Experts have warned that the current government figures for free care fail to take into account either an increase in demand with time, or the effect of people who previously chose to pay for private care switching to free care because they now qualify for it (a situation described by the Guardian as ‘redistributing to the rich’).  Whilst challenging the Personal Care at Home bill in the House of Lords, former health minister Lord Warner warned that when Scotland began offering free personal care in 2003, the costs doubled within four years and the number of claimants went up by 36%.  Although the bill survived the challenge, more and more organisations are now backing the view originally put forward in the Green Paper that individuals must share the cost of care with government funding.

Other concerns around the Personal Care at Home bill centre around how it will be decided which people have ‘critical’ care needs and will therefore receive funding.  How will needs be assessed as ‘critical’ and what help will be available for those whose needs are severe, but not ‘critical’?  This is made more complex by the fact that currently, local authorities all interpret care needs differently.  Some authorities currently classify ‘critical’ care needs together with the lower category of ‘substantial’.  With councils also offering different care services at different prices, there is a risk that many people will miss out on funding due to a ‘postcode lottery’ – as was the case when continuing care eligibility criteria were first introduced in 1995.

Wales has launched a consultation period on the reform of its social care structure and funding system. Entitled ‘Paying for Care’, the consultation Green Paper can be downloaded or read from a new, dedicated website www.payingforcareinwales.net. The website will be kept updated with the latest developments in and responses to the consultation process as well as information about how to get involved and have your say. The consultation will run until 28 February 2010.

A selection of initial responses to the Green Paper:

‘This cloned version of the UK government’s Green Paper offers no specifically Welsh solutions. The only thing that is clear is that the Assembly Government has no clue on how to deal with the looming funding crisis in social care.’

Peter Black, Welsh Liberal Democrat health spokesman

‘The care and support system in Wales is in need of a radical overhaul and it is under-funded and overstretched. The system is also overly complicated and unfair and it penalises savers, even those with modest assets. We need to identify what people should expect from care and support services, in terms of when they should be eligible, how much support they should receive and the quality of that service. We believe the fairest way to achieve this is by sharing the costs across society as whole. We conducted research this year which showed that 80% of people of all ages across Wales feel that care and support for older people should be free at the point of use and paid for through taxation. If taxation is being ruled out as an option then we must explore alternatives that will balance the responsibility of paying for care between individuals and the state so that everyone receives care when they need it.’

Victoria Lloyd, Age Concern Cymru and Help the Aged in Wales

‘It is clear that the current system for the provision of care and support is widely accepted as being outdated and in many cases grossly unfair. However, Saga’s research shows that there is no one size fits all solution with all of the proposals receiving a decidedly cool reception amongst over 50s. While many support the abolition of the postcode lottery in care provision and funding, many are still concerned that these proposals do not protect the family home as accommodation and food costs are still going to have to be met by the family.’

Emma Soames, Saga

‘Older people need a system that is fairer, more consistent and which addresses the longer-term financial issues as well. We need to listen to what people say as part of this consultation and look at what consensus comes through and take steps forward as this result. We have some concerns as a commission about proposals around future claims, claimants for Attendance Allowance which we think needs to stay as a benefit which benefits a lot of older people directly so we need to get involved in Wales in the UK consultation as well.’

Sarah Stone, Deputy Older People’s Commissioner for Wales

posted by Cheselden Continuing Care at
10:02

As the consultation period for the English social care Green Paper ends, Wales is launching its own consultation process into the future of the country’s social care services and funding structure. The Welsh Green Paper, entitled ‘Paying for care in Wales: creating a fair and sustainable system’, is divided into two parts: the shape of the new social care system and the way in which it will be funded. As the Welsh healthcare system is devolved, they are free to develop their own social care system and, to an extent, decide how it will be funded. However, the country’s welfare and benefits system is still controlled by the UK Government. This means that any changes that are made to English benefits as part of England’s new ‘National Care Service’, such as the proposed abolition of Attendance Allowance, must be implemented in Wales also. It is therefore crucial that the new Welsh social care system is structured in such a way as to remain fair and viable in the light of any enforced changes to the benefits system. Wales also needs to decide if far-reaching English decisions and recommendations, such as Gordon Brown’s pledge to make personal care free to everyone aged over 65 who needs it, are suitable for introduction in Wales, or whether things should be done differently.

