11/07/2012

Today’s publication of the ‘Caring for our future: reforming care and support’ White Paper and draft Care and Support Bill have been a long time coming but there is disappointment that many of the most difficult decisions, notably around the funding of social care, have been postponed. 

It’s been 15 years since a newly elected Tony Blair told the Labour Party Conference that no one should have to pay for the costs of care in their old age by selling their home. Endless talk of the standards of care for older people and the need to find a long term settlement to the funding crisis, brought about by an ageing population, has rumbled on without clarity or cross party consensus.

In its attempt to answer these problems the Government will hope that the measures set out today in its White Paper, the progress report on funding and draft Bill will convince critics that it is committed to making progress.  Importantly the Government has accepted the principle of a cap for a long-term funding of care; a key Dilnot proposal.  However, a definitive solution on the financing of social care is not outlined in today’s publications.

A focus on the individual
Much will be warmly welcomed – an expansion in choice, information, flexibility and control over the services and money allocated to those with care needs, a set of guarantees for minimum standards and new rights for carers. Reflecting the Government’s wider approach to public service reform, changes to the system look to focus on the individual – allowing people more choice to be provided with social care services closer to their families, promoting personal budgets and allowing more independence and care in the home.

However, the central plank of the Government’s proposals, that of councils lending money to nursing home residents to pay up front costs of care has raised many questions about how this will be achieved by already overstretched local authorities who are yet to agree with Government the specifics of their role in delivery. 

Implications for providers
Away from the operational issues, the measures outlined in the White Paper have significant implications for providers of social care services. The introduction of quality markers – a key benchmark in the wider NHS reforms – as a means of assessing how well providers are performing will no doubt prove controversial as will the practicalities of creating a ‘fit for purpose’ online portal for patients to access the quality profiles of individual providers.

In the wake of recent scandals surrounding the care of some residents, greater scrutiny by Healthwatch and the CQC is a welcome measure. There will also be a consultation on the ownership structures of care homes following the failure of Southern Cross. More broadly, the ongoing funding squeeze may lead to rising eligibility criteria for statutory social care services, facilitating a further shift in providers relying on private patients to plug gaps in income.

A cap without a timetable or limit
Unsurprisingly the political and stakeholder reaction has today centred on the fact that the various measures set out do not offer a comprehensive solution to either the long term crisis in funding highlighted by Andrew Dilnot’s recommendations or the more immediate pressures being faced by councils. Today’s interim solution – a deferred payment scheme enabling people to borrow funds to cover the costs of care to be repaid after death – has the feeling of a sticking plaster, applied before more difficult decisions are made at the next spending review.  A clear signal that the Treasury is pulling the strings here.

Elsewhere, Labour has declared itself committed to finding a solution. Its failure to do so during thirteen years in power makes its position slightly dubious. It is also vulnerable to the charge by some on the right that its handling of public spending was a contributory factor to the fiscal pressures now being faced. Andy Burnham and his team face an ongoing balancing act; supporting cross party talks without being railroaded into accepting a compromise solution due to the state of the public finances.

Treasury unwilling (or unable) to commit to long term solution
The standard attack line now is to blame the Treasury for failing to provide the necessary funding required to provide either councils with the short term relief required to continue providing for the most vulnerable or for a longer term settlement. It is something that both Labour and more rebellious members of the coalition have publically challenged the Health Secretary on. But in an era of public spending pressures and stagnant economic growth, gaining backing for significant and long-term financial commitments isn’t easy.

With no firm end in sight to ‘austerity Britain’, Andrew Lansley faces yet another uphill struggle to get his second flagship health bill through parliament and an even greater challenge still in convincing the coalition hierarchy to adopt Dilnot’s recommendations. In the meantime we can expect more warnings of impending crises and numerous legal challenges to the care delivered by struggling local authorities and hard pressed providers and little real improvement for those in need of care on the ground.

As was the case in the run up to the 2010 Election, it is highly likely that the issue of how we fund care for the elderly prove a key Election battleground as the 2015 election and deadline for decisions on the capped cost model and extended means test threshold loom. Given the existing direction of travel, the coalition is only too aware of this and a final decision still has ‘long grass’ firmly stamped on it.

SOCIAL CARE STATS

Care and support affects a large number of people. In England there are:

• 380,000 people in residential care, 65% of whom are state-supported
• 1.1 million people receiving care at home, 80 % of whom are state supported
• 1.8 million people employed in the care and support workforce
• 5 million people are caring for a friend or family member
• Around a quarter of people will have to spend very little on care, while one in ten will have costs of over £100,000.

KEY REACTION

Alzheimer’s Society: “This White Paper is not worth the paper it’s written on”
King’s Fund: “Financial vacuum at heart of social care proposals undermines ambitious vision for reformed system”
Carers UK: “A real step forward in the rights of carers”
Which?: “There are many unanswered questions”

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