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In the Long Term Who Cares
Update: Your Care, Your Say
Manchester LINk and MACC held a public meeting in October 'Your Care,
Your Say' where we discussed the government's proposals for the future
of long term care. The meeting focussed on the future funding of social
care in England and the proposals for changing the way we fund the
country's social care needs. Read our responses via the Older Peoples Notice Board.
The Government published their long awaited consultation document (known as a “Green Paper”) on the future funding of Adult Social Care in England, on 14th July. The Green Paper set out a vision for ‘a National Care Service that is fair, simple and affordable.’ It suggested ways to improve the care & support system in England: not only how it is delivered (through personalisation and the new social care reforms) but how it is to be funded in the future. The current care system is unfair, unclear and unsustainable and we know the arguments for the reforms.
The Proposals
The Paper set out a number of core options which effectively seek to
redefine the “social contract”, that is the balance of personal
responsibility and public / state responsibility for meeting the cost
of care. These are based around the idea of a partnership in which the
state funds a basic level of care and the individual would fund the
rest of the cost by one of two ways
- An insurance model in which people will be ‘invited’ to pay into a
state-backed insurance scheme which would meet the costs (estimated
amount is £20,000),
- A comprehensive model in which everyone who reaches retirement age
would be compulsorily enrolled into a state insurance scheme,
regardless of whether they went on to need care or not.
None of the options include costs for accommodation (board and lodging)
though the government is proposing a scheme where these costs could be
met after death by recovering the costs from the value of the estate.
- In principle, MACC welcomes the creation of a national care service
and the proposal that there will be a basic universal entitlement.
However, if the general public is to feel that comments on the options
will be valued and acted on, the Government needs to define ‘basic’.
- The proposals would end the unfairness in the present system of the
post-code lottery of eligibility criteria for state funded support.
With a national framework for funding, different Local Authorities
could not use budgets to determine different criteria.
- The proposals would also end the exclusion of “self-funders” from state
support: in many Local Authorities, those who pay the full cost of
their own care receive no support or even basic assistance with making
their care arrangements.
- If the preferred proposal of a partnership arrangement between the
state and the individual is to be effective, then services need to be
available to support the personalisation agenda - a choice of services
to provide individual support. An individual should be able to retain
these services if they need to move from one locality to another and
local authorities should have a clearly defined responsibility to put
in place adequate support mechanisms to ensure that people are able to
exercise choice and maintain control of their care arrangements.
- The Government will need to clarify how the proposed social care
insurance system would sit within the general tax and National
Insurance system. The Green Paper maintains the current arbitrary
division between “health” and “social” care services: a division which
is potentially becoming further complicated by an additional mechanism
of public funding.
Across the country, a series of debates were held during 2007 about the
future funding of long term care (the “Caring Choices Campaign”) At the
event in Manchester, reinvestment from other budgets was raised, as a
way of funding the social care reforms, but this was not considered to
be an option. An increase in taxes was an option at the time, but few
people supported the idea. MACC’s Connections newsletter June 2007
included the following statement produced in response to the Caring
Choices debates and which we would still support:
MACC still believes that the preset system is a mess which puts budget management before the needs of people. While we welcome the debate, there is a key starting point which must not be ignored: education, defence, criminal justice, healthcare and social care of children are all paid for through general taxation. We have yet to hear a single convincing argument as to why social care for adults should be any different.
This question has still not been answered. We finally have the Green
Paper, but this debate started back in 1997 with the Royal Commission
on Long-term Care for the Elderly.
Furthermore, we must now be concerned that that the timing of this
Green Paper moves the issue of the funding of social care directly into
the wider debate about the levels of public spending and taxation
during the recession and post-recession periods. The publication of the
Green Paper means it is now too late to introduce legislation before
the next General Election and it is arguable that a “state insurance
scheme” is a new form of taxation. This issue is too central to the
quality of people’s lives for it to become a political football in the
increasing debate between the major parties as we approach the
Election. We need to move the debate on to an all-party agreement about
an equitable and practical mechanism for funding social care for the
long term.
The proposals are focussed on the needs of older people and not adults
with long-term care needs (e.g. people with learning disabilities).
The Government has ruled out the option in England of ‘free personal care for all’ – the model introduced in Scotland in 2002.
Funding from the State
The Green Paper makes it clear that increased investment into social
care is not an option. Instead the Government proposes that funding for
the state contribution is found from the money currently spent on
Attendance Allowance (paid to older people with care needs, living in
their own homes)
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