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The long-awaited White Paper on adult social care is due out very soon, but the question on everyone’s lips is whether it will bring about the much needed reform of the care sector.
Charities and those in the care home sector are pressing for more funding and have expressed concern that it seems to be cost not care that is being prioritised.
Parliamentary evidence for the adult social care White Paper drew to a close on 1 May and the Government seems to be indicating that it won’t be providing the financial package that so many are asking for.
The absence of a social care Bill in the Queen’s Speech and the Care Services Minister, Paul Burstow, talking about nurturing older people’s interest in gardening rather than relying on the state to care for people, seems to signal a reluctance by the Government to address the urgent issue of funding.
Mr Burstow recently told social workers, that a “radical” shift away from reliance on the state to care for people to involving the wider community is needed.
He said social workers may be asked to help keep older people active and living independent lives for longer by nurturing hobbies such as gardening.
This would ultimately save the taxpayer millions of pounds, he said.
However, Jane Ashcroft, chief executive of Anchor, one of the UK’s leading care home providers, says “A failure to reform the system now would be nothing less than a betrayal of the public.”
Simon Bottery, director of policy for Independent Age, calls it “enormously disappointing” that the “f” word - funding – is again completely absent from the Government’s proposal for a draft bill on social care.
Labour has called the issue “too urgent to kick into the long grass” with Liz Kendall MP, Labour's Shadow Minister for Care and Older People saying: “We want legislation on long-term care funding in this Parliament, rather than simply producing a ‘progress report’, which is the Government’s current plan.”
The Care and Support Alliance, which represents over 60 charities and organisations, including the National Care Forum and Age UK, recently wrote a joint letter to Health Minister, Andrew Lansley, saying ‘a new framework without additional funding will not address the fundamental challenge: the shocking fact that at a time when more people need care, the numbers getting support from social care services are decreasing’.
It went on to say ‘if the plans published later in the Spring do not answer the question of additional funding, they will fail’.
In its letter, the Care and Support Alliance called on the Government to deliver on both fronts: the funding and legal foundation of social care.
Last year, two reports setting out proposals for care reform were published: the Law Commission on the legislative framework for care and the Dilnot Commission on Funding of Care and Support led by Andrew Dilnot.
The Government said it would incorporate responses from both into the White Paper.
It then backtracked and said it will publish a progress report on funding reform at the same time as the White Paper.
Since the reports came out, the economic climate has worsened, there has been a plethora of news stories of abuse in care homes and local authority spending on the care of older people has fallen.
Martin Green, chief executive of English Community Care Association wants the Government to publish a White Paper that will secure “a long-term future for social care”.
He says: “This Government has a golden opportunity to develop a social care system, that is fit for the 21st century and will meet the needs and aspirations of the growing number of older people.”
He also wants to see “integrated services that wrap themselves round the user, and which use resources in the most effective way to deliver long-term and sustainable outcomes.”
Integration seems to be a key word for many.
Mike Parsons, chief executive of Barchester Healthcare, says: “Integration is the key - the Bill needs to make the most of the strongest ideas from the coalition and the cross party consensus that underpins the best current thinking on the subject. The question is what can the Bill do to ensure it moves towards integrated services?”
Mr Parsons would like to see the Bill focussing on using residential care for older people with dementia and “putting a premium on dignity, choice, independence and quality of life”.
“Homes operating to this model could also provide practical support to the important move towards personal budgets. This is achievable, and would end the national disgrace of appalling treatment of vulnerable older people,” he says.
Oliver Thomas, UK director of Bupa Care Homes, says “the current chronic underfunding of aged care has to be urgently addressed and should be a Government priority.”
He backs the recommendations of the Dilnot Commission and would like to see social care costs capped so people do not lose large chunks of their assets.
The key reforms would be a life-time cap of £35,000 on the contribution costs people are expected to make towards their care costs with the mean-tested threshold for savings below which people become eligible for state-funded residential care increasing from £23,250 to £100,000.
Bupa Care Homes wants the government to address the "chronic underfunding" by committing an additional £1.7bn in the White Paper, not outlining an update in a ‘Progress Report’ alongside it. This money must be ring-fenced so councils can pay fees to care homes that match inflationary increases. This will ensure the sustainability of the sector and quality care homes available for those who need them, claims Bupa.
Not everyone believes Dilnot’s cap model is the way forward and many believe the Government will refuse to adopt it.
Chris Horlick, managing director of Partnership's Care Division, the UK's leading provider of long term care insurance products, is pessimistic and says: “I don’t think we will see the cap model that Dilnot has put forward”.
He suspects “there won’t be much on funding and even if they do accept it, and it gets accepted as a bill, it wouldn’t be introduced until at least 2015. I think one of the things Dilnot failed to do in his report was to come up with a plan to stimulate the financial services sector.”
Tom Scott, director of the Care Fees Advice Agency, believes the main problem is that Dilnot is “not tackling the problem of the care system and it is not about can you protect people’s assets”.
He argues that local authorities do not pay enough for care and says: “If Dilnot is going to spend £2bn improving the care system, I would like to see local authorities paying a fair amount for care in their areas. People paying for private care are subsidising people who are being paid for by the local authority.”
Mr Scott speaks for many people, when he says: “Simply the Government doesn’t pay enough. Care homes are now saying they will not accept local authority funding so people are having to leave their homes where they have lived for the last five years.
In my opinion Southern Cross collapsed because they were relying on local authorities for payments.”
The think tank, the Centre for Social Justice (CSJ), also believes it shouldn’t be about protecting people’s assets and says elderly home owners should not be the Government’s first priority.
Its report, 'Transforming Social Care', wants the Government to concentrate on the poorest older people and ‘deal with their needs first, before relaxing rules that require better-off pensioners to reduce their assets to below £23,250 before they are entitled to help from the state’.
‘It is difficult to see why the cure proposed by Fairer Care Funding (the Dilnot report) will do anything to improve the lot of the poorest,’ said the report.
Christian Guy, managing director of the CSJ, says: “Understandably, there is a lot of concern about better-off pensioners being forced to sell their homes and use the proceeds to pay for their care until they drop below the means-tested threshold.
“But ministers should make the most vulnerable people and the unacceptable conditions they face their first priority, then phase in the Dilnot recommendations so that help can be extended to all.
“If they do not, then inexcusable standards will persist and their much vaunted NHS reforms are doomed to fail because hospitals will be swamped by expensive new demands from near destitute old people with nowhere else to go.”
The health charity, the King’s Fund, predicts the White Paper will be published in early June.
It is still very much a case of wait and see as to what it will say, but let’s hope it won’t all be about gardening!
Image: Paul Burstow - credit Liberal Democrats photostream