The Welsh Green Paper puts forward the same three proposals to fund social care services in future:

• Partnership – the state and the individual both contribute a proportion towards the cost of care, with the Government ‘topping up’ contributions for the less well-off.
• Insurance – people make voluntary payments into private or state-run insurance schemes to guarantee that future care costs will be met.
• Comprehensive – compulsory, lump sum payments into state-run insurance schemes for those who can afford it, to be made on retirement.

Deputy Minister Gwenda Thomas commented on the Green Paper’s publication and the launch of the consultation period: ‘This is a vitally important issue for all of us in Wales and it is essential that we get as wide a debate as possible going on in our homes and communities. I would encourage everybody to read and respond to this Green Paper, so that our discussions with the UK Government are as informed as possible.’ She added that it is ‘…widely acknowledged’ that the current funding system is ‘complicated, unfair and unsustainable in the long term.’

For more information about the consultation process, find out how to respond and to download the Green Paper and supporting documents, please visit the new, dedicated website www.payingforcareinwales.net. The consultation period runs until 28 February 2010.

posted by Cheselden Continuing Care at
10:10

Plaid Cymru Assembly Member Leanne Wood has voiced her concern over the effect on the Welsh disabled population of the UK Government choosing to scrap Attendance Allowance (AA). The abolition of AA is proposed in the English Green Paper, published in July 2009, as part of the shake-up of the social care system. And because the Welsh benefits system is under UK control, Wales would be unable to retain AA, currently paid out to 115,000 people, if the benefit is scrapped. Wales has a higher proportion of disabled people than England and receives around 8% of total AA funding, but under the new system, funding would be cut to 6% – a loss of £130 million per year. Ms Wood comments: ‘This would be a significant cut to the incomes of disabled pensioners. Our research shows that the impact (of abolishing AA) in Wales could be even worse, with tens of millions lost to the Welsh economy because of the way Wales is funded by the Government in London.’ Ms Wood’s concerns were seconded in the Welsh Oral Question session on 11 November by MP for Brecon Roger Williams, who then called on the Welsh Office to abandon the entire social care consultation process. Deputy Minister Gwenda Thomas has responded to Ms Wood in writing, stating that her belief that the abolition of AA will be strongly opposed in Wales and urging the importance of ensuring that Wales’ own social care Green Paper gives the opportunity for affected parties to represent their interests to the UK Government.

In October, health secretary Andy Burnham confirmed that AA’s sister benefit, Disability Living Allowance which is paid out to disabled people aged under 65, will definitely not be abolished to help fund the new ‘National Care Service’.

posted by Cheselden Continuing Care at
09:54

Deputy Welsh Assembly Minister Gwenda Thomas has announced that a Green Paper will shortly be published proposing new ways of funding social care in Wales. Writing in Wales Online, Ms Thomas explains how the Green Paper will bring together ideas and opinions put forward in a national debate on paying for social care that she launched in 2008, as well as the findings of an Advisory Group that she set up to examine the issues in greater detail. The next stage of the consultation process will be launched on Monday 16th November with the publication of the Green Paper and the launch of a new website, www.payingforcareinwales.net, which will give further information and explain how to respond to the proposals put forward in the Paper. The Paper itself will have similar content to the English version published in July and will propose the same three options for funding social care in future: partnership, insurance and comprehensive. However, it is up to the Welsh Assembly to decide how social care is actually provided and funded in Wales. As with the English Green Paper, the Welsh version will not just focus on the needs of elderly people but will also consider how younger disabled people will be supported. A review of the benefits system and how it will fit within the redesigned social care system will also be included. The consultation period on the Green Paper’s proposals will run until 28th February 2010 and Ms Thomas is encouraging as many people as possible to get involved in the debate about how Wales’ social care system will be reshaped and funded.

posted by Cheselden Continuing Care at
17:44

The Care & Support Alliance, a group of charities which have joined forces to protect public interests during the reform of the English social care system, has criticised the Government for withholding financial modelling data that underpins the proposals put forward in July’s Green Paper. With the Big Care Debate on the verge of closure (16 November), the publication of the figures has now been delayed until 2010 – causing concern within the Alliance that the various funding options put forward in the Paper are not actually sustainable. Doubt has also been cast on the reasons given for general taxation being excluded as a means of funding the new ‘National Care Service’. The Care & Support Alliance comments on the delay: ‘How we fund the growing demand for better care is critical to all our futures. But we are expected to decide on funding options without the facts and figures they are presumably based on. Ministers want us to accept the “mathematics” underpinning the Green Paper but don’t seem to trust the figures sufficiently to publish them. People rightly want to know how much they may have to pay for care in the future.’ The Alliance now plans to request the financial modelling data through the Freedom of Information system.

