Tag Archives: white paper

Care funding commission must consider all adults

Here we go again. Today sees the launch of the latest Commission on the Funding of Care and Support (catchy title) for adults.

We’ve been here before, most recently with last year’s Big Care Debate. That got as far as a White Paper before the election, but as soon as the government changed the proposals were swiftly dropped. So we’re back to square one. Again.

Nevertheless, the new commission has been detailed to report back within a year. Health secretary Andrew Lansley expects legislation in front of Parliament next year, and it will eventually form part of a larger White Paper that also takes in the Law Commission’s work on creating a single modern statute for social care, and the Government’s vision for social care.

The commission will focus on:

  • The best way to meet care and support costs as a partnership between individuals and the state
  • How an individual’s assets are protected against the cost of care
  • How public funding for the care and support system can be best used to meet needs
  • How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.

The politicians have, as usual, made all the right noises about this; for instance, Lansley said; “we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term.”

All regulation political guff and nothing that anybody disagrees with; it’s just that successive ministers have said this for some years, so its hard not to feel cynical.

But reading between the lines, service users should not get their hopes up that reform will improve things too much. As care services minister Paul Burstow said: “Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Trade offs? Is that a euphemism? To me, that is a subtle way of saying that to get to a solution, some existing ways of being funded may have to be axed/cut back. However, this is just speculation on my part – I may be reading too much into it.

But the commission does take place against the backdrop of swingeing budget cuts and this will form a major spoke in their thinking, hence why a leading economist, Andrew Dilnot, has been chosen to chair it.

He will be assisted by the CQC’s Dame Jo Williams and Lord Norman Warner, a Labour peer and former director of Kent social services – and also an outspoken critic of Gordon Brown’s free personal care at home policy earlier in the year – who will help to ensure that the commission does not just focus on the numbers.

As with the last commission, a range of funding options will be assessed, including a voluntary insurance scheme, as favoured by the Conservatives, and a partnership of state and individual contributions, the Liberal Democrats’ preferred option. No mentions of a compulsory levy – aka Labour’s “Death Tax” – being considered in the press release however, so we can assume that that won’t be an option.

But if this is to be successful the commission has to look at funding care for all adults. One of the criticisms of Labour’s last attempt was that it focused too much on older people – especially the voter-winning solution to people having to sell their houses to pay for care – with people with disabilities sidelined.

While older people do make up a significant proportion of those receiving care services, those with disabilities are just as important and any solution has to appreciate their needs and circumstances as well.

The solution also must been seen to improve – or at the very least not cut – services, if it is to get widespread acceptance from the public. Again, this will require doing more with less – a neat trick if you can pull it off.

But what the commission must do above all is to come up with a conclusion. The Big Care Debate had 3 options, but no one option was significantly ahead of the others. This commission should look at all the options and consult widely with frontline workers and service users before making a decision – and then sticking to it.

Coming up with a solution to funding adult social care is not going to be easy – otherwise it would have been done years ago – but this time it needs to happen. However, while some tough choices will have to be made – the financial situation is inescapable – the option of doing nothing is even worse for service users.

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NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

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Back to the future for social care

I had a peculiar sense of déjà vu reading new care services minister Paul Burstow’s interview in the Daily Telegraph the other day. While spoke about his hopes – and the need – for reform of adult social care, I had the funniest sense I’d heard it somewhere before.

Maybe because I have; about the time the green paper on adult social care was first mooted by the old Labour government a few years back. And a various points since then, up to and including the run-up to last month’s election (Doesn’t it seem a long time ago now?).

In the Telegraph interview, Burstow – who has a decent reputation within the sector – spoke of the need to find “a sustainable funding settlement for social care” and to reform a system that will soon become “not fit for purpose”.

Nothing new there. Many commentators – as well as service users and workers in the sector – have been saying this for years, to no avail.

There is also nothing new in his outline for the funding options that will be discussed by the upcoming independent commission; a voluntary scheme, a partnership scheme where state and individuals contribute, and a compulsory levy after death – yep, Labour’s much-derided ‘Death Tax’.

This is something of a turnaround for the government, which only referred to the partnership and voluntary models in its coalition document, released just a couple of weeks ago.

But what is new is a little detail on the timescale for reform. Those of us who thought that the coalition’s plans kicked the issue into the long grass now know how far; Burstow wants the soon-to-be-formed independent commission report back on funding options within a year, with a White Paper ready by autumn 2011.

He admits this is ambitious, but necessary as the Baby Boomers hit old age.

Nevertheless, it is good to see a timescale being laid out, even if it isn’t the one most people involved in the sector would have liked – in an ideal world reform would already have been carried out.

Also, carrying on with the positives, Burstow does seem to have a good handle on what needs to be done – saying it would be wrong to fixate on the problem of older people having to sell their homes to pay for residential care, something that the last consultation seemed to, almost with an eye on the upcoming election – and is willing to consider a range of options.

But what the independent commission comes up with remains to be seen – as does how different it will be to what came out of last year’s Big Care Debate – although the rumoured presence of economists on it suggests that it may be geared towards saving money.

Again, it feels like we’ve been here before. So while this could easily be a false dawn – and there have been enough of those over the years – at the moment, it is probably best to give the benefit of the doubt to the government, while all the time reminding them of what is needed and why, and to call them to account if they let the sector down.

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What will new government bring for social care?

After all the courting of the past few days, the Conservatives and Liberal Democrats have finally decided on a political marriage. But what will this mean for social care?

Now the dust is settling, here is a little of what is known, plus some conjecture and guesswork.

