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.

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.

Paying for care still biggest concern for older people

How to pay for residential care is still the biggest worry for older people, their families and carers, according to a new report.

Older people’s charity Counsel & Care’s Care Concerns 2009 reported that 25% of calls to its advice line are about this.

Nothing new in this – it’s been a worry for years – but it shows that the issue will not go away and that reform is needed.

Indeed, the main concerns of older people are pretty much as they have been for years. Here are the top 5, according to Counsel & Care:

• Concerns about whether older relatives or friends starting to lose mental capacity are receiving the most appropriate and high quality care available in the setting of their choice
• Lack of available and meaningful information and advice for older people, their families and carers, particularly those who pay their care costs themselves
• Difficulty accessing the care and support system
• Difficulty navigating the complaints process if you experience poor quality care
• The ever-increasing costs of care and support.

Nevertheless, there are hopes that the government’s white paper on adult social care funding – promised to come out before the election – will address this.

While last summer’s green paper on the future of adult social care funding had some useful suggestions on providing better information for self funders, as well as making the care system easier to access and navigate, it still failed to address one of the most vexed points; people selling their houses to pay for care.

In addition, the government’s free personal care at home bill would go some way to addressing the concerns of older people paying for care, but it only helps those above the threshold for social care funding with high needs and who still live in their own home.

The green paper outlined several options to pay for care costs, from insurance to a mix of state and self funding, but none covered paying for the accommodation costs of residential care, which can still mount up if someone is in care for several years. In that situation, selling their house is still an option.

If nothing else, Counsel and Care’s report is a useful reminder of the main concerns of older people in the care industry and if the government does address these issues, it could leave a long-lasting positive legacy.

Keywords, however, are ‘if’ and ‘could’; if the white paper comes out before the election and if it makes it through parliament. Could, in that nobody knows yet what conclusions the government has come to.

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.

Scandal of selling homes to pay for care

Over the past few days, one of social care’s great recurring stories reappeared, as it seems to do every few months; the ‘scandal’ of old people having to sell their homes to pay for residential care and/or not being funded by the state for their care.

This time, it was the Daily Mail, which ran with a typically hyperbolic headline of ‘3,000 victims of home snatchers: Record numbers of elderly are forced to sell their homes to pay for care’ .

As usual with these stories, the gist was how scandalous it is that people who have worked hard all their lives to save money and/or buy a house now have to lose/sell it to pay for residential care in their old age, while people who never saved get it for free.

Leaving aside the rights and wrongs of this – there are good arguments on both sides – it again shows that politicians cannot afford to ignore this issue.

Social care has been getting a higher profile in recent months – the green paper on the future of adult social care funding was published in June, for instance – but little action has so far be forthcoming.

While Labour has announced its free personal care at home bill, this doesn’t address the problem of people having to pay for residential care and could even create other issues.

For example, it is likely to encourage older people to stay in their own homes for longer, knowing that if they move into residential care they will have to pay for it and possibly give up their home. As a result, some people may not go into care when they need to, and could suffer as a result, whether in the form of injuring themselves in an accident or fall, or in terms of isolation if they are housebound.

And for those who say ‘well, in Scotland they get it free’; they don’t. There, while the care element might be free, the ‘hotel’ costs of residential care – food, board and lodgings etc – isn’t, so many older people still have to stump up money to pay for their care, including selling their home.

This issue is hugely emotive and could become an issue in the upcoming election. Any party that offers a solution to this ‘problem’ would be onto a sure-fire vote-winner.

The options mooted thus far by Labour and the Conservatives involve insurance schemes, which involve paying a lump sum up front. Labour’s idea is a £20,000 scheme, which would cover the costs of personal care at home and residential care, and while the Tories’ response only costs £8,000, it just covers residential care.

The Liberals meanwhile have sat resolutely on the fence, calling for an all-party commission to come up with a solution, rather than posit any ideas of their own.

None of these options seem to have garnered much public approval so the way forward is unclear.

All it does mean is that the current system creaks on and the reform of it – desperately needed, as organisations within the sector have said time and again – is delayed again.

Perhaps if it does become an election issue, then something might get done. If not, then the Daily Mail, as well as the other national newspapers, will have a guaranteed headline article to publish every few months.

Big Care Debate – any closer to a solution?

The Big Care Debate closed last Friday (the 13^th, ominously, for those of a superstitious bent) ending the consultation on the government’s green paper, Shaping the future of care together , which set out the government’s options for the future funding of adult social care.

Now, the Department of Health will go away and contemplate the results, before, in theory, coming back with a White Paper, possibly in early 2010.

But with an election looming, I wonder if any of it will actually get through and make it into law.  

A spokesperson from the DH told me earlier in the year that if there is no consensus from the Big Care Debate on the best way forward, then it may go to a further period of consultation.

Looking at the reactions to the green paper from various groups, there seems to be little consensus; there have been criticisms, notably from mental health and learning disability groups, that the green paper focused on too much on older people. Indeed, much of the media focus has been on old age care funding and people not having to sell their homes to pay for residential care costs.

But then, older people’s groups, such as the National Pensioners’ Convention, have also voiced dismay over the government’s dismissal of the option to pay for care from direct taxation.

This option also found favour in a Joseph Rowntree Foundation survey. But then other organisations have supported the partnership and comprehensive models of funding the government suggested, which involve insurance and some state provision or the creation of a National Care Service.

If this is reflected among the wider responses, then we could be in for further consultation, which neatly kicks the debate into election time, when nothing concrete will happen because every politician will be scrapping for votes.

So, it seems like the social care industry will be in limbo for some time to come. And all the while the current regime will continue to creak along, and the problems within it will continue to mount, and – crucially – service users will continue to suffer at the hands of a much-disliked and over-complicated funding system.