The Commission on Funding Care and Support was set up by the Government to make recommendations on how to achieve a fair, affordable and sustainable system for funding adult social care in England. It is proposing a partnership model in which costs are shared between the state and individuals who have sufficient means.
The Commission’s report endorses the role of local authorities in commissioning and delivering local services. A consistent theme is that current funding for adult social care is inadequate and that the Government should ensure that local authorities receive sufficient and sustainable funding. While the details need to be examined in more depth, there is much in the report to welcome, and the question now is whether there is politcal will to go forward and to find the additional funding. The previous timetable for social care reform was a White Paper this autumn with a Bill in spring 2012. The White Paper has now been put back to next spring with a Bill ‘at the earliest opportunity’.
Local authorities and care and support services
The report describes problems with Fair Access to Care Services (FACS) in some detail. Basically, this framework has led to huge, unacceptable variations in how people with similar needs are treated in different areas. The Commission recommends that Government should work with social care experts to develop a new, objective eligibility framework with a nationally set threshold which allows assessments to be portable across local authority boundaries. In the short term, it recommends that the minimum threshold should be set nationally at substantial. This means that support in the means tested system would also start at this level.
Although a national threshold is proposed, the Commission emphasises the important role of local authorities in planning, providing, commissioning and arranging services that meet the needs of local populations (e.g. Inner London will have different needs from Cumbria). They would continue to use local prices to set the cost of care packages. As well as services subject to FACS, they should also provide a range of services to support their local population regardless of means such as community meals, telecare and information services.
The report considers in more detail how carers can be better supported. Building on the Law Commission recommendations, it recommends that a carer’s assessment should take place at the same time as that of the person being cared for, although separately so that people can speak freely. This avoids the carer’s assessment taking place weeks later and ‘nothing coming of it’. Carers’ assessments should also be portable across council boundaries.
The report briefly mentions that its measures are consistent with the personalisation agenda. It endorses free reablement services, early intervention and prevention, and says that it is broadly supportive of the Palliative Care Funding Reviews proposals for free end of life care. A thread running through the report is that by knowing the limits of their financial risk, people are more likely to plan for the future and invest in personal support such as assistive technology and extra care housing.
The Commission stresses the importance of aligning funding streams, particularly with health. It suggests that the government should consider how a new national eligibility framework for social care would sit alongside the assessment for NHS continuing health care. It urges the government to consider how the whole care and support system can be reformed and better integrated in the forthcoming White Paper on adult social care.
How individuals can pay their contribution
The Commission has ruled out prescriptive approaches such as compulsory insurance. Instead, individuals and families will need to consider how best to meet their contribution. This is likely to be through income, savings, property and other assets or through emerging financial products. Currently there is a lack of products offering insurance for adult social care – due to both lack of demand and uncertainty of risk for companies. However, the Commission has had lengthy discussion with the financial services industry and expects that the certainty provided by its model will encourage the sector to develop products, perhaps linking social care to critical illness or life insurance cover, or annuities linked to pensions. The report recommends that the government should set up a working group involving local government, financial sector representatives and third sector providers to progress this.
Currently local authorities are able to offer deferred payments so that payment for residential care would come from an individual’s estate following their death. Provision for this is patchy and where it exists can be costly to councils who are unable to charge interest. This is an important option for paying the contribution, and the Commission recommends that offering deferred payment should be mandatory but that councils should be able to charge interest.
A new awareness campaign about adult social care would be needed to inform people about the new system. Information and advice about adult social care is generally poor. There should be a new national website with information and signposting, and local authorities should be required to provide consistent local advice and information on a range of topics listed in the report. The Law Commission’s proposal for a statutory duty on local authorities to provide information should be implemented.
The Commission indicates that its reforms should not result in anyone losing disability benefits. A universal disability benefit for older people – Attendance Allowance – should continue to be available for support and care needs such as early intervention. However the purpose of Attendance Allowance is unclear and it needs to be re-badged by the Government so that more people understand its role. Also, Government should consider how to align the assessment for disability benefits with the adult social care system to streamline and simplify the process of assessment.
The commission also suggests that there are further changes to address current inconsistencies which could be considered once a cap was in place:
- creating a level playing field by taking housing assets into account in home care (would require a universal deferred payments scheme)
- a taper in the means test to encourage people to save.
- individuals receiving NHS continuing healthcare to pay general living costs.
Government response so far
In a Statement to Parliament, Andrew Lansley welcomed the report and confirmed the Government would progress the recommendations as a priority. However, he also warned that the cost of reform would have to be considered alongside other priorities, and pointed to the wider range of options in the report such as setting the cap at £50k. The Government’s response will appear in a White Paper which will now be published next spring. There will now be a period of engagement with stakeholders and with the Labour Party who have agreed to join discussions. The Secretary of State set out six tests that any reform would have to meet.
- promoting closer integration of health and social care
- promoting increased personalisation, choice and quality
- supporting greater prevention and early intervention
- promoting a viable insurance market for care and a more diverse and responsive care market.
- achieving a consensus that additional resources for care should be targeted at capping costs for individuals.
- ensuring a fair and appropriate method of financing the costs.
Further information may become available when the Minister of State for Care Services Paul Burstow addresses the All Party Parliamentary Group for Local Government on Wednesday.
The Dilnot Commission has produced an elegant solution to a long-standing problem which enables individuals to contribute to care funding but with a clear and limited risk. Overall, it has been welcomed by individuals and organisations involved in adult social care, although some measures, such as setting minimum national eligibility at substantial, are not favoured by all.
As to whether the public will support the proposals, this is not clear. Although the Commission indicates that everyone who gets free support from the state will continue to do so and that everyone else will be better off, there was a significant response to the Commission’s consultation from those who believe that social care should be free. A recent survey by the charity Anchor found that 44% of people believe the state should fund care and only 11% thought it should be split between the state and the individual. In a speech at a Kings Fund event before the report was launched, Care Services Minister Paul Burstow indicated that the public response to the report by the public would at best be ‘lukewarm’ and could be influenced by media reporting. (In the day after publication, one paper headlined ‘Retire THEN pay a care home tax’ in an article including the information ‘State funding would cover ‘bog standard’ care homes only – decent quality care will require top-ups from individuals’.)
At this stage it is difficult to predict what will become of the proposals. The additional funding required will involve difficult financial decisions for the Government, while the proposals have the potential for public controversy. All party consensus for a final solution, which will become a legacy issue, is essential. It is a well-known phenomenon that previous reviews on this subject can disappear without trace. This time, however, the issue has had a particularly high profile and there may be the will to put pressure decision-makers to take action. This is vital for individuals with care needs who have assets who will be in limbo until a solution is found. For local authorities it is also crucial – funding levels for adult social care mean that most will continue to struggle to meet social care needs until matters are resolved. The Commission has highlighted adult social care’s position within overall expenditure – ‘an affordable one four-hundredth of total public spending (£700 billion)’. It also sets it within the context of spending on older people – of the £140 billion spent, 35% goes to the NHS, 59% to benefits and 6% to adult social care.
While the delay in the White Paper, and, as yet, no firm date for the Bill, are concerning, it is right that there is a consultation period on the proposals, to try and raise public awareness and to examine details in the report in more depth. In the meantime, councils may wish to consider the proposals in LGiU’s report Independent Ageing: Council support for self funders which makes suggestions for how councils can take action to gain clarity about the financial impact of self-funders moving to council funding in their areas, and to signpost people to independent information about financial products to help with funding care in older age.