Dilnot or Not Dilnot - The think tank question

At the start of the month there was a call from the think tank, Centre Forum, for Winter Fuel payments to be concentrated on those who receive pension credits in order to fund the reforms proposed by the Dilnot Commission, particularly those focused on capping the cost of care for individuals who have to contribute to their care costs.

This week another think tank, the Centre for Social Justice, have called for the Dilnot Commission proposals to be ignored stating, “Whilst the CSJ is not against the Dilnot proposals in principle, it insists this measure must come further down the Government’s priority list. Any new funding, says the CSJ, should be targeted at the poorest people in the current means tested system who have few or no assets. It adds that the Dilnot plans are the wrong priority at the wrong time.”

Naturally the question many will ask is who is right yet, perhaps, it would pay to look a little deeper.

Both think tanks describe themselves as independent organisations. The Centre Forum describes itself as liberal and there can be no doubt of its Lib Dem leanings, just a quick glimpse at its advisory board will tell you that. The Centre for Social Justice has a distinctly Conservative flavour, founded by Iain Duncan Smith and currently chaired by Mark Florman, a former senior deputy treasurer of the Conservative Party.

Obviously it could be entirely coincidental that the Centre for Social Justice raise the issue of the Dilnot proposals in the same month as Centre Forum, in which case we are faced with the equally daunting case of bewilderingly mixed messages being sent out by organisations with very close links to senior coalition Ministers.

So is Dilnot the solution for social care or not?

Perhaps surprisingly of the two messages it is the Centre for Social Justice who stress the current care crisis calling it a broken system stating “People delivering care services can think of much better ways to spend the £3.5billion that is about to be invested in the Dilnot proposals.” The CSJ focus on the elements of the care crisis that will not be settled with the capping of care cost, such as 15 minute home care visits and “Tackling the destructive underpayment from Councils to care homes which forces many providers to cut corners”.

Centre Forum on the other hand focused on paying for the Dilnot proposals and the particularly controversial idea of withdrawing the Winter Fuel Allowance as a universal benefit and calling for “ the "appropriate legislative levers" to be inserted into the draft care and support bill so that the Dilnot Commission's proposals on care financing can be delivered in full by the end of this parliament.”

Certainly, as I have argued before, the Dilnot Commission was limited in its scope, focusing almost entirely on who pays for care and bypassing the crucial question of how much does quality care actually cost. It also has some short comings in terms of the reality of imposing a cap (see The Social Care Capping Debate MUST be Wider) and is unclear on how some of the proposals will impact on younger adults who need care and support services (Isolated and Underfunded). Yet it remains an important part of the debate.

 

The danger is that with two think tanks with close connections to the coalition partners calling for different approaches to social care that the debate with Government will become protracted to the extent we see nothing happening in this Parliament and social care left in the wilderness for another few years until the next Government either acts or, as previous Governments have done, prevaricates over social care to the detriment of the millions who need or provide care services.

The Centre Forum Report 

The Centre for Social Justice Press Release

The Social Care Capping Debate MUST be Wider

Whilst the social care debate on funding has once again been raised by Paul Burstow and Centre Forum, calling for the implementation of the Dilnot proposals with funding from means tested winter fuel allowances the fact remains that this is only one side of the debate and, arguably, unanswerable without tackling how much social care actually costs and who is eligible for funded social care.

One issue largely glossed over is who will be eligible for social care services and state funding under any new scheme.

Over the last few years those entitled to funded support have been needing to meet ever tightening criteria meaning many thousands have not been entitled to support even when they have high (but not critical) needs. This naturally has led to a fall in the numbers of older people receiving supported care services and increased the numbers either paying for themselves or relying on family and friends for support in everyday life.

The debate on the Dilnot proposals must include the level of need at which people are entitled to state support. For those not quite meeting the criteria but with little other option may well still need to sell their homes in order to pay for necessary care services and it is essential that this element of the proposals is equally publicised before many thousands are led into a false sense of security believing that their care needs will be met by the state after the cap.

Local Authorities have, over recent years, continued the practice of increasing fees to providers at less than the rate of inflation and over the last two years many have given no increases at all. The shortfall is often made up by care service providers by charging top up payments which individuals pay themselves or by the level of fees they charge private paying users.

While the Dilnot proposals state that no one should pay more than £50000 for their care costs it does not mention the level of fees in the equation.  So once an individual has reached that cap will the Government/Local Authorities pay the higher rate normally charged by providers or will they only pay the reduced fee associated with the current system.

Additionally Dilnot proposed a rise in the means testing threshold to £100,000 if introduced this will immediately move many of those who currently pay private fees to being on local authority fees, dramatically reducing the income of care service providers

If there is a dramatically big drop in what providers are receiving then how will care providers survive with radically reduced income and what impact will that have on the quality of care services.

Of course that debate is somewhat mitigated by the fact that the Dilnot proposed cap only applies to care services not to accommodation or food. On this issue the recommendation is that individuals be charged between £7000 & £10000 a year to cover such costs.

The debate needs to be wider than the proposed cap and include exactly who will be eligible, how the cap will impact on the quality of care provision and the impact it will have on the lives of those not eligible for state funded care services.

Social Care: A Culture of Unimportance

The Government’s Winterbourne View final report talks of a ‘culture of abuse’ being allowed to flourish within the establishment. This is nothing new there have been plenty of cases where this has happened and many commentators have mentioned this, we have periodic exposes of abusive culture within social care settings followed by a brief blustering of politicians yet these things keep happening.

The real issue that needs to be addressed in adult social care is the culture of unimportance that pervades society when it comes to the needs of the elderly and disabled in the country.

