The government’s plans for reforming social care in England – at the heart of a planned green paper – have been criticised as costly and unfair in a report on the future of funding care for older people.
The report from two highly respected thinktanks, the Kings Fund and the Health Foundation, finds that the idea of increasing the number of people paying for care, and how much they pay, put forward in the Tory manifesto last year, would be almost as costly as making all care free.
The much-anticipated green paper on social care for older people is set to be published by summer 2018 – although, having been promised before last year’s general election, there were hopes the paper would appear much sooner.
It was also hoped the paper would address needs across the entire adult social care sector. Instead, the paper will be limited to the government’s plans for improving care and support for older people and tackling the challenges presented by an ageing population.
There will be a ‘parallel work stream on working age disabled adults’, but some are concerned this report will focus on getting more disabled people into work.
The government has invited a number of people to advise on the paper, including Paul Burstow, chair of the Social Care Institute for Excellence; and Caroline Abrahams, charity director of Age UK. However, no user or care worker representatives have been invited.
During a cabinet reshuffle in early January, Jeremy Hunt became secretary of state for health and social care. Despite already having social care in his mandate, the change gave Hunt lead responsibility for the green paper.
The proposals set out in the paper will build on the additional £2bn the government has provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market over the next three years. Once published, the paper will be subject to a full public consultation.
The proposals, based for the first time on putting housing assets into the means test for people needing personal care at home as well as those in residential care, puts a floor of £100,000 on assets.
After a disastrous weekend of negative publicity following the plan’s unveiling, a cap on the total amount paid for care needs was proposed. For their report, the thinktanks have set it at £75,000.
“It catches a lot of people who are not paying now for the support they get at home,” Anita Charlesworth of the Health Foundation said. “It is even more complex than the current system and it’s only a very slight improvement in terms of the cash it raises.”
Jeremy Hunt, the health secretary who is now also responsible for social care, put this so-called “cap and floor” approach at the heart of his thinking when he set out the principles that would underlie his green paper earlier this year.
Wednesday’s report joins a long list that predicts the need for a huge rise in spending to meet the needs of an ageing population.
Even to maintain the current system, which steadily squeezes the criteria for eligibility for support in order to keep it affordable, faces a £1.5bn shortfall by 2020. If standards and availability were raised to the level the coalition government inherited in 2010, an extra £8bn would have to be found.
The cap and floor system would need an extra £5bn over the same period, while providing free personal care would cost an extra £7bn. Free personal care has been introduced in Scotland, where it is very popular. But one of the main justifications for such a policy, that it would ease the pressure on the health service by helping people stay at home, has not been fully realised.
While there is some support for a hypothecated tax, according to a detailed study of public attitudes to funding social care done for the report, focus groups also understood that in an economic downturn it might not raise enough income.
Most of those questioned agreed that responsibility for care costs should be shared. But there was widespread hostility, regardless of age or home ownership, to taxing housing wealth.
The report’s authors conclude that very few people understand how social care funding works, and many assume it will be free.
They also find that the government is not trusted to deliver on its promises for quality as well as availability. They suggest the government does not even have enough trust to be believed when it tries to explain the scale of the problem.
Charlesworth concludes: “Everyone agrees that the social care system is not fit for purpose. But finding reforms that balance good quality care for those who need it with the funding needed to provide it is incredibly challenging.”
A health department spokesperson indicated on Tuesday that the summer deadline for the green paper might not be met.
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