Tag Archives: free personal care

Adult social care White Paper: good points but short on funding detail

For all Andy Burnham’s fine words about following in the footsteps of Bevan and establishing a National Care Service, the White Paper – Building the National Care Service – doesn’t address the main problem with social care – and the original purpose of the green paper last year: how it is paid for.

But first, the good points:

The proposals for a National Care Service – free at the point of use, given according to need, with the principles of being universally accessible, having a strong national framework locally delivered, being preventative and flexible, with support for carers, and information and advice for all – is admirable.

Social care has – as the government admits – lagged behind other sectors, such as healthcare in terms of provision. It has never had a national structure and one is well overdue. It is hard to argue with the government’s aims here.

The commitment to put in place nationally consistent eligibility criteria for social care – enshrined in law – is one that many have been crying out for. The ending of the postcode lottery will go some way to addressing the perceived unfairness of the current system.

Likewise, ensuring accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone, and improving the gateway for accessing social care and disability benefits to make it simpler and easier for people, are also welcome and long-overdue developments.

Keeping Attendance Allowance and Disability Living Allowance also shows that the government has listened to some outcomes from the Big Care Debate – getting rid of this would have proved very unpopular.

The continuing commitment to the personalisation agenda – in giving service users choice and control – will also be welcomed by the majority, not least social workers who may have feared yet more upheaval.

But on the downside…

It also talks about people in residential care only having to pay their own fees for 2 years. Fine, but the average time spent by an older person in residential care is 3 years, so they would only get one year ‘free’.

Also, while people in residential care would still have to pay their accommodation costs, there is a commitment that no-one will have to sell their house to pay for care within their lifetime. With a deferred payment plan, their family may have to pay for it out of their estate after their death.

This leads neatly to the crucial bit – and one I suspect made with an eye on the election – no decision on the funding of the National Care Service will be made until 2015 at the earliest. Not so much kicking it into the long grass but the jungle.

This is where the White Paper falls down. The social care sector has been creaking along with the much-hated means testing system for years. It is widely accepted that the system needs reform – mostly because it is too complicated and perceived as unfair in some cases – and while it says it will address this, it doesn’t say how.

The government still leans towards some sort of compulsory levy – which means the so-called “Death Tax” isn’t dead – but is not specific on what. Indeed, they have called for a new commission to look at when and how the fee should be applied, and how much it should be. But wasn’t that the original aim of last year’s green paper?

However, in fairness, there wasn’t a great deal consensus on funding. Andy Burnham revealed that, of the 3 funding options outlined in the green paper, 35% favoured a partnership approach, 22% opted for an insurance model, while 41% backed the comprehensive approach.

Meanwhile, the Conservatives are still talking about their £8,000 voluntary insurance scheme to pay for all this. As mentioned before, this doesn’t seem to be enough and I doubt enough people will sign up to it, knowing it is something they may not need in the future.

So, much-needed reform is on the way for the social care sector. While the proposals are great in principle, I can’t help but worry how all this will be paid for – there is precious little on that.

Also, the lack of political consensus on this – the Tories branded the White Paper a ‘train crash’ in today’s Daily Mail – means that after an election we could be back to square one again.

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Free elderly care tax rises warning

Ever since Gordon Brown announced plans to give free personal care to the elderly late last year, the policy has faced a sustained barrage of criticism. And it isn’t showing any signs of stopping.

While in theory, free personal care for the elderly in their own home sounds like a great idea, the practicalities of it could well outweigh the benefits, according to leading figures in social care.

One of the major bugbears is the cost. The government reckons it’ll cost £670 million, but nobody else seems to; the vast majority of commentators think they have significantly underestimated.

Where the money will come from is another bone of contention. There is no new government money for this, it will come from a variety of sources; the majority, £420 million, will come from existing Department of Health budgets, while local authorities will provide the remaining £250 million from ‘efficiency savings.’

‘Efficiency savings’ is a woolly phrase at the best of times, but it is particularly worrying for council leaders because they are already trying to find millions of savings in anticipation of swingeing budget cuts in 2011.

Now some, including the heads of Hampshire and Essex councils, are publicly warning that to pay for the policy could mean council tax rises of a couple percent – never popular among the public, even less so when there is a recession on – or cuts to frontline services.

But the objections are not solely for financial reasons. A senior figure within social care told me that the policy could create perverse incentives for people to not go into residential care; if they went into a care home, if they have assets worth in excess of £23,000 they would have to pay for their place, whereas in their own home, care is free.

As a result, older people could stay in their own home for longer than it is really safe for them to do so, and could also become isolated, if they are housebound. Is that really a better option than residential care, where they have round-the-clock care, plus the company of the staff and other residents?