posted by Cheselden Continuing Care at
17:42

A group of care home owners has formed a coalition called the Fairer Fee Forum to try and bring to an end the differing fee levels that they say they are forced to charge. The providers have admitted that self-funders are paying considerably more per week – sometimes more than £200 – in order to subsidise state-funded places. However, many people who should qualify for free care are also being charged top-up fees averaging £250 per month. The care homes maintain that this situation has arisen because local authorities are not paying enough for state-funded places, so they are forced to charge both self-funders and state-funded residents extra fees to cover their costs. The coalition has instructed Cherie Blair, QC, to take all 150 local authorities in England to the High Court to make councils pay care homes a fair price for state-funded places. The move has been welcomed by a number of charities that campaign for the rights of the elderly, including Age Concern and Help the Aged, which commented: ‘We hear a lot of complaints, both from those who are self-funders, who are paying too much, and those who are funded by the local authority, but forced to make huge top-ups, but often they don’t want to cause upset in the home where their elderly relative is living.’ More information about the Fairer Fee Forum and their legal campaign can be found at their new website.

In related news, Counsel + Care and the National Care Forum have launched a joint research report in response to the Green Paper on the future of social care funding. The report concludes that ‘more resources are needed to fund better quality care’. The research looked at the variations in care quality across providers and found that those with the highest star ratings were spending up to 20% more than other providers on staff salaries and training as well as basing all their activities around the needs of service users. It found that, due to variations in local authority funding, some care home providers are able to spend, for example, three times as much as others on meals for residents. Stephen Burke, Chief Executive of Counsel + Care, comments on the report’s findings: ‘The underfunding of care in this country means that many staff are poorly paid and poorly trained. Older people and their families are the real losers. The government’s consultation on the future funding of care must address urgently the need for extra resources for unmet needs now.’

posted by Cheselden Continuing Care at
17:26

The Learning Disability Coalition (LDC), a group of 15 charities that campaigns for the rights of adults with physical and mental disabilities, has warned that the proposed National Care Service focuses too much on caring for the elderly at the expense of younger adults with life-long disabilities. The LDC argues that, as the proportion of adults with learning disabilities is rising sharply, the Government needs to give more attention to meeting the spiralling costs of their care. Funding for these adults is particularly vulnerable because so much of it comes from local government and community budgets which are likely to be hit hard by forthcoming cuts in public spending. John Smithies, spokesperson for the Down’s Syndrome Association, comments: ‘The government recognises the demographic argument but hasn’t met the increased need by providing additional funding…The green paper addresses chiefly the elderly, not those who are younger.’ Phil Hope, minister for health, disagreed, stating that younger adults are a priority and that the Green Paper addresses the social care needs of all adults, regardless of age. He added: ‘We have increased investment in local council services by 39% since 1997, and this will rise to 45% by 2010-11. We’ve put £520m into making social care services more tailored to individuals’ needs. We’re also helping to improve healthcare for all people with learning disabilities by offering annual checks through the NHS.’

The ‘Big Care Debate’ on the proposals put forward in July’s Green Paper on social care ends on 13 November 2009. Anyone still wishing to give feedback on the Paper can do so online at www.careandsupport.direct.gov.uk.

posted by Cheselden Continuing Care at
17:22

Health Secretary Andy Burnham has announced that the DLA benefit will not now be abolished to help fund the forthcoming ‘National Care Service’ that is outlined in July’s Green Paper. The news will come as a relief to the 2.5 million disabled adults aged under 65 that currently claim the benefit. Plans put forward in the Green Paper had proposed scrapping DLA, which is not means-tested, and replacing it with a social care fund that would be based around a recipient’s ability to pay for care. Conservative MPs reacted to Labour’s change of heart by challenging the Government’s ability to plug a funding gap of £4.6 billion for the National Care Service, which could have been at least partly filled by the abolition of DLA. But Mr Burnham commented: ‘We are looking at how we can make this benefit more progressive, so that the money works harder for those in greatest need. The important principle is that nobody who is receiving disability benefits will lose out from the reforms.’

