The White Paper on Social Care is coming “very soon” and promises to strengthen carers’ rights but appearance of a funding solution to the impending crisis in adult social care looks increasingly unlikely. Despite the ‘Quad’ (the regular meeting of the Prime Minister, Deputy Prime Minister, Chancellor of the Exchequer and Chief Secretary to the Treasury that discusses important coalition issues) discussions last week over the government’s position on Dilnot and funding reform, hopes of even having sight of a progress report on social care funding are fading fast. It looks like there may not be any progress on addressing the funding crisis in adult social care until the autumn at the earliest.
It is in this expectant and what is feeling like an increasingly hopeless atmosphere that the Local Government Association has issued its stark warning about social care funding – either we reform the system now or fundamental change will be needed to the way local services are funded and organised and or to statutory and citizen expectations of what councils provide.
The LGA projections show that even if social care demand is met (and this will still only be services for a minority of people) there will be a likely funding gap of £16.5 billion a year by 2019/20. What this means is that there will be hardly any money left at all for all other council services like libraries, housing, parks, playgrounds, street lights, community centres, leisure centres to a name a few.
The projections are based on the fact that central government funding for local government has already been cut from 29.7bn 2010/11 to £24.2bn in 2014/15 and that there will be further reduction to around £17.6bn by 2020 in line with Departmental Expenditure Limits set out in the Budget 2012.
The LGA projections appear to leave local government with two choices. Either maintain spending on social care and reduce spending in other areas which will drastically impact our communities or distribute spending across social care and other services. This would leave more vulnerable people with care and support needs with inadequate services or without any services at all, which is why the LGA have put it quite simply – “Without money and reform, there is no solution”.
This is really bad news for many carers who are already battling on a daily basis to get the care and support that they and their loved ones need. At the many events during Carers Week, it was made clear to me that many carers are incredibly worried about the future and how they will cope with the costs of care. They experience a lot of anxiety about their own ability to fund the care their loved ones needs and about financial restraints on the services they rely on. One carer explained “the day centre is very important for my son but also for me – it really is the best respite for a carer”. Someone else commented that the centre offering many of the activities that she and her husband take part in is closing. She’s not sure whether there will be anywhere else to go.
Carers Week was all about the fact that carers have poor health outcomes. But doesn’t it seem odd that despite the Government making it clear that they think carers should get breaks and that their health should not suffer, carers are actually experiencing high levels of stress and anxiety about funding for the services that their loved ones need?
Contradiction is at the heart of Government’s policy making on adult social care – they are willing to overhaul the complex and messy legal framework and willing to look at strengthening carers’ rights to assessment and support, but currently there is no way of funding the increase in demand for care and support. This will make it extremely difficult to fulfil carers’ rights. Of course, we welcome the Government’s “determination” to do more for carers but the legal reforms alone will not result in access to high quality care and support.
Carers know only too well that, without a funding solution for adult social care, they will continue to worry about the future because they will be left responsible for meeting the care needs of their family member of friend. We know that many of those being cared for are receiving the bare minimum from local services. This increases carers’ responsibility which is why they constantly tell us what they really need is more support for the person they care for. If the Government is serious about making support for carers a reality then it’s time to listen to them and have that difficult conversation about how we’re really going to pay for adult social care.
Whereas Labour are still deciding their priorities, the Conservatives appear to have nailed theirs to the mast. And social care isn’t there.
Eric Pickles MP, Secretary of State for Communities and Local Government began their conference by announcing that
£250m had been found which would be given to councils for weekly bin collections. Funding for social care comes from councils, and funding for local authorities comes from the Department of Communities and Local Government. So rather than giving this money to councils to spend on social care, the Government are saying it has to be spent on bin collections.
This Government, and Pickles in particular, has been adamant that decisions must be made at the local level, and councils given freedom to decide. Yet, Pickles is not making this £250m available for whatever councils think it could best be spent on; it is only available for councils who want to move to weekly bin collections.
Of course, some councils already run weekly bin collections, and a couple of councillors at the Conservative conference were left wondering whether they should stop that so that they can claim some of the £250m to reintroduce what they are already doing.
This was followed by George Osborne’s announcement that Government had found an extra £800m to give to councils who committed to freeze their council tax rates. Again, this newly found money is not available for councils to spend as they see best but can only be used to compensate councils who do not increase council tax rates.
Compare this focus on bins and council tax to social care. I asked Lord Freud (DWP Minister) and Greg Hands MP (Parliamentary assistant to George Osborne) about how important it was to implement the Dilnot Commission’s recommendations on social care but received no answers. I asked Maria Miller MP (Minister for Disabled People), who said meeting the challenge of our population’s changing demographics was one of our biggest, but instead of discussing Dilnot’s report, focussed on how introducing the right to request flexible working for all will help carers trying to juggle work and care.
Andrew Lansley in his speech did mention the £400m given to the NHS to support carers, but there was no mention of social care or Dilnot. When asked about it, no firm commitments were forthcoming. Understandably, Lansley is focussed on getting his Health Bill through Parliament but we must get the Conservatives to see social care as a priority.
Instead of commitment to reforming social care, there is a reticence emanating from Conservatives. It usually starts with talk of implementing Dilnot being very expensive and a lot of work still to be done. Implementing Dilnot is £1.7bn per annum; the Tories have just found, out of nowhere, £1.05bn for bins and council tax.
