05/07/11

By Andrew Holt

The Commission on Funding of Care and Support has presented its findings to the Government in its report Fairer Care Funding, and the sector has generally welcomed the report, albeit with many qualifications.

The independent commission, set up by the Government last July, was asked to recommend a fair and sustainable funding system for adult social care in England.

Among the recommendations in the report are:

■ Individuals’ lifetime contributions towards their social care costs – which are currently potentially unlimited – should be capped. After the cap is reached, individuals would be eligible for full state support. This cap should be between £25,000 and £50,000. We consider that £35,000 is the most appropriate and fair figure;

■ The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000;

■ National eligibility criteria and portable assessments should be introduced to ensure greater consistency; and

■ All those who enter adulthood with a care and support need should be eligible for free state support immediately rather than being subjected to a means test.

The Commission estimates that its proposals – based on a cap of £35,000 –would cost the State around £1.7billion.

Andrew Dilnot, chair of the Commission, said: “The issue of funding for adult social care has been ignored for too long. We should be celebrating the fact we are living longer and that younger people with disabilities are leading more independent lives than ever before.

"But instead we talk about the ‘burden of ageing’ and individuals are living in fear, worrying about meeting their care costs.

“The current system is confusing, unfair and unsustainable. People can’t protect themselves against the risk of very high care costs and risk losing all their assets, including their house. This problem will only get worse if left as it is, with the most vulnerable in our society being the ones to suffer.

“Under our proposed system everybody who gets free support from the state now will continue to do so and everybody else would be better off. Putting a limit on the maximum lifetime costs people may face will allow them to plan ahead for how they wish to meet these costs.

"By protecting a larger amount of people’s assets they need no longer fear losing everything.”

NCVO
Sir Stuart Etherington, chief executive of NCVO, said: "This review makes major strides towards identifying how we can achieve an affordable, sustainable and fair funding system for all adults in the UK.

"The challenge now falls to all parties to resist turning the review into a political football and to prioritise responding swiftly and decisively. It is the most vulnerable who will suffer if we cannot seize this golden opportunity to improve the funding of adult social care.

"NCVO will continue to monitor the situation closely and will be working with leading social care charities to take these recommendations forward."

The voluntary and community sector makes a significant contribution to social care in the UK, with over 33,000 organisations and over half the sector workforce (56 per cent) covering a wide range of activities from care of the elderly to services for the blind.

The King's Fund
Richard Humphries from The King's Fund commented: "In establishing the Dilnot Commission, ministers challenged it to produce a blueprint for a care system that is fair, affordable and sustainable.

"The report delivers on that challenge and offers a credible and costed way forward. The government must now move quickly to endorse the framework for reform it sets out, outline a clear timetable for change and honour its commitment to bring forward legislation in 2012.

"Where previous attempts at reform have failed due to lack of political consensus, this report offers the prospect of a lasting settlement based on a new partnership between the individual and the state - a principle long argued for by The King's Fund.

"While we need to study the detail, overall, the recommendations appear to strike a balance between fairness and affordability that all the political parties should be able to support.

"The budget deficit should not be used as a reason for inaction. This is a long term issue and questions of affordability go beyond the current economic situation. The additional public expenditure needed to fund these proposals is less than 0.25 per cent of GDP– this should not be too high a price to pay for providing a care system fit for the 21st Century.

"The proposals to cap individual liability for the costs of care and raise the upper threshold of the means test would protect people against the worst aspects of the current care lottery and deliver a more generous system.

"While the funding proposals will no doubt generate the headlines, there are a number of other important recommendations including national eligibility criteria and portable assessments, better information and advice, and improvements to the deferred payment scheme. We also welcome the emphasis on integrating health and social care services - a more unified system will deliver benefits for the NHS and social care alike.

"The coalition agreement stated that the government understood the urgency of reforming the social care system. A year on, the need for reform is even more pressing. Where they have failed in the past, politicians from all parties must now seize the best opportunity in a generation to ensure that people can access the care and support they deserve in later life."

The Princess Royal Trust for Carers
Liz Fenton, chief executive of The Princess Royal Trust for Carers, said: "We welcome the report from the Dilnot Commission on funding social care. This represents a fairer way forward for people with care needs and it means they and their families can plan for the future without the fear of losing everything.

"We are pleased the Commission has recognised the key role of England’s five million unpaid carers in underpinning care and support in our society and suggests a way forward that will support carers in this fundamental role. We call upon all parties to seize this opportunity and change social care to ensure a fairer future and more peace of mind for everyone."