Although the future of DLA is now secure, Attendance Allowance (AA), which is a similar benefit for adults aged over 65 may still be abolished. Also not means-tested, AA is paid out to 1.6 million adults per year at a cost of £4.4 billion. A petition protesting against the scrapping of both DLA and AA has been signed by more than 18,000 people so far and is open until 1 December 2009.

posted by Cheselden Continuing Care at
17:54

In July’s Green Paper on the future of the social care system and its funding, one of the ideas put forward was the abolition of certain disability benefits and the re-routing of the resulting funds into social care provision. The benefits in question are Attendance Allowance (AA) and Disability Living Allowance (DLA) which are currently available to anyone with a certain level of disability that affects their mobility, regardless of means. The proposed changes have led to concerns being raised by a number of charities and organisations that campaign for the rights of elderly and disabled people. They argue that by replacing these benefits with means-tested social care support, many people that currently receive AA and DLA will lose a significant proportion of their income because they will not qualify for the new type of support. An official petition has now been set up to appeal to the Government ‘…to recognise the vital support that Attendance Allowance (AA) and Disability Living Allowance (DLA) provide to disabled people, and to ensure that these benefits are secured and are not removed as part of any future reform of the social care system in England.’ You can sign the petition by clicking here. It will remain open until 7 December 2009.

posted by Cheselden Continuing Care at
11:28

Stephen Burke, chief executive of the charity Counsel + Care has urged the Conservative party to consider their stance on the future shape and funding of the social care system. Writing for the Guardian, Mr Burke anticipates a Conservative victory in 2010’s general election and asks how they are preparing themselves to take over the work done so far by Labour on its National Care Service. When Labour’s Green Paper was published in July 2009, launching the nationwide Big Care Debate, the Conservatives responded by criticising Labour for its delayed action on reforming social care rather than countering the ideas put forward in the Green Paper with concrete plans of their own. With the Conservative party conference looming, Mr Burke suggests that social care should feature strongly on its agenda – especially given that almost half of people that will turn out to vote next year are aged over 60 and so will be among those most affected by changes to the current system. He reiterates that the main issues to be tackled are the inconsistencies and unfairness that dog the current system along with the key problem of deciding how social care should be funded in future. The article closes with a call for ‘a groundswell of public support’ for social care reform which will ensure that any future government is forced to face up to its responsibilities.

posted by Cheselden Continuing Care at
14:55

Further to the publication of the Government Green Paper on the reform of social care, ‘Shaping the future of care together’, the Government reports that the consultation process – otherwise known as the Big Care Debate – is going well. The aim was to spark a nationwide debate on the future of adult social care services and how they are funded. The large amount of publicity that the Green Paper has received in local and national media, as well as health and social care-specific publications and websites, has brought the issues at hand to the attention of the general public, who are taking the opportunity to air their views. Since the Big Care Debate was announced in June, its official website, www.careandsupport.gov.uk, has received over 3,000 responses to the ideas put forward in the Green Paper. A nationwide road show is also underway which is enabling members of the public to access information about the proposed changes, put their opinions across and ask questions. Road show events are running until mid October, with all dates available on the official website.

A key area of the debate so far is the benefits question, with many respondents stating their concern about the proposed abolition of disability-related benefits such as Attendance Allowance (AA). This issue has also drawn strong responses from a number of charities that campaign for the rights of disabled people, such as the RNIB which claims that many sight-impaired people will lose out if AA is replaced with a means-tested social care benefit, for which many are unlikely to qualify. Commenting on the website’s blog, the Government responds to this by stating its commitment to ensuring that disabled people end up receiving the same level of benefits under the new system as they do now. It goes on to say that a new system is needed for older adults to remove the inconsistency, confusion and unfairness that result from the existing, fragmented social care and disability benefit systems for the elderly.

