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.

The Department of Health has published a report outlining its 5 year plan for reshaping the NHS. Entitled ‘NHS 2010-2015: from good to great. Preventative, people-centred, productive’, the report tells how the NHS plans to meet the country’s increasing care needs whilst dealing with the financial constraints of the recession. Its publication comes in the wake of a recent report from the charity Age Concern, ‘Waiting for Care’, which describes how current NHS targets and initiatives are not meeting the most pressing needs of the UK’s elderly population.

Chapter 2 of the NHS report describes how it will deal with the health and social care issues posed by the UK’s ageing population, in particular long-term health needs, by focusing on preventative medicine, more personalised care with greater patient choice and wider access to community care. Specific measures that will be implemented include:

• Individual strategies to tackle the five most common long-term illnesses: respiratory disease, diabetes, heart disease, asthma and dementia. Notably, the report proposes reducing the use of anti-psychotic drugs to treat dementia by a third over the next 3 years.
• Support for patients to ‘self-care’ at home, reducing traumatic hospital admissions and allowing better management of their condition.
• Joint working with social services and wider access to services such as GPs, to provide better community support.
• Tackling all forms of discrimination, including ageism, and promoting patients’ rights to safe, effective treatment.
• Introducing the National Care Service from October 2010, which will include free personal care at home to all elderly people that require it, helping them to stay independent for as long as possible.

The report can be read in full or downloaded from the Department of Health’s website.

posted by Cheselden Continuing Care at
08:16

The Queen’s speech at the state opening of Parliament on 18 November – the last before the next general election – has echoed Gordon Brown’s recent pledge to provide free personal home care to the UK’s neediest elderly and disabled people. Around 280,000 people can expect to benefit from the move – although 160,000 of these already receive free home care. However, a further 130,000 could receive cash from a second initiative, the ‘re-enablement allowance’, which would provide funding to help people live independently in their homes for longer, through adaptations such as stair lifts. The changes, which will form part of the new National Care Service, will be rolled out from October 2010 if Labour remains in power. However, charities including Counsel + Care and Age Concern and Help the Aged have questioned the Government’s ability to fund these new services, which would cost an estimated £670m per year. They have also criticised the proposed system’s failure to benefit the UK’s 400,000 care home residents as well as voicing concerns that many younger disabled adults could potentially miss out on funding. Jane Ashcroft of the English Community Care Association commented: ‘It is unhelpful to just have one piece of the jigsaw. Ultimately, the proposals could lead to an even greater drain on public resources without having a tangible impact on the quality of life of our older people.’

posted by Cheselden Continuing Care at
10:00

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

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

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

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