Small print reveals continuing costs of residential care

So, Conservative shadow health secretary Andrew Lansley has pointed out that the government’s plans for funding residential care doesn’t include the ‘hotel’ costs of it.

For those of us that have followed this closely, this is not a revelation. This debate is about paying for care – board and lodging doesn’t come into it. When the green paper on adult social care funding was released last June, some people in social care pointed out that the proposals wouldn’t mark the end of people having to sell their house to pay for care. Interestingly, at the time, this was largely ignored.

Even in Scotland people in residential care have to pay ‘hotel’ costs – something which isn’t pointed out as often as it should be when people in England moan about ‘free’ care north of the border – and older people do still in some cases have to sell their house to pay for it.

But with the government set to shelve plans for the “Death Tax” this week, according to the Guardian, this seems to be the latest attempt to derail plans for reform.

Again, Lansley seems to be at the heart of this. While this smacks of another attempt at cheap political points-scoring ahead of the looming election, it does raise (albeit in a not-too-helpful way) a legitimate point.

One of the aims of any reform of adult social care funding, according to government messages when the green paper came out, is to eliminate people having to sell their homes. The options listed in the paper didn’t seem to do that.

It is still a problem – many voters see the practice as unfair and penalising those who have worked to own their own homes and leave an inheritance – and if it isn’t addressed many will see any white paper as a failure.

However, the green paper was only a consultation, and the white paper – apparently coming this week – may have a solution. We shall wait and see – and expect Labour’s opponents to seize upon it if it doesn’t.

Can England afford free personal care?

This will have set alarm bells ringing in Westminster this morning; Harriet Dempster, president of Scottish social work body the Association of Directors of Social Work, has admitted on radio that Scotland may not be able to afford its policy of free social care for all elderly people for much longer.

With costs for the policy rising – it was up 11% last year to £358 million – and swingeing budget cuts on the horizon, Ms Dempster said the policy may have to become means-tested.

Ms Dempster has called for a debate on the policy’s medium to long-term viability, including whether more well-off elderly people could afford to pay for services. In response, the Scottish Government has said it remains committed to the policy.

The Scottish experience should be heeded by ministers in England as they consider introducing a similar programme, as outlined in its Personal Care at Home Bill earlier this week. The government says that it “will cost £670 million per year”, but these have been widely questioned.

Indeed, the £358 million cost of the Scottish scheme is for only 50,000 people; the English version could cover up to 280,000 people with ‘substantial and critical’ needs. So if the costs were the same on both sides of the border – they won’t be, but this is just for example purposes – in England that could mean the policy costs about £2 billion per year. This figure doesn’t include the further 130,000 people who will help with ‘re-ablement’ in order to regain their independence and prevent ill health.

If – and it’s a big ‘if’ – the policy did come in, that £2 billion figure would quickly rise, simply because of demographics; the UK has an ageing population so more people would need it in time.

Again, with budget cuts coming, where would the money for this come from without making cuts to other services? Answers on a postcard please…

When free social care isn’t really free

Continuing my recent theme of social care funding (or lack of it), this story from the Financial Times website on Sunday – and oddly, not really picked up by anyone else – caught my eye.

In it, Lord Lipsey and Lord Joffe – 2 former members of the Royal Commission on Long Term Care – attack Gordon Brown’s plan for free personal care for all. They claim it would create ‘perverse incentives’ for people to stay in their own home, where they would have care for free, rather than going into a care home, where they would have to pay.

While these 2 have form here – their 1999 minority report rejected the Royal Commission’s proposal for free personal care, for instance – they do have a valid point.

In Scotland, where there is already free personal care (it isn’t totally free, as some think, but that is another blog for another day) the costs of it have far outstripped the initial estimates and there are fears over the sustainability of the policy.

The government reckons this policy would cost £670 million, but given the Scottish experience it could be far higher and, given the state of public finances currently, I’m struggling to work out where the money would come from without affecting other services.

Cynics might say that the policy is just an attempt to win votes at the next election – it is said that it was dropped into Gordon Brown’s conference speech at the last minute – but if it works, it could have adverse consequences for other social care services, something they can literally ill afford.