posted by Cheselden Continuing Care at
10:29

The charity Royal National Institute for the Blind (RNIB) is gearing up to challenge the proposal put forward in the recent social care Green Paper to abolish the Attendance Allowance (AA) benefit. The charity fears that the move, which would redirect the monies saved from scrapping the benefit into other areas of social care funding, would leave many of the UK’s 53,000 visually-impaired people with no state support. Head of campaigns Steve Winyard has urged blind and partially-sighted people, as well as local organisations that support and represent them, to get involved in the Green Paper consultation process so that they can give their views on the proposed changes. In the meantime, RNIB is developing a report that will prove the importance of AA and demonstrate why it should remain, which will be used to lobby the national Government. Mr Winyard described the AA as ‘a beautiful example of an individual budget’ due to the flexible way that it can be spent by benefit recipients to meet their precise needs.

posted by Cheselden Continuing Care at
13:09

On 5 August, the Guardian newspaper held a roundtable, sponsored by the Department of Health, to allow disabled people and the organisations that represent their rights to discuss the recently-published Green Paper on social care. Overall, the participants voiced their support for the introduction of a new social care service that is presented in the Paper, entitled ‘Shaping the future of care together.’ But they felt that the scope of the paper focused too much on caring for elderly people at the expense of younger disabled adults. Issues discussed at the roundtable included:

• The language used in the Green Paper, which some felt was patronising to disabled people and younger adults. Terms such as ‘national care service’ and being ‘looked after’ were seen as contrary to the outlook of most young disabled adults who want to be independent and included in society.
• A concern that the Paper implies through its tone that the cost of funding care for younger adults is a burden rather than an investment.
• The Government’s encouragement of people to participate in the Big Care Debate was seen as an opportunity to effect cultural change and to get the rights of disabled people to be reflected in mainstream Government policy.
• The roundtable liked the idea that, further to a single needs assessment, their care package would be ‘portable’ and they would be entitled to the same level of care funding wherever they lived in England. However, it was noted that the Paper did not refer to any specific services that an individual could expect to receive from the national care service. Participants also pointed out flaws in both of the proposed methods for setting funding levels – locally and nationally – and expressed concerns that adopting either method would not eradicate the current ‘postcode lottery’ of care funding and standards.
• Although the roundtable was told that the Government does not intend to abolish the Disability Living Allowance (DLA), some people were worried about the intention to re-allocate funds from Attendance Allowance (AA), a similar mobility benefit for those aged 65+. However, others considered that funds currently spent on AA might be better spent elsewhere.

To read the full article about the roundtable discussion, visit the Guardian’s website.

posted by Cheselden Continuing Care at
14:13

Charities campaigning for the rights of elderly and disabled people have raised concerns about the proposed scrapping of the Attendance Allowance (AA) benefit to help fund the reformed adult social care system. The plans are outlined in the Green Paper published on 14 July which states: ‘In developing the new system we think that there is a case for drawing some funding streams together to enable us to deliver the new and better care and support system we want to create. We think we should consider integrating some elements of disability benefits, for example attendance allowance, to create a new offer for individuals with care needs.’ AA has been targeted as it is a non means tested benefit that is provided on the grounds of an individual’s disability and not their availability to pay for care. AA is designed to help disabled people to meet the extra costs associated with limited mobility, such as adapting their homes or buying a wheelchair. The Green Paper proposes to replace its universal availability with a discretionary social care grant that would be means-tested by local authorities. However, the new system would not convey the advantages that are associated with qualifying for AA such as increased access to other benefits (such as council tax benefit) and a higher allowance rate for carers. Many older disabled people would be likely to end up worse off under the new system. The RNIB has expressed concern that many of its clients who rely on AA would not qualify for any funding at all as their needs are often classed as low or moderate. Michelle Mitchell of Age Concern and Help the Aged added that AA is vital to help people stay independent and in their own homes rather than needing residential or hospital care, commenting: ‘That extra bit of help may help prevent or delay the need for more formal care.’

posted by Cheselden Continuing Care at
13:15

The Guardian has questioned why the option of ruling out funding social care through general taxation has been ruled out in the recent Green Paper on the future of social care in England. Their article points out that, during the research that preceded the Green Paper, many people were found to be in favour of this option. Despite this, the Green Paper states that ‘This is ruled out because it places a heavy burden on people of working age.’ This argument is described as ‘Orwellian’ by the Guardian, which comments that older people are tax payers too and are increasingly being expected to stay in employment for longer – and therefore pay more tax. At the launch of the Green Paper, the Guardian asked David Behan, the Department of Health’s director general for social care why this widely-supported option was dismissed whilst other funding options with ‘a limited evidence base’ were included instead. Mr Behan stated the need to maintain equality and fairness between the generations, but acknowledged that the issue of funding through general taxation would arise during the consultation process – implying that this option could be ruled in again. To read the article in full, visit the Guardian’s website or click here to read a full or abridged version of the Green Paper.

