Cap on care costs risks more complexity and complaints for social workers

Flagship government policy to reform care funding will be highly complex to implement and increase workloads for council practitioners, warns report from the King's Fund.

Implementing the government’s cap on care costs may leave social workers facing more “confusion, complexity and complaints”, along with “substantial extra work”, a leading think-tank said today.

The King’s Fund said there was a “real danger” that many families would see the reform as a “worse alternative” rather than an improvement to the current system of paying for care, in a report on how rising social care costs can best be met. It also warned that the £1bn-a-year funding reform – included in the Care Bill – would do nothing to address the under-funding of the existing adult social care system because it would not impact on quality or eligibility thresholds.

From April 2016, people who have had £72,000 spent on meeting eligible care needs would have all subsequent costs met by their local authority, while people with assets of £118,000 will be entitled to means-tested help with residential care costs, up from £23,250 now.

Increased workloads from care cap

This will result in many existing self-funders who would have had little or no contact with their local authority having their needs assessed and having regular reviews so that they can qualify for the cap. Besides the extra care management workload for social workers, councils will need to implement new systems to provide qualifying individuals with virtual personal budgets and “care accounts” to track their progress towards the cap, and to account separately for care costs and daily living costs in care homes, as the latter not count towards the cap.

These reforms will have to be implemented a year after significant other changes to the funding system through the Care Bill, including a single national eligibility threshold for care and a nationwide system of deferred payments to fund people’s care through a charge on the value of their house.

The King’s Fund said this would all require “an immense amount of detailed planning for a potentially complex new set of arrangements” for councils at a time when they were experiencing a significant squeeze on their budgets.

More complaints

The report warned that social workers could face increasing numbers of complaints from families because the cap policy would require councils to count what they would have spent on meeting individuals’ care needs towards the cap, not what the self-funding individual actually spent themselves. Care fees for self-funders tend to be higher than those paid by councils for equivalent services, including because authorities can use their larger buying power to bargain down costs with providers.

While the King’s Fund said the policy was not unreasonably in this respect, “the potential for confusion and complaints arising from the disparity between actual spending and the notional costs assessed by local authorities is very substantial”. This reflected the low level of public understanding of the care system.

It warned: “Without a major and sustained public relations and awareness campaign, there is a real danger that many will see the reform as as a worse alternative rather than an improvement to the actual realities of the current system.”

The report also stressed that the cap and more generous means-test would do nothing for those deemed ineligible for council-funded social care, nor address other pressures on the current funding system, such as increasing demand from the rising number of older and disabled people and the squeeze by councils on payments to providers.

Health and social care divide ‘untenable’

It also warned that traditional dividing lines between health and social care were becoming untenable because of the increasing number of people with long-term conditions who required joined-up support from both services in the community, as opposed to separate hospital or residential care. This meant the anomalies between a free, universal NHS funded from government and a means-tested social care system run by local authorities would become unsustainable.

It said these issues needed to be addressed in the government’s spending review announcement on 26 June, which will set out public spending limits for 2015-16, including for local authorities. It rejected the idea of siphoning funding from the NHS budget into social care, as the government has done since 2011, saying this was “robbing Peter to pay Paul”.

Instead, the government should move towards a single budget settlement for adult health and social care to drive better joint working between councils and NHS clinical commissioning groups, to help improve efficiency and shift support out of acute hospitals and care homes towards community-based services.

It also called for a public debate on how health and social care should be funded in future; the fund is due to launch such a review shortly.

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