Social care white paper: what has the government agreed to?

If that's what happens when they agree with you, heaven help you if they disagree.

In its social care white paper published last week, the government finally "agreed" that the principles set out over a year earlier in the Dilnot report on fairer funding are right. But ministers don't know if they want to find the money to pay for it, they won't consider it for another year or two and – if they do get round to it – they might opt for a watered-down version. Forgive me if I don't get the bunting out.

The huge question of whether to cap individual liability for care costs has been ducked and providing loans so people's homes don't have to be sold until after they have died is no substitute. But the white paper also sets out some other important changes, both good and bad.

Local authorities will be required to apply a national minimum eligibility threshold for access to free social care. And they will have to continue to meet the assessed needs of people who have moved into their area immediately, until they carry out a new assessment of their own. This is a step towards the portable assessments that organisations such as Anchor have called for but it still leaves room for unnecessary duplication among local authorities.

An interesting idea is promoting time share initiatives in which people build up a "bank" of care by caring for others that they can later draw on for themselves. Another is social impact bonds, where investors accept a lower return because they know that their investment is doing some good. Given the low levels of trust in traditional banks, this could be an idea with legs.

A new care and support housing fund will provide £200m of capital funding over five years from 2013-14 to encourage providers to develop new accommodation options for older people and disabled adults. But it says nothing about addressing the significant planning issues currently preventing such housing from being built.

The white paper also promises websites to help people compare the care market (not a great deal of help to those older people who don't have access to the web).

And within 12 months the government will enable open access to data to support the production of independent quality ratings that are easy to understand and continually updated. This sounds remarkably similar to the short-lived but very positive star ratings system, so possibly a recognition that scrapping it was a mistake.

A new care audit will be introduced in 2013 to highlight how well residential care providers are delivering dementia care. While this sounds good, many providers already groaning under onerous regulation which in some cases is duplicated by local authorities may see this as yet another layer of checks and double checks.

There are welcome noises around better integrating health and social care funding and government will "legislate to introduce a clear duty on local authorities to incorporate preventive practice and early intervention into care commissioning and planning". The draft care and support bill will set out new duties to be placed on local authorities to ensure that adult social care and housing departments work together.

The restated commitment to personal budgets is welcome. But it is hard to see how the government's April 2013 target will be met at the current rate and concerns still remain about protecting vulnerable groups.

The white paper says commissioning inappropriately short windows of care is "unacceptable and cannot be part of the reformed care and support system" but unless the Government tackles the big question of funding it's hard to see how this will change.

While free social care at the end of individuals' lives is a significant and positive move, it further raises concerns that many of those who aren't approaching the end of their lives will be on their own when it comes to funding.

Recent research from Anchor found that just 23% of older people are confident that good quality care will be made available to them when they need it. Politicians should see that as a damning indictment of the status quo.

But in the hundreds of pages published last week, there were two key sentences which should deeply concern anyone who wants to see real meaningful change: "Many commentators have suggested that those who benefit most from reform should be asked to meet the cost of reform. One way of doing this is through a voluntary or opt-in funding system, where people have a choice to pay a specified amount to receive financial protection from the state."

With little understanding among the general public about what social care is and what it costs and most people in denial that they will ever need it, a voluntary system is unlikely to ever operate at a scale which will deliver the radical change that's needed. Few campaigners have been pressing for an entirely state-funded system. Most support the principle that individuals and the government both have a responsibility.

Adequate funding has to be found for a true partnership between the individual and the state. Let's just hope the government agrees.


Sourced from The Guardian, 18th July 2012.