posted by Cheselden Continuing Care at
13:12

Further to the publication of the social care Green Paper, the House of Commons has set up a select committee to investigate ways that residential and domiciliary care will be provided and funded in future. It will also look at how social care services can be personalised, so that individuals have greater control over the care that they receive, for example, in the form of care budgets that they can spend as they wish. The committee is inviting social care organisations and experts to submit written evidence to the committee on how they think these services should work and be funded. The deadline for submission is 1 October 2009. The committee also intends to hold a series of consultation meetings, with the dates still to be confirmed. To find out more, visit Parliament’s Health Committee website.

posted by Cheselden Continuing Care at
13:42

In response to the recent Green Paper, the University of Leeds and the Bow Group have published new research which demonstrates the benefits of introducing telecare to the social care system. Telecare involves remotely monitoring an individual’s condition so that changes are picked up and treatment administered at the earliest possible stage. It has been proven to help prevent unnecessary hospital admissions, enable earlier discharge and significantly save on care resources and costs. Patients also benefit by being able to stay in their own homes for longer, rather than having to move into residential care, as they have the reassurance of being constantly monitored. The Telecare system consists of wireless sensors which communicate with a base unit that is linked to a 24 hour monitoring and response centre. As well as changes in health conditions, the sensors can also pick up on risks such as falls, fire, gas leaks and security – helping to prevent accident or injury. The behaviour and movements of dementia patients can be monitored to ensure that they do not do anything or go anywhere that might endanger them or others. Telecare fits in with the Government’s commitment to providing more people with care in their own homes, greater independence and dignity, and increased choice over how their care is delivered. Unpaid carers, usually family members, will benefit greatly from the increased support that can be provided as well as the lower costs involved. Professor Sue Yeandle of the University of Leeds urged that the Government acts on its research and makes funding available for the widespread implementation of telecare. She comments: ‘This research evidence clearly demonstrates that telecare is already making an impressive impact in helping sick, disabled and older people remain at home for longer, supporting unpaid carers and saving money in the health and social care system. Progress is being held back because of a lack of investment, low awareness among health and social care staff and access which is limited by eligibility criteria.’ You download Professor Yeandle’s research report by clicking here.

In related news, the technology trade association Intellect has launched a project called ‘Fitting IT all together’ which sets out the technology industry’s view on health and social care, and which calls for more openness and transparency, a roadmap to support joined-up working, and earlier engagement with industry. You can read or download the ‘Fitting IT all together’ paper at Intellect’s website.

posted by Cheselden Continuing Care at
13:39

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.

posted by Cheselden Continuing Care at
13:32

The Conservative and Liberal Democrat parties along with campaign groups have attacked Labour further to the publication of its long-awaited Green Paper on the reform of adult social care, published on 14 July. Labour has been accused of sidelining the issue for 12 years and then raising it shortly before a General Election is due to occur (2010) which means that any reforms that are approved will be delayed or may never happen. It was also pointed out that the proposals covered in the Paper are for long-term reform only and do nothing to help those that are struggling with the costs of care at the present time. On Labour’s current timescale, the first of any implemented reforms would not take effect for another five years – leaving those who are already retired or are about to retire with little hope of being able to benefit from them. Dot Gibson of the National Pensioners Convention commented: ‘The fact that it has taken 12 years for the Government to come up with any proposals – with the prospect of up to another five years before any legislation, is a terrible betrayal of Britain’s pensioners and their families. In the meantime, the system continues to crumble and older people continue to receive a second-class service.’

Shadow Health Secretary Andrew Lansley was also critical of the fact that the Green Paper is merely a consultation document and that no costs were presented for the options detailed within it, commenting: ‘We don’t need to start another debate. One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis of that decision.’ If elected, the Conservatives have their own plans to overhaul long-term care funding and have stated their aim to stop people being forced to sell their homes to pay for care.

posted by Cheselden Continuing Care at
13:07

The Health Service Journal has raised concerns that the new national care service put forward in the recent social care Green Paper will pit the interests of the NHS against those of local authorities. The Paper aims to achieve better co-ordination and working between health and social care services in England. However, a conflict could arise around how funding levels are set. The King’s Fund supports the idea of the Government determining funding levels for each region as this would help to eradicate the current ‘postcode lottery’ and ‘…might also be better for the NHS because there would be less unmet need.’ But Liberal Democrat MP David Rogers, chair of the Local Government Association, considers that a national system would ‘destabilise the whole of local government funding and won’t take into account factors that lead to huge variations in the cost of care’. This could lead to increased strain on the NHS rather than being ‘better’ for it.