Turning Point
Turning Point’s chief executive, Lord Victor Adebowale observed: “We have long needed to achieve an affordable and sustainable system for funding long-term care in this country. The fact that this is being looked into in such detail can only be applauded but the main dialogue surrounding the report has been focussed on care of the elderly.

"It is not only older people who are affected though and we feel more attention should be paid to other recipients of long-term care, including those with learning disabilities and mental health issues.

“A great deal of work has been done to improve the life chances of those with a learning disability over the last 30 years, but we need to make sure that any changes which are implemented help to keep us moving in the right direction.

"People with a learning disability have their own unique needs. Greater attention should be given to these, so that the hard work that has gone before is not in danger of being undone.”

Leonard Cheshire Disability
Guy Parckar, acting director of policy, campaigns and communications at Leonard Cheshire Disability, said: “Today’s report is a major contribution and represents a crossroads for social care. The system as it stands is creaking at the seams, with more and more people missing out on the care that they need.

"This report must be seen as a clear call for action. All of the political parties must come together with one agenda and that is to agree a fairer settlement for social care. We cannot go on with disabled and older people missing out on care because of a system that simply cannot cope with the demands placed upon it.

“From a Leonard Cheshire Disability perspective the report’s recommendation around free care for those who develop social care needs early in life is particularly crucial.

"Too often disabled people with significant social care needs can be charged into poverty by our social care system. People are unable to work, unable to save, unable to buy a home as any income or assets will simply be taken to cover the costs of care. This is a critically important recommendation that could make an immense difference, and it is absolutely imperative that the Government acts on it.”

The report sets out a number of key recommendations.

Leonard Cheshire Disability’s summary response on each of these key issues is set out below.

Introduce a cap on total personal expenditure on social care
The Dilnot Commission report says: “To protect people from extreme care costs we recommend capping the lifetime contribution to adult social care costs that any individual needs to make at between £25,000 and £50,000. We think that £35,000 is an appropriate and fair figure and have used this example throughout our report. Where an individual’s care costs exceed the cap, they would be eligible for full support from the state. This change should bring greater peace of mind and reduce anxiety, for both individuals and carers.”

Leonard Cheshire Disability response: “While Leonard Cheshire Disability would favour a system that is free at the point of use for all, like the NHS, a cap would be a very positive step forward. This proposal would help mitigate against some of the astronomical costs that some disabled people with higher level care needs can face.

“A cap would help make planning for the future possible for those who develop needs later in life but it must be seen in conjunction with the proposals for free care for those who acquire needs early in life. The system will need to work for all age groups if it is to make the care system fairer, and the Government will need to act on all these recommendations.”

Increase the threshold for receiving means-tested support
The Dilnot Commission report says: “Not everyone will be able to afford to make their personal contribution, and those currently just outside the eligibility for means-tested help are not adequately protected. To address this, means-tested support should continue for those of lower means, and the asset threshold for those in residential care beyond which no means-tested help is given should increase from £23,250 to £100,000.“

Leonard Cheshire Disability response: “Too many people at the moment are seeing their assets stripped down to nothing by social care charges. For younger disabled people, and those with significant social care needs throughout their life, this can mean being trapped in poverty.

“Raising the threshold would help prevent people being left with nothing, or opting out of care for fear of losing any savings that they have built up.”

Introduce free social care for people who acquire care needs early in life
The Dilnot Commission report says: “People born with a care and support need or who develop one in early life cannot be expected to have planned in the same way as older people. Those who enter adulthood already having a care and support need should immediately be eligible for free state support to meet their care needs, rather than being subjected to a means test.”

Leonard Cheshire Disability response: “This is a hugely important and extremely welcome proposal. The social care charging system, as it currently stands, can actively prevent people from taking work, building up savings and buying a house. This is grossly unfair and simply must be challenged.

“The impact of care costs on those who acquire social care needs early in life, for example through a sudden accident, or ill-health, can be massive. This recommendation could make a tremendous difference to many people and it is imperative that the Government takes it forward.”

Maintain disability benefits
The Dilnot Commission report says: “Universal disability benefits for people of all ages should continue as now. We recommend that the Government consider how better to align benefits with the reformed social care funding system.”

Leonard Cheshire Disability response: “We welcome the commitment in the report to maintaining disability benefits in their current form. Disability Living Allowance (DLA) is a vitally important benefit for thousands of disabled people.

