Peers have overturned a government change to the cap on care costs that would reduce its benefit for less well-off people, and also voted to bring forward its implementation date from October to April 2023.
The House of Lords yesterday backed a cross-party amendment to remove a clause from the Health and Care Bill that would only count client contributions to personal care costs – not the full bill – towards the £86,000 cap, for those receiving means-tested council support. As a result, they would take much longer to reach the cap, and become eligible for free personal care, than wealthier self-funders.
The clause, inserted into the bill in November during its passage through the House of Commons, would hit older people in the second poorest fifth of the population, and those in the North East, Yorkshire and the Humber and the Midlands, hardest, found an analysis last month by think-tanks the Institute for Fiscal Studies and the Health Foundation.
The Lords vote returns the cap on care costs to the model legislated for in the Care Act 2014, under which the full costs of meeting a person’s eligible personal care needs, as assessed by the relevant local authority, would count towards the cap. The government has estimated that the Lords change would cost £900m a year compared to its favoured approach.
Poorer people ‘exposed to same costs as wealthiest’
Moving the amendment to remove the clause, Labour peer Baroness Wheeler said the government’s approach would leave “poorer people …exposed to the same care costs as the very wealthiest in society”.
The Lords vote was hailed by sector bodies for removing a “regressive” government change.
“The [government] change would leave many poorer people still exposed to the risk of having to sell their home to fund their care, whilst wealthier people would enjoy protection from the very high costs that can come with needing social care for long periods of time,” said Sally Warren, director of policy at the King’s Fund.
Age UK charity director Caroline Abrahams said: “If it had passed, it would have taken the cap beyond the grasp of older people with few or modest assets, poorer places and disabled people of working age. This would have been an extraordinarily unfair and regressive outcome and the House of Lords quite rightly said ‘no’.”
Anita Charlesworth, director of research and the REAL Centre at the Health Foundation, said:”When MPs originally voted in support of the government’s amendment they were effectively voting in the dark. Research from the IFS and the Health Foundation has since shown that the change would leave more people worse off compared to the original reform proposals.
Working-age adults ‘disproportionately affected’
“Among older people, those most affected are those with modest assets and wealth, and by region, those living the North East, Yorkshire and the Humber, and the Midlands. It will also disproportionately affect working age adults with disabilities.”
All three warned the government against using its 70-seat majority in the House of Commons to reinsert its proposed change.
Warren added: “I encourage members of parliament to consider whether they want to back a policy that will save the Treasury money, but at the direct expense of poorer people living in the North and Midlands who need social care.”
Cap would be ‘unaffordable’ with Lords change
However, in response to the Wheeler’s amendment, junior minister Lord Kamall said it would leave the government unable to afford the cap on care costs and the wider funding reforms – including a more generous means-testing regime – of which they are a part.
In a statement following the vote, the Department of Health and Social Care made clear it remained committed to its preferred approach.
“Our social care charging reform proposals provide a limit to the cost of care for everyone and strike the right balance between public contributions and people’s personal responsibility for planning for their care,” a spokesperson said.
“They are necessary, fair and provide certainty and reassurance so people can both plan for their future and pass on more of what they have saved to their loved ones.”
Bid to bring forward reforms
It also seems certain to seek to overturn an amendment, also passed by the Lords last night, to move the implementation date for the funding reforms forward from October to April 2023.
Under draft guidance published for consultation last week, the DHSC said a number of “trailblazer” local authorities would implement funding reform early to test their impact.
Kamall said: “We do not believe that there is sufficient time for local authorities to prepare for full national rollout by April 2023. It is vital that we take the time to work with the sector and local authorities on the process of implementation if we are going to get this right. To enable a successful rollout, we want to see how the trailblazers will work before we go for the full national rollout by 2023.”
Duty to consult carers before discharge reinserted
In a further change yesterday, the Lords voted to require NHS bodies to consult current or prospective carers of hospital patients before discharge to determine whether they are willing and able to provide care, if they consider it would be unlikely to be safe for the person to be discharged without care.
There is currently a requirement under the Care Act on relevant NHS trusts or NHS commissioning bodies – where a person has been placed in an independent hospital – to consult any carer where they consider it would be unlikely to be safe for the person to be discharged without care and support.
The Health and Care Bill, as drafted, would remove this requirement, along with the rest of the existing legal regime for tackling delayed discharges, as part of the shift to the discharge-to-assess model. The model, rolled out at the start of the pandemic to help clear NHS hospital beds, defers assessments of people’s needs until after discharge.
Despite intending to remove the legal duty to consult carers, the government’s impact assessment on the bill says forthcoming guidance would “make clear that before discharge, a determination must be made about the status and views of any carers who provide care, including that they are willing and able to do so”. In yesterday’s debate, junior minister Lord Kamall said the guidance would be statutory – meaning NHS bodies would be required to have regard to it.
‘Rowing back on carers’ rights’
However, moving the amendment that would retain a legal requirement, Labour peer Baroness Pitkeathley, a past chief executive of Carers UK, said that “guidance, however strongly worded, is not the same as having concrete rights in legislation that can be quoted and used”.
She added: “I cannot express how disappointed I and all who work with carers are that the government are for the first time rowing back on the rights of carers, for which we have fought so hard.”
It is not clear whether the government will seek to remove the amendment when the Health and Care Bill returns to the House of Commons.
Carers UK chief executive Helen Walker said: “When this bill returns to the Commons, it is essential that MPs understand why protecting carers’ rights is so important. It is vital to uphold this amendment and ensure that it remains in the bill. Our evidence shows what a devastating time hospital discharge can be for carers if they are not consulted, involved or given the right information and support to care safely and well. They should not be taken for granted.”