Social care leaders’ verdicts on the adult care green paper July 2009

    The government’s new green paper on social care and support has emerged against a background of rapidly rising demand and a potential funding shortfall of £6bn a year unless action is taken. Here, we ask a selection of experts to give us their opinions on the future funding options set out in the green paper:

    Funding Options

    Pay for Yourself : everybody responsible for paying for own basic care and support. The green paper rules this out as some people would be unable to pay and the system would be fundamentally unfair.

    Partnership; state pays possibly a third or a quarter of an individual’s basic care and support costs. Less well off would have more paid by the state, for example two thirds, or all costs in the case of the least well off.

    Insurance: Same as partnership model but people could cover additional costs through a voluntary insurance scheme, either privately or state-run. Those paying into scheme would receive all basic care and support free.

    Comprehensive: Everyone over retirement age with sufficient resources would be required to pay into a state insurance scheme. The less well off would contribute less than everyone else. Basic care and support would be free.

    Tax-funded: Care and support funded from taxes and would be free, like NHS. Green paper rules this out as places a ‘heavy burden’ on people of working age.

    Gillian Crosby, director, Centre for Policy on Ageing:

    Increased investment in care over the long term, that delivers quality support for all based on need, requires costs and risk to be shared fairly, and at present the comprehensive option comes closest to this. The debate must be informed by the full costs including accommodation, protection for those with so-called low level needs and the needs of carers. All services should be based on the principle of age equality. Funding proposals need to be sustainable, transparent and understandable with risk pooled to avoid devastating financial risk; proposals need to be fair regardless of current age. Ideally, there should be choice to make payment for care during working life, on retirement or after death, where accumulated individual resources make that possible.

    A tax-funded system has been ruled out on the grounds that it places a heavy burden on people of working age. But it should be remembered that those of working age today are tomorrow’s older people, who would then be supported by the tax payments of those then working. Also, by removing the age at which employers can insist on employees leaving employment, and encouraging employers to create flexible working patters, older people remain as contributors to the scheme. The scheme could mirror the principle of the National Health Service, providing universal care according to need and free at the point of delivery. It would seem wise to at least keep this option in the mix for consideration.

       Jon Glasby, professor of health and social care, University of Birmingham:

    My  preference is for free long-term care funded from general taxation one of the few options the Green paper immediately rules out. In an era of long-term conditions, it no feels meaningful (if it ever was) to distinguish between people who are ‘sick’ (who we see as having ‘health’ needs met free by the NHS) and people who are merely ‘frail’ or ‘disabled’ (who we see has having ‘social care’ needs and who pay for their care). We are very proud as a society of the core values of the NHS and I see no reason why we shouldn’t fund long-term care in the same way. While this has been rejected as placing too heavy a burden on the working population, this seems to me a political choice. Something is only is only unaffordable if we are not prepared to pay for it. If we decided as a society that we valued older people sufficiently to make this a priority, we could pay for it tomorrow. Admittedly, we’d have to be clear about what else we wouldn’t fund  but faced with the option of paying for long-term care, Trident, ID cards, GP pay rises or shares in RBS, I know which I’d choose.

    Stephen Burke, chief executive, Counsel and Care:

    As the dust settles following the launch of the care green paper, the ambition and the gaps are clearer.

    Creating a national care service is ambitious. It could put care on a par with the NHS. Making care a universal service that everyone has a stake in and everyone benefits from would certainly make a big difference.

    What is surprising for a green paper on funding care is the almost complete absence of financial figures and modelling. There is no clear indication what a national care service and the extra demands of our ageing population might cost; how much would be paid by the government; and critically what individuals would get for their contribution.

    Of the three funding options, I support the comprehensive option as being the simplest, fairest and best way to share the risks and costs of care. Everyone would get the care they need in return for a one-off contribution.

    What needs to be debated is how that contribution could be made in a way that is fair. I have argued for some time that a care duty on people’s estates would be the best way to pay for care we already have a collection mechanism and the level of payment could reflect an individual’s wealth, rather than everyone being required to pay the same lump-sum. A care duty could also be linked to the proposed universal deferred payments mechanism for accommodation costs.

