Directors of adult social services have welcomed “without reservation” the report of the Commission led by Andrew Dilnot into the funding of adult social care in England.
The report sets out a number of far reaching recommendations based on shared responsibilities between the state and individuals (and possibly potentially emerging care insurers), which echo previously recommended partnership models.
Most importantly it makes a clear connection between reforms and resources by recommending an overall increase in resources for social care to the tune of £1.7bn at 2010/11 prices rising to £2.8bn in 2020/21.
There seems to be something for everyone in the report:
People with high lifetime care costs: The report proposes a life time cap of £35,000 for individual responsibility for care costs. Everyone would get free care once they have reached the cap of £35K expenditure.
Younger disabled people: Those who enter adulthood already with care and support needs will be eligible for free care immediately with no requirement for contribution.
People on low income and/or with moderates assets/ savings: The £35,000 contribution will be mean-tested. Everyone who currently gets free care under the means-tested system on account of low income will continue to do so.
People with moderate assets/savings: The asset threshold (including property) to those in residential care will increase from current 23,250 to £100,000, so people below this level will only pay a means-tested part of the £35,000 life-time cap. However, the report makes a distinction between care costs and general living costs and also proposes a standard contribution towards accommodation and food in residential care of £10,000 per year.
People receiving Attendance Allowance: Universal benefits such as Attendance Allowance will continue though may be “re-branded”.
Carers: Carers will be supported by improved assessment, and the report supports the Law Commissions recommendation on legal rights to services.
Local authorities: Local authorities will continue to play a central role in ensuring the delivery of care and support services to their local populations. Funding and responsibility for adult social care will continue to rest with local government, and local authorities would continue to assess people presenting with a care need, and assign personal budgets or direct payments. For those eligible under the means-tested system (and, in future, those reaching the cap), local authorities would continue to fund their care packages; for people funding the care themselves, local authorities would assign notional care packages.
The recommendations, if implemented would make it easier for people to plan for care in old age and, possibly encourage the development of financial products that offer insurance against care costs. For some, the reliance on voluntary insurance is controversial though. Professor Ray Jones, in a commentary in The Guardian, notes that the history of insurance is not reassuring and there are many examples of mis-selling of private policies that have left people stranded at the point of need while generating windfalls for investors.
The proposals are in the main focused on people with care needs that meet current eligibility thresholds. It is recommended that eligibility for service entitlement should be standardised across England and a more objective assessment framework developed, but that for the moment at least the national threshold should be set at “substantial”. The report does not make any specific recommendations about prevention, early intervention or people with moderate or low care needs, though the continuation of universal benefits, including re-branded attendance allowance, is mentioned as a means to support early intervention.
The main question will be whether the governments is ready to accept the additional cost to the public purse. Andrew Lansley has already warned that the cost of the reforms, would need to be weighed against other priorities and that “trade-offs” would have to be made. This might involve going for a cap of £50,000 as opposed to £35,000 on individual care costs, which would reduce the bill for the reforms to £1.3bn. Lansley has also indicated that the government’s response to Dilnot would not be produced until next spring, in a White Paper, with legislation following “at the earliest opportunity”, a timescale derided by campaigners as “indefensible”. The King’s Fund who has long campaigned for reform are firmly behind the proposals and the necessary additional public expenditure:
“ The budget deficit should not be used as a reason for inaction. This is a long-term issue and questions of affordability go beyond the current economic situation. The additional public expenditure needed to fund these proposals is less than 0.25 per cent of gross domestic product – this should not be too high a price to pay for providing a care system fit for the 21st century.”
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