After years of lobbying, the government last week gave the strongest indication yet that it would act to reform the funding system for adult social care.
Launching a six-month consultation on the issue, ahead of a green paper next year, prime minister Gordon Brown said rising demand and expectations meant the system was in need of “fundamental reform”.
A Department of Health consultation paper published last week said there would be a £6bn funding gap for adult social care by 2027 if increases in expenditure only kept pace with economic growth. And this is if eligibility criteria stay at their current level, which excludes many people with care needs from publicly-funded provision.
By 2027, the number of people over 85 will have doubled and the number over 100 will have quadrupled. Combined with the fact that disabled people will be living longer, an additional 1.7 million people will be requiring care and support.
Fairness of the system
It is not just the level of funding that’s the problem, but the fairness of the existing system for residential and domiciliary care. The consultation paper identified two possible areas of unfairness – the variations in access to services around the country and the way the current system of means-testing penalises savings.
Over the next six months, the DH will hold events around the country to enable people to influence the process.
It will also be informed by a body of research into the issue, led by Derek Wanless’s review for the King’s Fund, which reported in 2006, recommending that the state should fund most of the cost of personal care for all service users, regardless of wealth, with individuals contributing the rest.
Added to this is the Commission for Social Care Inspection’s government-commissioned review into eligibility criteria, due to report in September.
One tension already evident in the debate is between the needs of disabled people with lifelong conditions and older people who come to social care late in life.
Disability charities have already warned that much of the focus so far has been on the latter. “There are massive problems now, not just in the future,” says Guy Parckar, public policy manager at Leonard Cheshire Disability. “There needs to be a clear focus on ensuring that younger disabled adults are fully reflected in the way the system develops. At the moment there are concerns that it might end up as a system designed around the needs of older people.”
The consultation reflects this concern, asking whether tax funding for social care should be “protected” for people with lifelong conditions, with those who acquire social care needs later in life having to contribute themselves.
Parckar says: “If you need social care services throughout your life, you simply don’t get the chance to save. There’s not enough in this paper to suggest there is a solution yet.”
Leonard Cheshire will be calling for one of the more radical options. “We support free personal care for everyone, as older people receive in Scotland,” Parckar says. “Social care is a public service like education, it shouldn’t be available to just those in the greatest need or who can afford it.”
But this seems to have been all but ruled out by the government as unaffordable. The Liberal Democrats even dropped their longstanding support for free personal care last year, backing Wanless’s “partnership” model instead, while a recent review of the Scottish system revealed it had a £40m shortfall.
The Conservatives, who may well be the party that implements any reform to the funding system, have yet to state their position formally, but shadow health secretary Andrew Lansley backed the Wanless model in a speech last year.
Hard to quantify cost
Parckar insists the argument on free personal care is not lost. Surveys suggest people may be willing to pay more tax to fund “better and fairer social care”.
But he says it is hard to quantify the cost of free personal care given the lack of information on the number of self-funders and those receiving informal care.
Mencap’s head of campaigns and policy David Congdon agrees that more needs to be found out before a proper response can be made. “The government has helpfully put some data in there about the demographics and possible costs,” he says. “But they need to explain how they’ve derived the £6bn funding gap figure. Many in the field would say that those figures don’t seem to bear any relation to what the costs are likely to be. What do they mean by a funding gap? Does it include disabled people, does it take into account rising expectations?”
Other funding options mooted in the consultation paper include private or social insurance. Under the latter, the government would set up a compulsory savings scheme to pool resources for the care system, which people could draw on in times of need.
Ministers are believed to be supportive although Brown pointed out last week that there was “no country in the world where such a system was fully formed”.
Older people’s charities Help the Aged and Counsel & Care have been enthusiastic in their support of the consultation, calling it a “golden opportunity” to solve the postcode lottery for care that exists around England, with different eligibility criteria, charges and quality of service operating around the country.
Tackling inconsistencies in eligibility is the job of CSCI’s review. Its director of strategy, David Walden, says there are important links between his review and the new consultation.
He says. “There are big variations in how councils are applying criteria, and even within their own social work teams you get variations in practice.
“We found that the tightening of eligibility thresholds for publicly supported social care was putting a greater burden on individuals and their families and was happening without any real public debate. We certainly welcome the fact that this debate is now underway for real.”
One of the more radical solutions suggested by the consultation is a centralisation of the social care system with uniform eligibility criteria and funding no longer channelled through councils. Predictably, the Local Government Association has rubbished the idea, saying that councils are best placed to serve the needs of their area as long as proper funding is in place. Voluntary organisations have a different view, however. Parckar describes the LGA’s contention as “highly dubious”, pointing to the levels of inequality in care that exist today.
There is a long way to go – this is in effect a consultation before a consultation, with the green paper due next year – but it is clear that expectations in the social care sector are high that a fairer, more generous social care system is within reach.
How do you think the system should be reformed? Have your say on Care Space
Community Care is running conferences on the eligibility crisis in adult care on 24 June, and on the adult green paper on 8 July
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