Firstly, it means that Labour’s plans for a National Care Service are dead. The Tories always opposed it, and the Lib Dems also had problems with it, so it’s a definite no-go. This means that social care will go back to square one, waiting again for the reform it so badly needs.

On the upside, it looks likely that plans for a set of national eligibility criteria for social care services, proposed by Labour, will be brought in as the coalition parties also both support it. This should end the ‘postcode lottery’ of unfairness in social care and can only be a good thing.

Now, things become less clear; we know there will be big public sector spending cuts in the Budget, which will probably be in June. Both parties have denied that it will hit frontline services, but councils will have to make some big savings and services could be hit – such as scrapping some services that are not perceived to deliver value for money – and eligibility criteria could be ramped up again.

I suspect that a new White Paper on the future of social care may be commissioned in the near future. The Liberals are in favour of (yet another) commission on reforming care funding, but the Tories aren’t, so action may come relatively quickly – we all know the problems in the sector, they just need to be addressed.

Whether the Conservatives’ stated plan for a voluntary £8,000 insurance scheme to pay for elderly residential care comes to pass remains to be seen.

Both parties were relatively light on detail about reform in their respective manifestos, but there were differing ideas, such as the Lib Dem idea of giving all carers one week of respite, so it is hard so say in which direction the government will go.

Also, remember there were the secret cross-party talks about the future of social care earlier in the year – which Andrew Lansley, the new health secretary, scuppered – could anything come out from that?

Hopefully in the coming weeks we will hear something more concrete about what will happen to social care. The sector needs reform quickly, so the coalition needs to work together to find the best solution – whatever that is…

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White Paper reflections

It is now a day since the White Paper came out, and the response from the media, social care organisations and rival political parties has been quick and, in the main, fairly critical.

The White Paper was given short shrift by most of the mainstream media. While its aims of creating a National Care Service were seen as laudable, many focused on the delays to making changes, how it would be paid for – and by whom – and the lingering “Death Tax”.

Those that gave the White Paper the most enthusiastic welcome tended to be the organisations that are government-backed. To paraphrase Mandy Rice-Davies, well, they would, wouldn’t they?

Charities and third sector organisations seem to have generally given the White Paper a good welcome, but again question where the money will come from for it.

Meanwhile, think tank the King’s Fund – an advocate of the partnership approach before the paper came out – welcomed the ‘ambitious’ plan, but questioned where the money to do it would come from, calling for detailed proposals urgently.

I reckon the King’s Fund was spot-on.

Now I’ve had time to reflect, it seems clearer that the White Paper has been geared to the election – it is big on ideas, but short on detail. Style over substance, if you will.

I really like the idea of the National Care Service – its aims are laudable and it is something to be aspired to. In an ideal world it would be here already.

But – and it’s a big but – I cannot work out how it would be paid for, without having to raise taxes, impose compulsory levies on the public or take money from other budgets. Nether, I suspect, judging by the content of the paper, do the government.

Also, given that the original aim of its preceding green paper was to address the funding of adult social care – with the hope that it would get rid of the current means-testing system – it has singularly failed to do it.

Indeed, the whole question of funding was fudged, with a call for another commission to be set up to investigate the best ways. Evidently the government didn’t want to be associated with any new taxes before the election, so has kicked it into the next parliament.

As a result, the system will creak on, as it has done for years, hated by many. A chance for genuine – and needed – reform of the funding system has been lost, sacrificed at the altar of electioneering.

For me, that clouds all the good ideas contained in the White Paper.

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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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What will be in the white paper?

After what seems like an eternity, the adult social care funding White Paper will finally be published tomorrow. So what will be in it? Here is my bit of crystal ball gazing…

Firstly, it will lay out Labour’s plans for a National Care Service that provides clear national entitlements for everyone, rather than the current postcode lottery. This was first mentioned in last year’s green paper and the idea at least was widely welcomed. The White Paper should flesh out exactly what that might entail and the funding for it.

The free personal care at home policy will also be in there. This has been championed by Gordon Brown and there isn’t a chance it will be dropped now, although the timing of its introduction may be put back until after the election.

In terms of funding, I expect that a ‘partnership’ model – where the state pays a portion of care costs and the service user pays the remainder – will be proposed. In the debate over funding, this seems to have garnered the most support and is something of a ‘middle’ way – and less politically divisive than, say, putting a levy on the estate of every person.

That option is a non-starter because the Conservatives branded it the “Death Tax”. Leaving aside whether it is a good idea or not, the negative publicity already around it would make implementing it political suicide.

Funding will probably be the most controversial part of this; while it is widely accepted that the current adult social care system needs to change, funding it is the tricky bit. For instance, the free personal care at home policy has been consistently lambasted because nobody believes the government’s estimate that it will cost £670 million – some say it could be more than £1 billion.

In addition, setting up a National Care Service, and contributing to everyone’s care costs, will cost billions. In a time where government departments – including the Department of Health – are scrabbling around trying to save billions, you wonder where the money would come from.

And then there is the election. The white paper will probably become a large spoke of the election campaign, which will be a bad thing. As I’ve mentioned previously, cross-party consensus is needed if the best solution for the public is to be reached. With an election, and all the ‘our policies good, your policies bad’ mudslinging that comes with it, this is out of the question.

Of course, the election also means that the White Paper may come to nought if Labour is ousted from power. The Tories have suggested they may go for another consultation before they do anything. If there is a hung parliament, who knows what will happen to it?

So, with that in mind, tomorrow’s White Paper may make promises, but it is by no means certain that essential reform will come to the sector just yet.

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