Another issue is the proposed abolition of Attendance Allowance, a non means-tested benefit that is worth £3.7 billion to 1.4 million older people. The £3.7 billion saving has been earmarked as a way of partly funding the reforms put forward in the Green Paper. But Stephen Burke of the charity Counsel + Care warns of the implications of abolishing the benefit, commenting: ‘Rather than a discussion on how we pay for care in the longer term, we may see instead a massive rearguard action to defend this benefit, which is very popular.’

posted by Cheselden Continuing Care at
13:05

Below is a selection of official responses to the Green Paper on the future of adult social care in England that was published on 14 July. To read Cheselden’s official response, click here. [link to response in Media section]

Social and health care sector responses

‘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.’

Dr Peter Carter, chief executive of the Royal College of Nursing

‘Sharing the financial responsibility is the only way that good social care can be afforded. The case for change has been made and we must all respond to the green paper because there are huge implications. This is a long-term issue; it’s about what happens over the next quarter century and it also affects the NHS, housing and benefits.’

Allan Bowman, chair of the Social Care Institute for Excellence

‘The green paper, we hope, points the way towards ending a system in which people find it hard to understand what they are entitled to and what financial contribution they will have to pay towards the cost of their care. Any new system which emerges must be open, transparent about costs and what people can expect to pay and are entitled to receive wherever they live. And it must enhance the continued transformation of social care in a way which helps individuals take greater control of their lives, and care budget.’

Jenny Owen, president of the Association of Directors of Adult Social Services

‘The current system of care is unsustainable in the future and even today has woeful inadequacies… There has been chronic under funding of care services for decades. The sector can rarely put into place the improvements it wants and its customers will expect. A National Care Service in England must also go hand in hand with improvements in quality of care. We urge people to respond to this green paper and to highlight that any new system must drive up quality if it is to command the confidence of citizens.’

Professor Jill Manthorpe, director of the social care workforce research unit at King’s College, London

Charity responses

‘Creating a national care service on a par with the NHS is just what this country needs to meet the demands and expectations of our ageing population. Filling the care gap is one of the biggest challenges we all face. We simply can’t do nothing and ignore the needs of this and future generations of older people…Any new funding system must be fairer, simpler and transparent for all. A ‘care duty’ on people’s estates as a one-off payment to fund comprehensive care has the hallmarks of a better system. Better care is key to building a better country for everyone.’

Stephen Burke, chief executive of Counsel + Care

‘What we need to do now is to test these ideas with the public and importantly, with families – disabled and older people and the people caring for them. They need to tell us what they think will work. It is time for the public to make their views heard in this big care debate. We must make this one of the most important policies of the decade since it touches so many people’s lives.’

Imelda Redmond, chief executive of Carers UK

‘High quality care must be available to all who need it regardless of where they live and whether they are rich or poor. With time now short, the government must set out a clear timetable to move from debating options to agreeing and implementing specific proposals.’

Michelle Mitchell, director of Age Concern and Help the Aged

‘Today the Big Care Debate begins on three new models of funding social care, an essential lifeline for millions of people. Only a system that delivers good care at a fair price will succeed. Currently, if you are unfortunate enough to be amongst the one in three people over 65 who die with dementia you could face enormous bills for poor quality care. This is a gamble people shouldn’t be forced to take…A national care service is a bold vision and it will take courage to see it through. It cannot afford to fail.’

