in crisis for decades, but many older people and their families will not be able to wait until 2016 before they get any help.’

Dot Gibson, general secretary of the National Pensioners’ Coalition

‘We’re disappointed by the delay, lack of detail and any figures. Overall, it seems like a lot of waiting just to be told that they are going to a Royal Commission – which they could easily ignore as they did with long term care in 1999 – to draw up proposals for a change in the system for 2015.’

Emma Soames, Saga spokesman

‘The Government is in complete retreat and they have ended up with not a White Paper but frankly a train crash. We seem to have arrived at the point where Andy Burnham is saying he wants everyone to have free care but he doesn’t know how to pay for it.’

Andrew Lansley, the shadow health secretary

‘After 13 years in power spent ducking social care reform, we probably shouldn’t be surprised that Labour has once again hit it (the funding issue) into the long grass… We’re now being offered a series of piecemeal reforms that have not been properly thought through or costed.’

Norman Lamb, the Liberal Democrat health spokesman

Health secretary Andy Burnham has finally published the long-awaited White Paper on social care reform. The Paper, entitled ‘Building the National Care Service’ was unveiled on 30 March 2010 to mixed reactions from social care experts, charities and the political opposition. The Paper combines elements of July 2009’s Green Paper with the more recent Personal Care at Home Bill and some new proposals for the structure and funding of England’s social care system.

The National Care Service (NCS)

Andy Burnham says he has based his plans for the NCS on the same principles that were applied when the National Health Service (NHS) was established in 1948 – everyone will be covered under a universal NCS and everyone will have to contribute to its funding. He comments: ‘I…propose a system for social care similar to the rest of the welfare state, organised on a population basis where everyone makes a contribution and where everyone has a choice over how they make that contribution.’

The aims of the NCS

• To introduce better preventive care, to reduce unnecessary hospital and care home admissions and support more people to live at home for longer
• To provide personalised and person-centred care
• To enable health and social care services to work together to provide integrated care
• To stamp out the unfair aspects of the current system, such as varying standards and access to services across the country, and people having to sell their homes to fund care.

A staged introduction

It will take at least six years for the NCS to be fully rolled out. Mr Burnham has announced a three stage process to introduce the main elements:

• From April 2011 (at the earliest), the Personal Care at Home Bill will allow 410,000 people in England to receive free care at home. 280,000 of these will have critical care needs and another 130,000 will receive support to enable them to keep living in their own homes. The estimated cost of implementing the Bill is £670 million.
• In 2014, the government will start paying the nursing care fees for people that have lived in care homes for two years. Accommodation costs will not be included in this new initiative. Between 50,000 and 65,000 people are expected to benefit at an estimated cost of £1.1 billion. In addition, the government will introduce national social care criteria to assess people’s eligibility to social care funding, in an attempt to stamp out the current ‘postcode lottery’.
• The third stage is the launch of a comprehensive NCS where care is free to everyone at the point of delivery and is funded by compulsory contributions from all taxpayers. This is scheduled to happen in 2016.

Funding the NCS

It will cost around £4.4 billion a year to fund the NCS. Mr Burnham has outlined £4.7 billion of measures so far, including:

• £1.8 million of funds to be diverted from the NHS into social care in 2014-2015
• £2.2 billion in savings from helping people stay in their own homes instead of moving into care homes or being admitted to hospital
• £500 million a year from the freeze on inheritance tax announced in the recent Budget
• £200 million from the recent decision to abolish the compulsory retirement age of 65.

However, the White Paper does not set out how the NCS will be funded in the long term. Instead, Mr Burnham intends to appoint a cross-party commission to decide this, after the forthcoming general election. The commission will base its decisions on the ‘comprehensive’ model of funding proposed in the Green Paper. This model, where the government contributes towards basic social care costs and the individual funds the rest themselves, proved the most popular during the Green Paper consultation process. People will probably have a choice about how they pay into the social care fund, for example:

• Paying into a fund during their working lives
• Contributing a portion of pension benefits after retirement
• Paying a 10% tax on estates at retirement or after death.

The commission will also look at other ways of funding the NCS, including redistributing the funds currently used for non-means tested benefits such as Attendance Allowance.

Find out more

• You can read the White Paper and supporting documents at the Department of Health’s website
• You can watch a video of the White Paper’s launch event at the Care and Support website

The Department of Health (DoH) has announced that it is aiming to relocate some social care services from hospitals to within the community, including patients’ homes, to enable it to make better use of its resources. A new organisation, the Centre for Workforce Intelligence (CWI) has been created to help move staff and facilities into a community setting and manage workforce planning in the longer term. Health minister Ann Kean has described the initiative as essential to improving the standard of social care in Britain and as enabling the DoH to provide more productive and person-centred care. You can find out more at the DoH website.

From April 2010, unpaid carers will receive a better deal on pensions if they work between 20 and 34 hours a week. They will be able to claim National Insurance credits for the hours they spend caring for elderly relatives, enabling them to build up a larger state pension. Previously, credits were only available for carers that work 35 a week or more. 70,000 carers are expected to benefit from the new rules. For more information, call the state pension helpline on 0800 678 1132.

