Reform of long-term care funding is yet again postponed. The coalition programme states that a commission on the long-term care funding of adult social care will be set up and report within a year. This will consider a range of ideas including voluntary insurance scheme and partnership model. Extended roll-out of personal budgets. boosting prevention and better provision for carers are also part of the programme, as is a pledge to help elderly people live at home for longer through solutions such as home adaptations and community support programmes. However, while the programme guarantees NHS health spending increases in real terms in each year, no such guarantees are given for social care. The impact of local government cuts of £1.165bn are still to be seen.
Meanwhile PSSRU has modelled the potential impact of a tightening fiscal situation on social care for older people, using a 6.7% per annum cut as their ‘reduced budget scenario’ against a ‘demand-led’ scenario which requires funding increases of nearly 3,5% per annum just to keep up with current level of access to public support in the context of changing demographic.. In the PSSRU modelling, expenditure is managed by raising eligibility thresholds, which is what councils have been doing for years. The reduced budget scenario would lead to very significant reductions in the number of people entitled to state support: recipients of publicly funded support would be approximately one half lower than under the demand led scenario. This would prompt more people to pay privately for social care and/or seek more informal care, but as the substitution from public to private is limited by individuals’ financial resources budget constraints are likely to lead to a significant reduction in overall social care consumption. As a result unmet need levels are calculated to rise by 56% and 90% in 2011/12 and 2012/13 (an increase of approximately 170,000 people in the latter year). With more private funding required, the rich would do better and the poor would be the biggest losers.
Whether local authorities will be able to protect social care remains to be seen. The PSSRU report provides a stark illustration of some likely consequences if they don’t., and there is likely to be a knock-on effect on increasing demand for health services, especially emergency health care. Under this scenario, the coalitions’ stated aspirations for social care are challenging – with more detail needed on how these aspirations will be met. Given the protected status of NHS resources, one optimistic reading is that the coalition’s pledge to ‘break down barriers between health and social care funding’ means that NHS resources could be used for supporting those in need of social care. The more pessimistic of us may think otherwise – watch this space.
Click here to view a copy of; The Coalition: our programme for government, HM Government May 2010
Click here to view a copy of; Forder J, The impact of a tightening fiscal situation on social care for older people, PSSRU 2010