Neil Hunt, chief executive of the Alzheimer’s Society

posted by Cheselden Continuing Care at
12:48

Health secretary Andy Burnham gave the background to the Government’s Green Paper on adult social care reform, published on 14 July 2009, in an interview with GMTV that morning. ‘We have an ageing society and it is a cruel lottery – some people end up paying lots of money in their later years to look after parents and some 50% of us end up paying more than £25,000 every year. A very small number, particularly those who develop, say, something like Alzheimer’s, can pay up towards £200,000 over their lifetimes.’ Mr Burnham went on to describe how, using the Green Paper as a starting point, he intends to overhaul the current system of adult social care so that it is fairer for everyone whilst providing a higher standard of care. Referring to the estimated 45,000 people per year that have to sell their homes to pay for care, he commented: ‘If we can get to a system that is fair and universal, that doesn’t put pressure on people to do that [i.e. sell their houses], then that is a huge step forward.’ Although he admitted that Labour ‘should have grasped the nettle’ of social care funding earlier, Mr Burnham announced that the Government has increased funding by £40 million, much of which will be paid out in the form of direct payments and personal care budgets that allow service users greater control over the type and location of their care. You can read the Green Paper and find out how to join in the consultation process at the Care & Support website. You can also read a summary of its contents on the Cheselden website as well as our official reaction to the Paper.

posted by Cheselden Continuing Care at
12:32

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.

posted by Cheselden Continuing Care at
11:57

A political storm has blown up around the long-awaited Government Green Paper on the reform of social care funding – and publication has been delayed once again. The Paper is now expected on 14 July. The latest delay is allegedly the result of a Whitehall row over some of the proposals made in the Paper, which it is feared could be viewed by the public as a tax raid. A particular area of contention is a proposal which plans to abolish two benefits that can be claimed by disabled people – Attendance Allowance and Disability Allowance – and which are worth £10 billion per year to claimants. These non means-tested benefits, which are available to anyone who meets certain disability criteria, would be replaced by a discretionary social care grant for those that are most in need. If this proposal goes ahead, the move will represent a retraction of the Government’s statement in the 2008 ‘Cause for Change’ document that ‘any changes that emerge (from the Green Paper) will not affect existing benefit recipients.’ Fears over reactions from the public and from charities supporting the rights of disabled and elderly people are believed to have caused the Paper’s publication to be blocked by work and pensions secretary Yvette Cooper.

Both the Green Paper itself and the inability of new health secretary Andy Burnham to force its publication have attracted heavy criticism from the Conservative party, which is planning its own reforms for social care funding should it succeed in the 2010 general election. Shadow health secretary Andrew Lansley comments: ‘Unlike the government, we will set out a clear plan for change for both the providers of social care and the 45,000 people who are forced to sell their homes every year to pay for it.’

The key aims of the Green Paper are to reform social care funding in ways that make the funding system more efficient and fairer for everyone that uses it. Allan Bowman of the Social Care Institute for Excellence comments on these goals: ‘We’ve got to end this postcode lottery in social care and we’ve got to find a way of achieving a national approach, that ensures people get the best quality of care at whatever fair price can be achieved.’

posted by Cheselden Continuing Care at
16:25

A Whitehall source has revealed that the Government’s long-awaited Green Paper on the future of social care funding is likely to introduce new measures that will no longer require pensioners to sell their homes to pay for the costs of residential care. Instead, the discussion document will put forward a range of other options to plug the £6 billion care funding gap that is expected to appear within 20 years. These are likely to include a compulsory insurance policy that everyone of working age will pay into and a one-off levy of around £12,000 to become payable on retirement or death. A further possibility is the concept of co-payment, where the Government provides a basic level of funding for everyone regardless of status and ‘top ups’ from wealthier individuals help to subsidise the cost of caring for poorer people. The Whitehall source claimed that the Government is keen to find ways of funding care that do not necessitate house sales or depletion of life savings, both viewed by the public as highly unfair and representative of the current care system’s worst failings. With an estimated 45,000 homes sold in 2008 to fund care costs, the proposals received a cautious welcome from charities campaigning on behalf of the elderly. Conservative MPs were more sceptical, claiming that the timing of the Green Paper will prevent or delay the passing of actual legislation due to an impending general election next year, with shadow health minister Stephen O’Brien commenting: ‘…it looks like, once again, they (Labour) are kicking the issue into the long grass.’

As well as looking at ways for funding residential care, the Green Paper will also tackle issues including:

• How personal care provided in the home (domiciliary care) is funded
• Ways to help elderly people stay independent and living in their own homes for longer
• Giving elderly and disabled people greater choice over how and where their care is provided.

It is expected to be published on 7 July with the consultation period continuing until October 2009.

posted by Cheselden Continuing Care at
16:00