All Change for Social Care in England?

Author: Chris Moon-Willems

After a long career in Social Services and the NHS, I was naturally interested in the publication of the Government's plans to reform social care. My passion for changing the way we care for senior citizens in England also fuelled my frenzied activity between live web coverage, watching the TV and listening to the radio on the day it was published. With the experience of helping my elderly parents manage their personal budget, more recently caring for my terminally ill father and my elderly clients and their relatives in mind, I found myself vacillating between excitement and outrage.

So what was all the fuss about? The government has set out its proposals for the reform of social care in a White Paper which was published alongside a draft Care and Support Bill which will become the main plank of social care legislation, effectively replacing many statutes from the last 60 years. A progress report on funding reform was also published.

So let's begin with looking at the funding of long-term care. I was thrilled to learn that the government made a commitment to the principle of capping costs for the long term funding of elderly care, but that is where the good news ends because no decisions have been taken on funding at all. It has to wait for the next spending review, in two years time, when the government wants to look at cheaper options to the £35,000 level suggested by the economist, Andrew Dilnot, last year.

Andrew Dilnot CBE, was asked by the Government to chair an independent body, the Commission on Funding of Care and Support, with a remit for reviewing the funding system for care and support in England. It built on an extensive body of work already undertaken in this area and carried out new analysis before providing advice and recommendations on how to reform the system in July last year. The point I am making here is that over a year ago, an independent commission of experts were selected by the government to undertake extensive work and recommend a way forward. So why is the government procrastinating now?

According to Dilnot’s Commission, the contribution any individual makes to their care, not including general living costs, should be capped at £35,000 and the level of assets at which people living in residential care should have to pay the full cost, should rise to £100,000. This simply makes the cost a bit less daunting and would mean that nobody would have to spend more than 30% of their assets paying for their care.

According to Dilnot the figures that the government themselves published, show the cost would be significantly less than one thousandth of total public spending over the three years covered by the Comprehensive Spending Review. Dilnot further claims that the average person pays £10,000 tax a year and to implement his recommendations, which received wide support, would require a mere increase of 10 pence per person, in taxation. Can we really not afford 10p to improve the appalling and unfair situation for when we too become old? Why is social care one of the few areas that we don't fund through general taxation, like education and the NHS?

Let's not consider how quickly the Government can find money for other things if it seems electorally prudent. This is about the future shape of our society. It isn’t a transitory decision, a momentary crisis. It is a decision that will affect us all in one way or another. If politicians think that a better deal for older people is unaffordable, they need to put their cards on the table and have a debate about it, not bury their heads in the sand.

Having finished my rant about the Government’s lack of backbone to adequately fund social care, here are some of the other important points in relation to older people, that were raised in the Social Care White Paper and Draft Care and Support Bill.

From 2015 the government will introduce national standards on access to care services. At the moment each council can set its own criteria, creating a so called postal lottery. Introducing standards will help people to understand what they are entitled to.

New rules will be introduced to make it easier for older people to move around the country, to live for example, nearer to their relatives. Currently they have to undergo new assessments, which results in some people losing out. This will give people the flexibility to make the most appropriate choices about where they and their families live.

The Government will offer state loans for care costs and residential fees can be taken from a person’s estate after death. Interest will be charged but the level of interest and whether this will be capped is not known. However this is nothing new and most local authorities already offer deferred payment schemes without interest. 

People will be given access to personal budgets (money given to the person in lieu of services) by 2013 and have a legal right to them by 2015. The government will also invite expressions of interest to pilot direct payments in residential care in the summer of 2012. I was involved in Personal Budget pilots and feel that until alternatives to direct payments are offered universally to older people who are unable to manage direct payments, nothing much will change. Council managed budgets will continue to deceive government statistics into thinking local authorities have more older people with a personal budget than they actually have.

There will no longer be a requirement for carers to provide regular and substantial care, so any carer with needs could be assessed. The government plans to extend the right to a carer’s assessment and provide an entitlement to services for the first time. A national minimum eligibility threshold for support will be set for carers. However the amount of money needed to fund this new entitlement will be dependent on what money is available in the system, so it will be another case of 'robbing Peter to pay Paul'.

Local authority’s will be able to charge for services that they are not under a duty to provide. For example, people who are not eligible for the local authorities help. For these services, local authorities may also charge 'arrangement' costs. Up until now, it has only been the services that have been charged for, not the 'management' or 'arrangement' charge.

The government will be strengthening support within communities. They will introduce a duty on local authorities to commission and provide preventative services and fund or encourage a number of projects to encourage supportive networks of volunteers within communities, including Time Banking. The latter was news I particularly welcomed.

The social care needs of people facing the end of life are recognised with a commitment to abolish means testing for people on the end of life care register. Most people would prefer to die at home but currently less than a quarter are able to do so. We simply cannot afford, in human or cost terms, to continue to allow people to die in hospital against their wishes.

Only time will tell if political will can be turned into reality. If I sound cynical it is because I have found that the devil is in the detail and the way policies are implemented. As people come to terms with an ageing population and the reality of a care system stretched to breaking point, I have faith that ‘the people’ will decide. Let politicians from all parties heed my warning.

The publisher is The Centre for Welfare Reform.

All Change for Social Care in England? © Chris Moon-Willems 2012.

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