Background

On the 14^th July 2009, Andy Burnham, the Health Secretary announced in the House of Commons the long awaited Green Paper on Adult Social Care.  He is proposing that everyone in England will have access to a National Care Service that is “fair, simple and affordable”.

This, of course, is only the Green Paper, which sets out the Government’s proposals. Nothing becomes law until the White Paper is ratified in Parliament. Indeed, it is not expected to be effective until 2014.

 

There will now be a consultation process running up to mid-November and it is expected that a detailed White Paper will be published in 2010.  The General Election will have to take place before June 2010. It will be up to the new Government, perhaps a change in colour, to carry these proposals forward, or not.

 

Tony Blair, the former Prime Minister, told the Labour Party Conference in 1997 that he did not want children “brought up in a country where the only way pensioners can get long term care is by selling their home”.

 

Twelve years on, we have finally got the Government’s proposals but we have not got any real progress. Families currently dealing with long term care for their loved ones have to act now to protect their family’s capital from erosion.

 

Proposals

 

The Secretary of State for Health is proposing that everyone in England will have access to a National Care Service that is “fair, simple and affordable”.

The National Care Service is aiming to create a level playing field and end the postcode lottery of care services currently affecting those needing long term care.

 The Wealth Care Partnership fully endorses the setting up on such a service and feel it is well overdue. The current situation is totally unacceptable where families are bounced around Government agencies with no-one taking full responsibility of guiding and helping those thrust into dealing with a loved one needing care. It is our experience that the levels of service provided by Social Services and The Primary Care Trust differs widely across the country and this simply should not be the case. We do hope that the National Care Service does not turn into yet another inefficient, expensive and confusing, state-funded institution. It simply must be primarily a “Care” service.

Andy Burnham also claims that everyone in England will be guaranteed:

• Prevention services - the right support to stay independent and well for as long as possible and to delay care needs getting worse. 

Karen Rayner, Partner at The Wealth Care Partnership says “Until the Government are prepared to accept that the NHS is not helping an aging population by treating an illness once it has happened, and only then by the over use of prescription drugs and surgery, there will never be a world without long term illness. Substantial investment into educating the population about preventing illness through healthy living, from school age onwards is what is required. This is a “slow burner” and this is unlikely to happen in my lifetime let alone those currently in retirement”.

• National assessment - care needs will be assessed and paid for in the same way across the country.

“We do hope the National Care Service will remove the current Postcode Lottery affecting everyone who is facing long term care”. Ms Rayner continues, “It is to be remembered that Andy Burnham is talking about care costs and not living costs being covered by the new proposals. Living costs for those continuing to stay in their homes are likely to increase. For those moving into a care home the living costs will need to be paid for by the elderly person and may be higher than if they stayed in their own homes.”

• Joined-up services - all the services will work together smoothly.

Tim Anstee, Partner at The Wealth Care Partnership comments, “If Andy Burnham is able to pull this off, he will be seen as the next Nye Bevon, founder of the NHS in 1948.” He continues, “It is a terrific objective, but 60 years of the NHS has proved that it is totally unworkable.”

• Information and advice – the care system will be easy to understand and navigate.

Tim Anstee agrees that this is a wonderful objective. “There is a confusing maze of legislation and information depending on the levels of care and support an individual needs. People are genuinely confused about what is right for their loved one. Even those who work within Social Services or the NHS can find themselves lost in the maze and it is so difficult to know that you are doing the right thing for the elderly person concerned.”

• Personalised care and support - services will be based on personal circumstances and need.

Is this not something that should already be in place?

• Fair funding - money will be spent wisely and everyone will get some help meeting the high cost of care.

Again, these are wise words and make a good political soundbite. However, the reality is that whatever is paid to the care providers it will not be enough to give a high level of care to all. The Government are proposing they will pay towards the cost of care for all, but care costs vary from provider to provider and the support being offered will not be about everybody getting the same. Many care homes now insist on “third party top up” arrangements whereby family members must fund some of the care fees charged because the homes simply cannot provide the high levels of care their residents deserve, on Government payments alone. We cannot see the proposals changing this position.

 

It is interesting to note that the Government has been running a scheme in Scotland, whereby the person requiring care is able to receive Personal Care at £153 per week. If a person qualifies for Personal Care they are no longer eligible to receive Attendance Allowance (a form of tax free disability benefit worth up to £70.35 per week regardless of capital and income levels).

 

The Wealth Care Partnership believes that it is likely that this system will be adopted in England and many will not be able to claim this very valuable state benefit in the future if these proposals are adopted.

 

The Options

The Green Paper has proposed three options to be consulted on:-

The first option would be a Partnership Service, where the State would offer a proportion, possibly a quarter or a third of the cost of elderly care and the individual would fund the rest privately.

The second would be a voluntary Insurance Scheme, where people invest into a scheme before they have to be taken into care with the State part funding the programme. The Government says around 20 per cent of people could take up this option.

The third option would be a compulsory Comprehensive model, where all those over the age of 65 contribute to a national scheme that would, if necessary, offer everyone full state funded health care.

The Green Paper also states that both a fully state funded scheme and fully privatised programme would not be recommended.

Andy Burnham says the Government has calculated that the Partnership Scheme would cost an individual around £22,000. The insurance scheme could cost between £20,000 and £25,000 as a lump sum and he says the comprehensive scheme will cost around £17,000 to £20,000. He also says these proposals will not result in an increase to National Insurance and says the White Paper will include details for those currently in need of care.

The Wealth Care Partnership’s Tim Anstee states, “Each of the proposals are suggesting a cost of around £20,000, paid either during our working lives or towards the end of it. We would question the quality of care that this would provide. In certain parts of England a typical care home costs in the order of £35,000 to £40,000 per annum (including living costs) and we believe the Government has seriously underestimated the ongoing costs of care. People are living longer and spending many more years in a care environment.  It is also not clear whether social care is included, which is particularly important for the growing numbers of people suffering from dementia, who require no nursing care but cannot live on their own.”

Mr Anstee concludes, “The result of the debate will be released with a White Paper which is forecast to become effective in 2014. It is crucial that those in care now or about to go into care seek advice on the best way to plan for the costs involved. It is my belief that whatever option is chosen, although the Government are proposing to provide some support to all, we are still going to be paying for our care.”