    Michelle Mitchell, charity director for Age Concern and Help the Aged:

    Although we welcome the publication of the government’s green paper on care and support, there are still many challenges that lie ahead to ensure high quality care is available to all who need it.

    The current care and support system fails too many older people and their families. The Green Paper signals a welcome willingness to confront some of the hard questions about how to fix our broken care system, however all political parties and the public must now look beyond the short term squeeze on our national finances to agree a fairer way to pay for care.

    Concerns remain over a number of matters including the government’s preferred method of funding the improved care system, which seem to be at the expense of older people. This includes proposals to abolish a benefit that helps older people meet the cost of dealing with disability (Attendance Allowance) and to charge older people a lump sum of at least £20,000 from retirement for a form of social insurance. Age Concern and Help the Aged strongly believes that while more money is needed to improve the care system, all generations should make a contribution to the cost of care in later life.

    Richard Humphries, senior fellow in social care, King’s Fund:

    The leading funding options are variations of the partnership model originally developed by the King’s Fund in the Wanless Review. The underlying principle of all three options is that funding is a shared responsibility between the individual and the state. This is a sensible platform for debate, but the costings need to be clearer and more attention paid to what happens to working-age adults.

    The bottom line is that as a society we need to find substantial extra money to pay for care in the future – who pays, how much, when and how represent really hard choices but ones that cannot be fudged. And funding cannot be seen in isolation from the green paper’s wider proposals to create a National Care Service. We welcome the aspirations for more joined-up services but we need new and imaginative thinking about how this gets translated into practice.

    Overall, the government should be applauded for having the courage to raise a hornet’s nest of issues when the long grass could have been a more attractive place. What matters now is that the ‘Big Care Debate’ is indeed big and leads to specific, costed proposals. Ideally we need an all-party roadmap for reform.

    Councillor David Rogers, chair of the Local Government Association Community Wellbeing Board:

    We have long argued that our adult care and support system needs to make better use of the existing resources within it, and be supported by additional money to meet the demands of our changing population.  We need to do some further work and analysis on each of the funding options to see what the practical implications of each might be, but whatever system is implemented we can be sure that councils will continue to play a crucial role in supporting people to receive good quality financial advice, and incentivising financial products which enable people to make their personal contribution. 

    The funding proposals will no doubt become a central feature of the debate on reform of adult care.  Equally central in our minds is how any future system will work in practice.  Of the two models proposed – part national/part local and fully national – we believe there is a sound rationale for the part local/part national model, which will deliver better outcomes for people.  More than that we believe a fully national system could undermine councils’ flexibility in commissioning and designing care services around the needs of the user. In addition, the local council taxpayer contributes billions of pounds locally to the care service – a gap which a national care service would then need to fill.

    Over the coming weeks we will work closely with our members to explore the Government’s proposals in greater depth, and develop our position further. 

    Gillian Dalley, Chief Executive, Relatives & Residents Association:

    I favour the comprehensive option based on essential principles of fairness and pooled risk. It would ensure care free-at-the-point-of-need and a commitment to support the poorest in society.

    But the option is short on detail. Would income as well as savings and assets be taken into account? Would everyone above the agreed threshold pay the same flat rate (to the benefit of the most well off, paying less, proportionately, of their greater wealth)? Would outstanding instalments be recouped after death? Systems would be needed both to ensure that a legal charge was put on capital assets and to guard against unfair disposal of assets during life (aimed at avoiding payment out of the individual’s estate at death). People falling on hard times during retirement because of unforeseen events such as caring for grandchildren in circumstances of family breakdown would need protection.

    Too much emphasis is placed on protecting assets for inheritance and too little on guaranteeing consistent standards of care. There is no recognition of the need for safeguards to prevent care costs being surreptitiously offloaded onto accommodation charges (for which individuals would have to pay).

    Lastly, nowhere is there any attempt to resolve the persistent conundrum: free (NHS) total care for cancer patients and costly care for people with Alzheimer’s.

    But it’s a start. Now for the debate.

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