What Do We Make of the new Health & Social Care proposals?

As promised earlier in the week, what follows is a critique of the new proposals (which look to become law this time), and how they might impact on your engagement with services in the future. In a couple of weeks, we will round this off in a separate article with how you might (or might not) approach your financial planning for future care needs.

Firstly, we assume that you have read enough in the papers, seen enough on the TV and online to come to certain conclusions about last month’s proposals for Health & Social Care.

As many of you have realised, this new plan is NOT a new plan to reform Health & Social Care “once and for all”. It is good, we think, that the issue has come to the forefront and we are finally seeing some action after decades of inertia. But that action has to be the right action: of themselves these proposals palpably are not that.

The rise in national insurance will raise £36bn in the coming three years. However, as is well documented, the bulk of that is going to tackle shortfalls and waiting lists in the NHS. Only around £5.4bn is being allocated to social care. Once you put aside the £2.5 billion which will fund the new cap on care costs, Adult Social Services are left with just £2.9 billion over those three years.

The government are keen to point out that there is a crisis in social care funding which has been decades in the making (and they are especially keen to blame their political opponents for this). But £2.9bn over three years to tackle this scale of crisis in social care is not going to scratch the surface. We think that this won’t go any way to make up for years of underfunding in the sector, let alone properly reward highly skilled care workers who are leaving the industry in their droves because of the lack of regard for them by the government and many sections of the public, let alone appalling pay and conditions.

The headlines on Tuesday were certainly eye-catching as you’ve all seen. However, it has quickly emerged that the figures, once you analyse them properly, mean that the people with more assets and higher incomes will benefit disproportionately more than those who have more modest assets.

Due to an over-heated housing market, much of this wealth is predicated on the value of a property, especially in London and the South East. In our experience, many people are “property rich” yet “cash poor”. The fairness of this is questionable in itself, even before you consider that people of working age, some of whom are struggling to get on the housing ladder themselves, are being asked to pay for it.
All of this can be found from other sources. However, what follows is our thoughts on how this might impact the sector in a “real-life” sense, because we are all impacted by this on a daily basis.

By our definition (and presumably yours), the Prime Minister’s 2019 electoral soundbite that “no-one should sell their house to pay for care” is a specious one. This new act changes nothing: the Deferred Payment Scheme that has been run by councils since 2015 is still (rightly) in place: so, to claim to the public that this is something new is most disingenuous.

In the nauseatingly self- congratulatory “Build Back Better” policy document (which was published on Tuesday 7th August) the government pledges to:
“… work with partners to review the existing scheme in order to provide more flexibility for people to defer their care payments”.

It goes on to say: “We will also tackle persistent unfairness in the social care system. Under the current system, people who fund their own care often pay more than people who are funded through their Local Authority for equivalent care. For the first time, using legislation included in the 2014 Care Act, we will ensure that self-funders are able to ask their Local Authority to arrange their care for them so that they can find better value care.”

Let us put aside our obvious question: “if the legislation has been on the statue book since 2014, why wasn’t it implemented before…” and examine the situation.

Cost Implications

Currently, Local Authorities will buy care home beds in bulk for people who they would be expected to fund towards. Now, the government is proposing that the same bulk buying benefits will apply to self-funders. However, care home providers will not wish to lose financially as a result of this, which would probably drive-up prices across the board now by care providers (in anticipation of these arrangements) – thus increasing further pressure on Local Authority budgets.

Under the new proposals, accommodation charges will still need to be paid and do not count towards the £86,000 cap for care costs. There are two issues here: firstly, a Local Authority would surely need to publish the rate it considers is payable for care (as distinct from their rate for accommodation) to ensure transparency and that people know how their individual “Cap Account” is operating. This rate will obviously differ by area. One wonders by which system they are proposing to capture and monitor the many thousands of self-funders who have assets in excess of the upper threshold of £100,000 who may choose to not engage with the Local Authority when they first go into care after October 2023. This would potentially be a massive undertaking involving increased staffing and a vast increase in requests for assessments.

Secondly, care home providers may feel the need to increase prices now to compensate for what they may see as a reduction in profits post October 2023. (remove as already stated above)

There are other factors to consider:

Local Authorities are already struggling to meet demands placed on them due to more than a decade of Local Government under-funding by central government which has severely impacted budgets and, by extension, service provision. It goes without saying that here will be a huge increase in the need for both financial and care needs assessments under the proposed arrangements, so it begs the question as how they will meet this new demand when the staff availability is far less in a post-Brexit world?

