Lack of funds means changes will be of little benefit
On 11 February Jeremy Hunt, Secretary of State for Health, announced changes to social care funding in England based on the Dilnot report. These proposals, which apply only to funding residential care, were brought forward by the Tories and will now be included in the draft Care and Support Bill. The Treasury argues the additional £2bn cost of the scheme could be paid through general taxation out of the NHS budget. Hunt claims the introduction of a cap on the care costs paid by a recipient will be fairer and end the scandal of people being forced to sell their homes to pay for care. Shockingly 40,000 people are forced to do this every year under the current system.
But the NPC believes the proposals fall short of tackling the problems of poor quality care, a post-code lottery of charges, rationing of services and the artificial divide between nursing and social care. Pat Healy, NPC vice president said: “Dilnot is no substitute for a National Care Service like the NHS”. Under the proposals the cost of care in residential/nursing homes will be capped at £75,000 as of April 2017. General living costs (estimated at approx. £12,000) are not included. Care costs will be based on an assessment made by the local authority, not on the actual costs paid by an individual. No details have been announced, but the eligibility criteria to determine whether the care cap applies will probably be based on the “substantial” and “critical” criteria currently used by local authorities. In future, anyone with savings and property of more than £123,000 (previous threshold £23,250) will pay the full £75,000 worth of care costs before receiving any state support. Anyone with assets between £17,500 (previous threshold £14,250) and £123,000 property will be means-tested and expected to pay some of the £75,000 costs. A universal deferred payment scheme will be introduced to enable individuals to receive care and have the costs paid from the sale of their property after their death.
Any measures which relieve the burden of the cost of elderly care on the poorest people should be welcomed. But £75,000 is still a devastatingly high cap. The vast majority of home-owners in England would have to fund the full £75,000 care costs. Since only 16% of people ever need this amount of care, the overwhelming majority will never exceed the cap and hence never receive any government support. The National Pensioners Convention points out that the proposed cap would “help only 10% of those needing care, while the majority will be left to struggle on with a third-rate service.” The cap does not include board and lodging if needed.
It is unclear what will happen to people who have already paid more than £75,000 in care fees, i.e. who could claim to have already paid their share of their care costs
And of course the gesture is pretty meaningless when social care budgets have been cut by an average of 10% across the country and privatisation has run the service into the ground, as was shown by the collapse of Southern Cross care homes in 2011. As none of the new funding arrangements will apply until April 2017, the £75,000 care cap applies only to care costs incurred after that date.
Another cause of concern is that it is not clear if changes will be made to the differing rules and means-testing thresholds that apply to domiciliary care (care in the home). Will the existing £23,250 threshold (above which people must pay for all their home care) be raised? If not, local authorities will still be able to means-test for these services and different councils will charge different rates – i.e. the much criticised postcode lottery will remain in place. Nothing has been done to change the situation whereby people who receive care in their own home, even if they’re funded by the local authority, are excluded from the Human Rights Act. This is also the case with self-funded residential care. This must be changed as a matter of urgency. The NPC points out that the government’s proposals are solely about funding and have ignored proposals that would help ensure greater dignity in care.
The NPC will therefore continue to campaign until the Dignity Code is included in legislation. It advocates a tax-funded Health and Care service (see The Politics of Care pamphlet).
The Convention has calculated that an additional £10bn (around just 1% of total government spending) would be needed in order to support a National Health and Care Service.
The NPC promotes the need to raise the standards of care, improve regulation and monitoring of care services, improve the training and terms and conditions of the workforce and provide greater support for family carers.
Dot Gibson, NPC general secretary said: “The social care system needs urgent and radical reform, but these proposals simply tinker at the edges. The current system is dogged by means-testing, a postcode lottery of charges, a rationing of services and poor standards and nothing in the plan looks like it will address any of these concerns. Setting a lifetime cap on care costs of £75,000 will help just 10% of those needing care, whilst the majority will be left to struggle on with a third rate service.”
“The government needs to be much braver and bolder if it is really going to sort out the problems – otherwise in a few years’ time we’ll be back again having another look at the issue. Using inheritance tax or money saved from the state pension system simply won’t raise enough to bring about the change that’s needed. It’s time we merged health and social care and had a truly integrated system which was funded through general taxation – like the NHS – rather than put all the responsibility on pensioners and their families. Getting older and needing care isn’t a lifestyle choice – so why should the cost of care not be shared by society as a whole? Frankly, the plan as it stands is about as credible as a Findus Lasagne.”