The big announcement from the Labour party conference was by Ed Balls regarding a commitment not to reverse the cuts of the current Government. What this actually means for future spending are not wholly clear, but probably means Labour will present a similar overall spending plan to the Tories at the next election.
Balls’ message disappointed some, but as I’ve argued a few times, there is still plenty of Government spending – £680bn p/a – so reprioritising what we invest in is a real option. And Labour seem to be indicating that they are prepared to do so.
As I heard from shadow Ministers John Healey MP, Emily Thornberry MP (both Health) and Barbara Keeley MP (Communities and Local Government), Labour would implement the Dilnot recommendations if they were in power. Furthermore, Labour are keen to work with the current Government to do so now.
Funding Dilnot’s recommendations for improving social care, must not come from further cuts to existing local government and communities spending. Indeed, we would want to see funding for communities and local government increase. I find it strange that Cameron professes it to be his number one priority yet spending on communities and local government received a larger cut than anybody else. The message I heard from some people at the Labour conference was that such funding is essential for councils and council funded groups to help isolated people engage with their community.
Conservative MP, Stephen Dorrell was also at the conference in a lively debate regarding current health care reforms with Labour shadow Minister, John Healey MP. Healey thinks the reforms could mean competition rules would hamper collaboration between providers of services harming patient care. Dorrell, while agreeing with Healey on many things, disagrees on this believing that competition law would not apply and that even if it did you could still have joined-up services. The example he gave was of supermarkets all offering joined up services (all those different types of clothes, food, white products etc) whilst operating under competition law.
Interestingly, Healey also said that Andrew Lansley has got his priorities wrong. He said it was not health care that needs reform but social care and that this should have been the priority. Emily Thornberry MP repeated this theme telling us that the health reforms were distracting focus from where changes did need to be made.
If the Government have got their priorities wrong, Labour must show what they would do to put it right.
PS: Vote to help Crossroads Care Chorley & South Ribble win £6000 http://communityforce.natwest.com/project/1818
On Monday, the Dilnot Commission published recommendations to reform social care in England. More people would get social care support; fewer people would have to pay for it; and everybody would be protected from paying huge costs for care over their lifetime. What’s not to like?
Well if you’re the current Government, two things. Firstly, some newspapers that are generally considered to support the Government have attacked it because older people may be asked to pay towards funding this new system. This wholly ignores the fact that people aged 65+ are already paying £8.3bn a year for social care at the moment. Dilnot’s recommendations would mean they would have to pay less
Secondly, it would mean additional Government spending of £1.7bn p/a, which would rise in the future. £1.7bn is 0.25% of public expenditure. Dilnot advised that this 0.25% could be found in three ways:
- Through an increase in general taxation income
- Reduce spending by 0.25% in other areas to pay for this
- Introduce a specific tax increase to pay for the 0.25%
The question is not whether we can afford the 0.25% or not. The question is do we want to afford it?
For me the answer was provided by another big story of the week – Elaine McDonald, the former ballerina. Her council is removing her overnight care that helped her use a commode, instead giving her incontinence pads to wear. And she’s not a one off. There are stories like this all over England where people’s quality of life are being severely affected because we are not providing enough social care support.
The immediate blame for poor social services is often laid at the door of councils as it is they who provide the services. We don’t blame Government for causes behind this, making it easier for them not to do anything to improve the system. That has to change. Government should act and find this 0.25%; if they don’t I won’t be the only one who will blame them the next time another person’s dignity is stripped away.
The Dilnot Commission will report next week on how social care in England should be funded. Currently, if you have assets, including property, worth over £23,500 you will likely pay for social services or residential care. This means a lot of people pay for all of their care whilst some pay for none of their care.
Dilnot is charged with finding a system that will create a “fairer” system that will also encourage people to save for care that they may need. The focus will be on encouraging people to purchase insurance to cover future care costs.
The choice comes down to a voluntary insurance scheme or one where everybody has to purchase care insurance – just like all car drivers must purchase car insurance. Or there could be a voluntary scheme where people are automatically enrolled into it but can opt out.
Politicians will then be left to choose, if they choose to do anything. But what hasn’t appeared in the debate so far, is the role of genetics.
Having a certain genetic profile can make it more likely (but not certain) that you suffer conditions such as Huntingdon’s disease or Alzheimer’s. However, your behaviour can also reduce the likelihood of these so knowing your genetic profile could encourage you to change behaviour and reduce the chance of having various conditions.
Knowing can also help you and your family prepare, which is what one person felt when faced with this experience who I was talking to recently. And genetic profiling will become much more common in the future as costs rapidly decrease.
The impact of this on a care insurance market are obvious. In a voluntary insurance scheme, if you don’t have to share your genetic profile with insurance companies, those most at risk of ill health will take insurance but companies won’t know who has the greater risk so all prices will go up, fewer people will take insurance and insurance companies will leave the market. And in a voluntary system where you do have to tell the insurance company, there could be lots of people who will be refused insurance. They will be discriminated against because of their genetic profile.
However, in a compulsory insurance model where you don’t have to tell insurance companies, people will still be able to know their genetic profile and plan for the future but without fear of discrimination, and insurance companies could spread the risk and costs amongst a greater number of people.
Interestingly in 2003, the Department of Health declared: “As our understanding of genetics advances, the case for private health insurance as an alternative to our universal tax financed NHS diminishes”. It may be the same should apply to social care as well.
About this blog
|At Carers Trust, together with our Network Partners, we provide support, information, advice and services for the millions of people caring at home for a family member or friend.|
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