PLMR examines the ‘Caring for our future: reforming care and support’ White Paper
The White Paper
The Government has already stated its support, in principle, for the recommendations of a cap for the amount of money people should pay for care, as proposed by Andrew Dilnot. This however was a very costly proposition, with a cap of £35,000 predicted to cost the tax payer around £1.7bn. Other recommendations from Dilnot include a more integrated approach to Health and Social Care, with the sector currently straddling Health, Work and Pensions, and Housing.
Whilst the White Paper today has not addressed this issue of the cap – to the disappointment of many – it does seek to:
1. Address inequalities in the current system
2. Introduce a universal deferred funding scheme
3. Improve information and control given to individuals accessing care
4. Achieve greater integration in the care system
5. Clarify the entitlement of carers
Although the headlines will no doubt be dominated by what is not in the White Paper, there was one proposal of note that came out of today’s announcement. Secretary of State Andrew Lansley set out a scheme that will allow anyone not entitled to state funded care – those with assets above £23,250 – to access loans from their local authority to pay care fees. The fees for their care will be paid up front, with the cost of the loan recovered from an individual’s estate after their death. This voluntary scheme will allow councils to lend money to nursing home residents, protecting up to 40,000 people each year who are currently being forced to sell their homes to access care and support. Loans of this type are already available in some areas of the country, but the White Paper opens up the possibility of these being rolled out across England, thus ending one aspect of the ‘postcode lottery’ of care. Only around 8,500 loans amounting to £200m were offered in past year.
The White Paper also seeks to tackle inequalities in the Health and Social Care system through the introduction of a National System of Eligibility by 2015. At present local councils are responsible for drafting their own eligibility criteria for social care, meaning inconsistency across boroughs is rife. The proposals outlined today aim to bring more clarity to both people accessing care, and those providing it.
Finally, the White Paper places a strong emphasis on the availability of information for people as they deliberate over their options for care. Funding has been given nationally and locally to allow for independent advice on care, and quality of care, in local regions. This is a major part of the Government’s attempt to pre-empt care crises and to give people the chance to plan and prepare for their futures. Central to this is the personalisation agenda and ensuring individuals, patients and care home residents are empowered.
Care and Support Draft Bill
This Bill takes forward the recommendations of the Law Commission report on adult social care legislation which was published in May 2011 following a three year review. The Commission concluded that existing care and support legislation is outdated and confusing and recommended urgent reform. Separate to the Health and Social Care Bill announced in the Queen’s Speech, the Care and Support Draft Bill will consolidate and modernise legislation, with the aim of creating greater flexibility and consistency across the country.
Progress Report on Social Care Funding
The Report sets out the Government’s support for the principles of the Dilnot Report’s model, whilst also stressing that the means to fund Dilnot’s recommendations are currently unavailable. Funding will be revisited at the next Spending Review.
The devil is in the detail
The system is going to be changed in two major ways:
1. “The focus of care and support will be to promote people’s wellbeing and independence instead of waiting for people to reach a crisis point.”
The White Paper seeks to support families and individuals to be able to plan for their future care needs. With better preparation and information individuals will have more options available to them, allowing them to remain independent for longer.
2. “We will transform people’s experience of care and support, putting them in control and ensuring that services respond to what they want.”
The White Paper plans to give people control over their budget and their care and support plans, providing them with greater influence over the options available to them.
Five new principles of Health and Social Care will be introduced, based on the concerns of those currently receiving care. The Government wants care users to be able to agree with the following statements:
“I am supported to maintain my independence for as long as possible”
Emphasis is going to be placed on maintaining contact with family and friends, and encouraging communities to reach out to those at risk of isolation. Better housing options and greater access to support are hoped to allow for more active and independent lives.
• This will be done by involving communities in decisions on Health and Social Care commissioning, development of services to help people stay independent and active, and a £200m fund for specialist housing.
“I understand how care and support works, and what my entitlements and responsibilities are”
Better national and local information on care and support services, as well as greater consistency across the nation. This will allow people accessing care to move across the country and still have the same entitlements they had before. A greater system of support for carers will also be put in place.
• This will be done by establishing a national website on care and support. Support for local authorities to develop new online information on local care will be provided with a £32.5m start-up fund from Government. There are also plans to introduce national minimum eligibility threshold, a right to assessment for all carers and clear entitlements for their needs.
“I am happy with the quality of my care and support”
Greater information and care options will empower people and local authorities, and enable care providers to respond more quickly to concerns, driving improvements in quality.
• This will be done by setting clear levels of expectation for the individuals supported, providing clear and comparative information on care providers (including feedback from users), maintaining a diverse range of care providers giving people a choice of quality services, and abolishing ‘contract by the minute’ care.