However, this unpopular policy may never make it into force. Lord Lipsey, a Labour peer – and vocal critic of the bill – believes that it has no chance of coming into force before the election. What happens after will depend on which party wins.

There is a feeling among some – including, perhaps inevitably, Conservative health spokesman Andrew Landsley – that the policy was announced to gain political capital.

If what its critics say will happen does, the bill could well end up backfiring on Labour, as well as the social care industry. For everyone’s sake, let’s hope they are wrong.

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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…

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Critics condemn planned cuts to fund free social care plan

Another day, another political row about the government’s free social care at home for the elderly plan. Today, it’s how the plan is being funded.

While the government has been criticised for thus far being oblique about where the money will come from to fund the plan – they estimate it will cost £670 million per year, but others think it will be much higher – now they are starting to say where money will come from, they are garnering more criticism.

Health minister Andy Burnham, as reported in today’s Times on the eve of the publication of the Social Care Bill, says that “£60 million would be diverted from the health service’s research and development budget and £50 million from public health promotions.”

Inevitably, scientists have warned against cutting research budgets. The current research budget is more than £1 billion per year, so that cut is hardly a drop in the ocean.

Research is key for the future of healthcare and should be considered an investment – having drugs that cure is cheaper than the cost of lengthy treatment – and cuts should be avoided if possible.

However, the money will have to come from somewhere – if the Bill actually gets passed before the election, which is not guaranteed – and tough decisions will have to be made about which budgets get cut. It’s what we have government for; they make the hard decisions so we don’t have to.

It could be that funds are found from elsewhere. For example, a productivity drive in the NHS is expected to make up to £20 billion in efficiency savings in the next 4 years, which would more than pay for the Bill.

But wherever cuts come from to fund the free personal care plan, someone is going to be left unhappy. Well, almost; nobody has criticised the plan to save £60 million by cutting down on management consultants. Strange, that.

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Consensus needed on future of social care

As the debate continues over the announcement in yesterday’s Queen’s Speech of plans for free personal care at home for those in most need, what it does highlight is a lack of political consensus over the future of social care.

Leaving aside the debates on whether the announcement was just electioneering or if the government’s got its sums right with the £670 million per year cost, the hammering it got from the other main political parties’ shows that all have different ideas about the future of social care.

Labour has pinned its hopes on a National Care Service, which yesterday’s announcement is a trailer for and has been covered in the recent green paper.

Meanwhile, the Conservatives have mostly criticised Labour’s plans, while their own proposals have been relatively thin on the ground. The main one has been the idea of the insurance scheme, where people would pay £8,000 and then get free personal care as and when they need it.

As for the Liberal Democrats, they have advocated greater integration of health and social care, and that care be provided on the basis of need rather than ability to pay, but nothing much else recently.

It is widely accepted that social care needs overhauling but surely on something as big as this, and that affects so many people, the parties should be working together on it.

After all, service users and social care professionals surely want to know that policies will be consistent and not changed every time a new government is elected – that can be as harmful as doing nothing.

Finding a way forward is difficult – the debates over the green paper demonstrate this – but this should surely rise above the usual politicking for the good of the millions of service users and carers out there. It should, but I doubt it will.

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Queen’s Speech not enough for social care bodies

While the announcement of free personal domiciliary care for those with the greatest need was a central point of today’s Queen’s Speech, finding anyone with a positive outlook on it is difficult.

The combined weight of anti-government feeling and deep-rooted cynicism in the care sector means that the policy has been given a lukewarm response at best.

Critics cite a number of problems that haven’t been properly answered. For example, many question the costs involved; it is said to cost £670 million a year, but nobody seems to believe that. Also everyone wonders where the money for that is coming from – woolly references to ‘costs savings elsewhere in the NHS’ don’t cut it. Some also suspect councils will start to get tougher on what exactly constitutes ‘substantial and critical’ needs in a bid to save money.

It also doesn’t address the media’s perennial favourite topic of people having to sell their homes to pay for residential care. Health minister Andy Burnham admitted on Radio 5Live this morning that when someone needs to move into residential care, they will have to pay for that as they would within the current system.

It is, as Labour admits, an interim measure before the full adult social care white paper is published – but no-one quite knows when that will be, or indeed if it will get published.

The cynic in me wonders if this is just an early bit of electioneering, attempting to embarrass the Conservatives if they decided to ditch the policy, and painting Labour as a ‘caring’ party.

Indeed, whatever the pluses and minuses of this policy, it is still unlikely to make it onto the statute book before the election comes – there are only 70 working days left before the election and Tory peers have vowed to hold up legislation in the House of Lords, if it gets there.

While the idea is good – it could help 400,000 people – it does not solve the social care problem, and this seems to be one of the big criticisms. Social care needs a radical overhaul, and this only goes a relatively small part of the way. The next government – whichever party it is – needs to go much further.

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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.

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