The Older People’s Commissioner for Wales, Ruth Marks, has announced that she is undertaking a review of the country’s hospitals to find out the extent to which older patients are being treated with dignity and respect. Around 40% of hospital patients in Wales are aged 65 or over. The review has been triggered by recent reports of poor care standards including mixed sex wards, neglected bed sores and older patients feeling too intimidated by staff to complain. The review will be chaired by former Chief Medical Officer for Wales, Dame Deirdre Hine, and the subsequent report should be published by March 2011. Age Concern Cymru comments on the review: ‘It is vital that we establish why dignified care remains a problem for older people. The debate around dignity must continue, it cannot remain static and it should be frequently reviewed.’

In related news, the Bevan Foundation thinktank has recently published a report concluding that a number of social groups in Wales, including the elderly, ‘…consistently experience disadvantage and discrimination in almost all areas of life.’

The House of Lords has voted for the introduction of Labour’s Personal Care at Home Bill to be delayed from October 2010 to April 2011 at the earliest. In the meantime, an independent study into the likely costs of the Bill will take place. The lengthy debate in the Lords saw a number of issues being raised around the Bill, including concerns that local authorities will struggle to find the £250 million that they are being asked to contribute to the total cost of £670 million. The Lords has also passed an amendment to the Bill which will cause it to lapse if it is not implemented within two years. Cross-bench peer Lord Best explained why the Lords has taken its decisions: ‘First there is the worry that they (the government) cannot get arrangements to help 400,000 people in a new way up and running in the next few months. These are months that will include local and national elections, with possible changes of local leadership and local policies, and which also cover the weeks of the summer holidays. And second, local authorities are concerned that their budgets have already been set for 2010-11.’ Care services minister Phil Hope expressed his dismay at the outcome of the Lords debate and spoke of the disappointment that care charities and people that are set to benefit from the Bill will feel.

The Personal Care at Home Bill, announced by Gordon Brown in October 2009, aims to provide free home care for 400,000 older people with the severest care needs. The Bill has attracted widespread criticism around the estimated costs – considered by experts as far too low – as well as doubts around how the care itself will be provided.

Further to the recent political rows about the future of England’s social care funding, a cross-party blueprint document has now been drawn up which will form the basis of the next round of discussion. The document, signed by social care experts from all three main political parties, builds on the recommendations made in July’s Green Paper on social care. It makes explicit criticism of Gordon Brown’s subsequent and conflicting announcement that personal care will become free for everyone aged over 65 that has ‘critical’ needs. The blueprint focuses on 10 core principles for reforming the existing system in a way that can be realistically funded. In line with the Green Paper, it sets out a funding model based on contributions from both the state and individuals. As the population ages, the burden of future cost will be spread across general taxation or some type of insurance scheme. The proposal of a one-off payment to be made on retirement or after death will not be used as a starting point for discussion, although lump sum payments of this kind could form part of an individual’s insurance contributions. Overall, the blueprint’s signatories conclude that any future system ‘must be predicated on choice.’

The charities Crossroads and Princess Royal Trust for Carers are claiming that millions of pounds of funding originally intended to pay for carers’ respite breaks has been diverted and spent on other NHS services. In 2008, the government announced that it would double respite care funding to £50 million this year and £100 million in 2011. But because the money has not been ring-fenced, local NHS Trusts have been able to spend the money ‘to best meet local needs’. The two charities say that only 23% of the funds are actually being used to provide respite care for Britain’s six million unpaid carers. Their statistics are based on responses to Freedom of Information requests from 100 NHS Trusts. Imelda Redmond of Carers UK comments on their findings: ‘The Government made a huge fanfare about the (respite care) strategy and it has amounted to so little. Respite care is the number one thing carers want. It can allow them to carry on, in many cases preventing an elderly person from having to go into residential care.’

A recent YouGov survey of 767 carers revealed that 41% rarely or never received respite care, with less than half receiving any support from social services or the NHS.

A survey by the Chartered Institute of Public Finance and Accountancy has revealed that 59% of local authorities in England and Wales are planning to cut adult social care budgets by an average of 7% in the next financial year. Although all areas of public spending will be under pressure, councils are safeguarding their budgets for children’s services in the wake of last year’s Baby P scandal – at the expense of adult services. With the introduction of free personal care looming for many elderly people, councils will be looking to cut back on other types of adult social care, such as community health care services. And home care charges for many vulnerable and elderly people that won’t qualify for free personal care are likely to increase. The eligibility rules for any type of free adult social care will also tighten. John Dixon, joint committee chair of the Association of Directors of Adult Social Care comments: ‘(The cuts are)…worrying because it is not a proper balance of needs and resources… Money is dropping fast and if you are having to increase your spending on children’s services, you will have to reduce spending on other services very dramatically.’

As the survey results were released, Cornwall Council has announced that it will increase its adult social care budget by £11 million to £90 million in the 2010-2011 financial year. The Council has agreed to boost its adult social care funding after a Care Quality Commission report rated its services as among the worst in the country.