“I know that the person giving me care and support will treat me with dignity and respect”
The Government plans to introduce clear minimum training standards, recruit more care apprentices and provide greater support through the transformation of the social work profession.
• This will be done by a new code of conduct for carers, new minimum training standards, doubling number of apprenticeships to 100,000 by 2017, appointing a Chief Social Worker by 2012 to lead the profession, and expanding the Care Ambassadors scheme.
“I am in control of my care and support”
Control of personal budgets and a more integrated system of health, housing and care services will empower people.
• This will be done by legislating to give people control to their personal care budget, with the intention of strengthening commitments on direct payments in the future. A test group of residential care users have been identified and direct payments of care budgets will be tested with a cost/benefit analysis to follow. Improvements of access to independent advice on care have been legislated for, with additional funding of £100 million (in 2013/14) and £200 million (in 2014/15) between the NHS and social care to support better, more integrated care and support, with a duty on local authorities to join up care in localities. Moreover, from April 2013 income that people earn in employment whilst in residential care is exempt from the calculation of care charges.
Draft Care and Support Bill
The Draft Bill will radically simplify the current legal framework for care and support, replacing provisions in well over a dozen Acts of Parliament with a single, modern statute. It adopts key recommendations from the Law Commission’s Report on Adult Social Care.
The Bill will:
• modernise care and support law so that the system is built around people’s needs
• clarify entitlements to care and support to give people a better understanding of what is on offer
• support the broader needs of local communities as a whole, by giving them access to information and advice, and promoting prevention and earlier intervention to reduce dependency
• simplify the care and support system giving flexibility needed by local authorities and care professionals to innovate and achieve better results for people
• consolidate existing legislation
Provisions of the Draft Bill:
• new statutory principles which embed the promotion of individual wellbeing as the driving force underpinning the provision of care and support;
• population-level duties on local authorities to provide information and advice, prevention services, and shape the market for care and support services. These will be supported by duties to promote co-operation and integration to improve the way organisations work together;
• clear legal entitlements to care and support, including giving carers a right to support for the first time to put them on the same footing as the people for whom they care;
• set out in law that everyone, including carers, should have a personal budget as part of their care and support plan, and give people the right to ask for this to be made as a direct payment;
• new duties to ensure that no-one’s care and support is interrupted when they move home from one local authority area to another; and
• a new statutory framework for adult safeguarding, setting out the responsibilities of local authorities and their partners, and creating Safeguarding Adults Boards in every area.
Health Education England (HEE) empowers local care providers to take responsibility for planning and commissioning education and training.
Health Research Authority (HRA) to protect and promote the interests of patients and the public in Health and Social Care research.
The Government have given a breakdown of recommendations and their progress thus far.
Reactions from the sector
Care & Support Alliance:
“As the social care system faces collapse, the key test for this white paper was to deliver an urgent timetable to reform social care funding. The government has failed this test. If long-term funding commitments had been set in place, this would have given some of the positive measures in the white paper a real opportunity to make a difference to the lives of disabled and older people and carers.”
“The government’s proposals for reforming social care law are a real step forward in the rights of carers. The measures set out in the draft care and support bill would move from piecemeal carers’ rights legislation to the establishment of carers’ rights in government legislation and, for the first time, equalise carers’ rights with disabled people rights. This is significant progress for a group who frequently feel like second class citizens – unrecognised for the contribution they make to society and left in ill-health and financial hardship as a result of caring.”
Local Government Association:
“We are concerned that under the proposed timetable, elderly and disabled people, as well as carers, could face at least a further five years of uncertainty.
“The introduction of a cap on the maximum amount an individual would pay for their care will provide some peace of mind for our rapidly ageing population, but for such a system to work it has to be universal. We do not think that the government’s suggestion to consider voluntary opting in or out of such a scheme is workable or provides people with clarity.”
“Council leaders are disappointed that the white paper does not address the reality of the current and growing funding crisis in adult social care and the subsequent huge financial pressures councils face. Small pockets of additional funding, while needed, simply paper over the cracks. Serious and real reform must include an honest appraisal of what a modern social care system costs and how it is to be funded.”
Reaction of Andrew Dilnot:
Andrew Dilnot voiced disappointment at the failure of the White Paper to address his proposals for a cap on care costs – suggesting that implementing his cap could be relatively cheap. The Dilnot Commission proposed capping the amount people would have to pay for their care at £35,000, which would cost the government £1.7bn. However, capping costs at £50,000 would make the scheme cheaper, he said.
“The figures that the government themselves published today show that in the three years starting in 2015, the cost of this proposal, if the cap was set at £50,000 would be £600m, £600m, and £700m in the first three years. That’s significantly less than one one-thousandth of total public spending in those three years – the three years that would be covered by the comprehensive spending review.”