Broon’s Care Bunny – Trick or Treat?

Broon’s Bunny makes roadkill of consultation?

Was it a conjuring trick to thwart the consultation or just a soundbite one has to wonder?  We find it strange that with little over a month to go for people to have their say about the government’s social care proposals for England, the Prime Minister pulled a monster rabbit out of his capacious hat which made roadkill of the consultation process.  Mr Brown pre-empted discussion by giving a personal care pledge to adults under 65 –  later clarified as also extending to younger disabled people aged 18-64 needing personal care at home.  That’s a lot of people and a awful lot of bawbees, Gordon, even if the Government is still around after 2010.

Bunny Distraction

After the Brighton rabbit trick, is there anything still to consult about?  The King’s Fund was bemused but thinks the devil will all be in the detail.  No doubt it will, but the bigger problem is that rabbits out of hats don’t make good policy. “Bunny distraction” is a disincentive to engage with the consultation.

How to fund social care costs as our population ages and more of us survive for longer could hardly be more important to all of us, yet most people outside the usual interested parties are only dimly aware this debate is even happening.

National Care Service and funding proposals

At the heart of the proposals is the establishment of a “National Care Service” providing all people with needs above a single England-wide threshold with access to some public funding for their care in older age: a minimum of a quarter to a third of the cost, rising to full support for those on the lowest incomes.

Three options are proposed for how people might fund care costs not met by the state:

1. A partnership model under which individuals are left to meet their care liability themselves. The Green Paper says that while average costs for people over 65 would be around £20,000 to £22,000 per year, those with the highest needs, such as people with dementia, could still face significant costs of £100,000 or above.

2. An insurance model under which people would be invited to enrol in a state-backed insurance scheme – either run by the state or private insurers – and then get all of their care costs covered. The Government estimated that people might need to pay £20,000 to £25,000 into the scheme, protecting those with higher needs against prohibitive costs.

3. A comprehensive model under which all people over 65 would be compulsorily enrolled in a state insurance scheme. This would reduce premiums from £17,000 to £20,000, because the risk pool would be maximised, but people would need to pay regardless of whether they needed care or not.

1 and 2 are nonstarters.  If it’s non-compulsory, those that are likely to need it most won’t bother.  Think about National Insurance contributions – no one would seriously suggest that should be optional.

Accommodation costs – the kicker jacking up the price

Accommodation costs in care homes would not be covered by these arrangements, but these costs would still be met for those with the least means, as now.  But there is a “fix” proposed for this – “care now and pay later”,  in effect  from beyond the grave.  Property owners could have their hotel costs for care met now, with cost recovery from their estates later on.  If this were nationally consistent and  transparent, it could work and should be seriously considered, we think.

Consistency please

Councils are notoriously inconsistent in setting and applying their eligibility criteria for social care.  Many people with needs judged to be low or moderate have been dropped off the eligibility list as resources are concentrated on “serious” need.  The Green Paper proposes a remedy in the form of a consistent care system with  a single national eligibility threshold, under which people who had difficulty with three or more activities of daily living would be covered. People would be able to move between areas and take their eligibility for care services with them, unless their needs also changed. The government would decide what proportion of someone’s care costs would be met by the state and what by the individual, rather than allowing councils to determine charges for non-residential services, as they do now.  Provided this was equitable, we think a move to national consistency would be welcomed.

There are things that could be done now

Are these proposals the future for adult social care in England?  They are one possible future, but not the only one.  According to the Joseph Rowntree Foundation’s ongoing research programme “paying for long term care” there are a number of successful current models of long term care arrangements for older people that could be rolled out more widely.  These should not be ignored in concentrating only on the Government’s options.

Get down to the basics about social care

Over and above commenting on the details, we think there are three things to be emphasised in this consultation:

First and foremost, we need one, integrated system of health and social care not two. A “National Care Service” that is insurance funded will always be problematic compared with a taxation funded National Health Service.  Why not combine the two into a universal service with a mixture of central taxation and insurance-based funding?  Service users don’t see the rationale for the division between health and social care anyway.  It is illogical in terms of how people with complex needs live their lives and need to access services.  Isn’t having a seamless service what we are supposed to be striving for?

Second, the social care debate must be widened to include younger adults with disabilities and chronic conditions and people who care for them. Adult social care is not just about elderly people.  Many thousands of younger adults 18-64 need better social care now  – generally at home – and will increasingly do so as they live longer.

Third, while raising the universal standard of social care we must reclaim the Beveridge principle of individual initiative to make extra provision.

We want to see these questions addressed in the responses to the consultation.  So we urge readers to ignore Mr Brown’s Brighton bunny and buckle down to thinking about the real issues around social care in England.  As someone from the government-in-waiting said recently, “We’re all in this together”.   How true.

Comments

  1. Andrew Craig says

    This week’s BMJ (2nd November doi:10.1136/bmj.b4515) carries a succinct report on the oral evidence given by Social Care Director General David Behan and senior colleagues on 29th October to the Health Select Committee. Watch it here http://www.parliamentlive.tv/Main/Player.aspx?meetingId=4938

    The BMJ report pulls out a key theme: the distinction between health and social care in England could become less precise under UK government plans to move the two closer together. MAC has argued consistently for one, integrated health and social care system so we welcome this move. As David Behan noted “we need to strike a new settlement between individuals and the state in relation to social care.”

    Included in David Cameron’s five health pledges issued yesterday is one about long term care. The “immediate action to be taken to achieve these goals” includes this bombshell: “Budgets combining social care and health care funding for people with long-term conditions will be rolled out.”

    That is a welcome acknowledgement that health and social care for most people with long term conditions is a continuum and their access to personalised services must not be artifically disrupted by having a separate healthcare budget and a separate social care budget.

    Integration is the key to this, just as it is the key to commissioning health and social care services that, as David Behan aptly phrased it “wrap around individuals, and the focus is the individual, to ensure they get access to appropriate levels of care rather than being told this is what we provide in this agency and this is how we provide it.” We hope he and Mr Cameron are talking about this.

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