“The mobility component of DLA in particular currently provides absolutely vital support to disabled people in residential care. It is absolutely critical that this support is maintained when DLA is changed into the new Personal Independence Payment.[1]”

Consider increasing the Personal Expenses Allowance
The Dilnot Commission report says: “As in the current system, no one will be expected to contribute their entire income to their residential care costs; everyone will be left with a certain amount of money for personal expenses each week. Under the current system, this amount is £22.60 a week (the Personal Expenses Allowance (PEA)). We think that the PEA should continue, but would encourage the Government to consider the case for increasing it in the future.”

Leonard Cheshire Disability response: “The Personal Expenses Allowance is simply not sufficient for covering people in residential care’s basic expenses notably clothing and toiletries, and recent rises have been criminally small – the last increase was just 30p per week. We are delighted that the report recommends considering raising the Personal Expenses Allowance. A significant rise could make a huge difference to many people in residential care services.”

National eligibility criteria for care and ‘portable’ assessments
The Dilnot Commission report says: “We recommend that eligibility criteria for service entitlement should be set on a standardised national basis to improve consistency and fairness across England, and that there should be portability of assessments. In the short term, we think it is reasonable for a minimum eligibility threshold to be set nationally at ‘substantial’ under the current system. The Government should also urgently develop a more objective eligibility and assessment framework.”

Leonard Cheshire Disability response: “We are very supportive of the idea of better, more consistent national eligibility criteria, and of improving the portability of social care.

“At present thousands of people with very significant social care needs end up missing out on the support that they require because of the ever-tightening, inconsistent eligibility criteria used across the country. While we are concerned that even a minimum of meeting ‘substantial’ needs will leave too many people outside of the system, struggling to cover the costs of care, it would at least be an important step to ensure more consistency across the system.”

Awareness raising campaign around social care reform
The Dilnot Commission report says: “To encourage people to plan ahead for their later life we recommend that the Government invest in an awareness campaign. This should inform people of the new system and the importance of planning ahead. This campaign could be linked into the wider work to encourage pension savings.”

Leonard Cheshire Disability response: “Dilnot rightly identified a huge lack of understanding about the way in which social care is currently funded. This will act as a block to the sort of long-term planning that the Commission sets out in its report. Any significant change to the system would need to be accompanied by much better and clearer information.”
Better information and advice about social care funding

The Dilnot Commission report says: “The Government should develop a major new information and advice strategy to help when care needs arise. It is critical that the public has access to better, easy-to-understand and reliable information and advice about services and funding sources. This strategy should be produced in partnership with charities, local government and the financial services sector. As proposed by the Law Commission, a statutory duty should be placed on local authorities to provide information, advice and assistance services in their areas. These should be available to all people, irrespective of how their care is funded or provided.”

Leonard Cheshire Disability response: “Advice and guidance is crucial, both for those trying to navigate around the system, and for those who are left outside of state provision. All too often people, who are deemed ineligible for state-funded care, despite real needs, are simply left to fend for themselves with no real support or advice.

“Even those inside the system often have very little real guidance as to their rights and responsibilities. The Law Commission’s work on simplifying social care law should be crucial here. Local authorities should be obliged to make sure that people get the right information and advice when they develop care needs.

Better support for carers
The Dilnot Commission report says: “Carers should be supported by improved assessments which take place alongside the assessment of the person being cared for and which aim to ensure that the impact on the carer is manageable and sustainable. We support the proposals set out by the Law Commission to give carers new legal rights to services and improve carers’ assessments. In implementing our recommendations on information and advice, the Government should ensure that carers have better information and advice about support and available services.”

Leonard Cheshire Disability response: “Informal carers perform incredible feats in keeping the current social care system going, often with extremely limited support from the state. Better recognition and support for carers will be crucial. But whilst information and advice will be very helpful, current levels of carer’s allowance should also be reviewed.”

Better integration between health and social care services
The Dilnot Commission report says: “In reforming the funding of social care, the Government should review the scope for improving the integration of adult social care with other services in the wider care and support system. In particular, we believe it is important that there is improved integration of health and social care in order to deliver better outcomes for individuals and value for money from the state.”

Leonard Cheshire Disability response: “This has long been an area where improvement is needed. There is a very clear overlap between health and social care services, but often there is a complete disconnection between the services themselves. Better coordination between health and social care services must be an important early step in this process.”

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