Mental Capacity Issues & Access to Services

In times of austerity, Local Authorities have been known to restrict care criteria due to budgetary pressures. There is a high possibility that this could happen again, particularly for residential admissions.

For instance, the children of self-funders often make the decision for them to go into residential care without the input of the Local Authority. As many of you are only too aware, this is usually due to the potentially huge costs of 24- hour care at home, a lack of domiciliary resources and family pressures. These parents may not have undergone a capacity assessment as to whether they can consent to this or not. Although the DOLS process is invoked once a person is admitted to residential care, DOLS assessments are taking up to two years in some areas.

The point we are trying to make here, is that people in that position, who then become the responsibility of the Local Authority to assess (under the new proposals), as to whether residential care should be considered, may be deemed to have capacity to remain at home if they so wish. This, in turn, places more stress on families who are no longer able to cope. As an antidote to that, will Local Authorities increase home care packages accordingly? At present, families are often told one (or all) of three things when trying to access care at home (all of which are incorrect under the Care Act:

  • A person is only entitled to a maximum of 4 calls per day
  • The Local Authority do not provide overnight care
  • They also do not provide 24 hour care

If local authorities are already restricting access to such services (using the above statements, one can imagine this will get even more difficult if the proposals are implemented.

Valuing & Retaining Staff

Of course, care is only as good as the people actually tasked with providing it. We believe that, as a rule of thumb, this means that they should really, erm.. “care”. We would argue that this requires a special skillset, aptitude and the passionate belief that they want to do the job for the long term.

In the“Building Back Better” document the government aims to:

“…provide support in professionalising and developing the workforce, including hundreds of thousands of training places and certifications for our care workers and professional development for the regulated workforce”.

There will be £500,000 over three years allocated for this.

We believe that the perception of social care being a low wage, high profit industry needs to change. Any businessperson knows that in order to recruit and retain good quality staff you have to pay them in accordance with their value to the business. This happens in most sectors, but is conspicuous by its absence in the care industry.

While better training is welcome, all too often in the past this is just a validation exercise which merely pays lip service to the development of staff.

Better pay and conditions along with the drastic improvement in the public’s regard for carers (both home carers and in residential settings) will improve the way carers’ regard themselves and their importance to society and the relief they provide for the public purse. No real account of this is taken by the government’s proposals.

They do, however, say that they will set out their proposals to recruit and retain in the “upcoming” White Paper which (they say) will be published in due course.

Timescale Issues

This begs the question as to why the White Paper has to come separately, and later, than Tuesday’s headline grabbing announcements? PR certainly, but are we going to see another promise of a further Act to “fix” social care postponed again. Tellingly, they give no timescale for a White Paper to be published. Even if it is produced in a timely way, will it be as a result of consultation with care user’s, Local Authorities and providers, or will it be offered as a “fait-accompli?”. Or indeed, as in the past, will it actually happen at all given the huge number of White and Green papers produced in the past on reform in the sector that never made it into law.

There is a heavy bias towards the NHS in terms of funding for the next three years. While, we think, this is perfectly understandable for the time being, what will be the provision for Adult Social Care if backlogs and waiting lists do not come down significantly in next three years? Will they push back meaningful Social Care reform even further, or will they raid the public purse again to ensure it gets done?

Final Thoughts

The language in the “Build Back Better” document also raises our eyebrows. The tone is very much an aspirational one: lots of talk of “we can”, “we will hope to” etc, rather than:- “we will”, “we must” or “we will guarantee” which should be the language used from a government sure in its conviction to solve the problem.

As it stands, the proposals are effectively the same as those in the Dilnot Report in 2014 with small tweaks to the thresholds and the level of the proposed “Care Cap”. At that time, there was no suggestion that this would be paid via an increase in taxes. The difference obviously now is that the NHS has been damaged beyond measure because of the pandemic. The proposed rise in National Insurance is really, we would contend, to pay for this. Our profound hope is that Social Care, despite the fine words of Ministers, will not be left out one again.

You will all have your own ideas as to what a proper “fixing of” of social care looks like, so please leave your comments in the group in the usual way. But please be kind to each other: we are here to challenge and question ideas, not people.

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