                                          

The Winterbourne report highlights this culture of unimportance. There is no Prime Ministerial forward promising whole Government action, there is not even a signature from the Cabinet Minister for Health. This should not distract from many of the good proposals in the report yet it, in terms of promoting social care as a national important area of policy it fails.

This is, obviously, only the latest in the line of things were the Government continues to cultivate the culture of unimportance around adult social care. The Dilnot Commission , set up as part of the coalition agreement,  submitted its final report in July 2011 and, since then, has largely been scrupulously avoided aside from the odd burst of political gusto when it seemed convenient. In the meantime the reality for many older people remains the same, sell your house to pay for your care.

Naturally Dilnot is itself a product of the culture of unimportance. The Commission was set up to tackle only how care is paid for, what has not been tackled is the ever tightening eligibility criteria for state support with care nor has the needs of other vulnerable adults, such as those with learning disabilities, had any consideration.

The social care culture of unimportance cannot just be ascribed to this Government, the previous Labour Government prevaricated and delayed taking action on social care producing a White Paper on 30 March 2010 just weeks before an inevitable General Election, and even then their ideas where merely a tinkering of what already existed rather than wholesale reform.  

The culture of unimportance that is allowed to flourish at Westminster inevitably and naturally trickles down to the rest of society. Undoubtedly if many average people in the street were to be asked what has been the most important issue discussed at Westminster this week the answer, inevitably, will be that of same sex marriage. While that is important in its own right surely the needs of the most vulnerable in society should take precedence and, although I don’t know the exact numbers, I suspect that the issue of same sex marriage will have a direct impact on far fewer members of the population than social care reform would.

The culture of unimportance MUST end and social care must take its rightful place alongside the other major areas of social policy. As society continues to age the implications for social care are significant, more and more people will need social care services and it is societies duty to ensure those needs are met.

Personally I feel it is obviously right that social care should have its own Cabinet Minister and Department for Social Care and have started a e-petition to this effect (click here to sign) as I believe that this will be a start to raising the importance of social care nationally. Yet beyond this we do need those in charge now to stop treating social care as a side issue to other areas of social policy and start treating social care with the importance it needs in order to ensure the well-being of the millions who need social care services.

Focus on Elderly Care

Over the last four years the number of people receiving council funded adult social care services has fallen by 17.5% and, given that in certain areas such as people with learning disabilities the numbers have increased, the majority of the decline in funded services has hit older people who are targeted under ever tightening eligibility criteria for Local Authority service.

This, of course, flies in the face of what we know about the population in general, the population is increasing and people are living longer so, in fact, we should be seeing an increase in the numbers of people accessing funded social care services, therefore we are seeing a bigger decline in services than the figures initially suggest, even if the numbers were to remain static it would, in real terms, still be a decrease.

Unfortunately much of the policy obsession (obsession used in a limited sense!) is focused on implementing the Dilnot proposals and focused on how much individuals should pay for their care. What this misses is the numbers of people who have no way of paying for their care and are entitled to local authority funded services, the numbers of which are decreasing at an alarming rate despite the fact they should be increasing.

In cases where older people do not meet ‘eligibility’ criteria the role of providing care and support goes to family and friends who, in essence, provide a free service for the state or, if they receive carers allowance, for the princely sum of £58.45 a week (subject to providing a minimum of 35 hours care - so £1.67 per hour!) and many do not receive the allowance because they have an ‘overlapping’ benefit. Research by Carers UK and the University of Leeds shows that, over the past ten years the number of those providing care has increased by 9% with the biggest increase in those aged over 65.

There are costs to looking after someone on a full time basis, particularly when it means giving up full time employment, not only are there the financial implications but also there is evidence of impact on health, well-being and social exclusion. There is help available for carers and many receive local authority assessments but, in terms of the wider social care picture, very little has been done to redress the increasing numbers needed to meet the shortfall in local authority provided services.

Despite these facts the plight of the most needy older people is still being overshadowed by the focus on who pays for care, and while this is important it is only a small part of the overall social care picture.

We need to widen the social care debate at national level which is why I have started an petition call for a Cabinet Minister for social care – I hope  you will take the time to sign  and pass on to others - http://epetitions.direct.gov.uk/petitions/39701

New Ministerial Team MUST Act on Social Care Now

The latest figures from the NHS on council funded care services show, one again, that there has been an overall fall in the numbers of people receiving services. 110,395 less people received services in 2011/2012 a drop of 7%.

At the same time the Royal College of Physicians warn that acute hospital services are on the brink of collapse because of the increasing number of elderly patients, particularly those with dementia, they claim that many feel that older people ‘shouldn’t be there’ and are calling for a redesign of services to better meet patients need (click here for RCP press release).

In other words it appears we are seeing a reduction in community care services resulting in increased pressure on the NHS and this is an issue that needs to be tackled immediately.

This situation is one that can only get worse if left unchecked by the new Ministerial team at the Department of Health.

Kent County Council, for example, are proposing (in their 2013/14 budget consultation) to reduce spending on adult social care by £18m, a cut of 5% and while they claim to be able to do this without harming care services it certainly seems the reduction in council led services is only increasing those in the NHS. Undoubtedly other councils are proposing similar cuts in the adult social care budgets which will lead to more elderly people entering hospital.

The popular press has lead the campaign on who should pay for social care and it seems likely that the Dilnot proposals will be introduced. However this does not solve the issue of how much social care costs and, it seems now, we have some evidence that lack of funding in social care simply transfers the issue to the NHS and, undoubtedly costs the state more in the process.

Care for older people in England, particularly those with dementia, needs to be examined properly and the costs of providing the best possible care acknowledged.

It is only by properly assessing the cost of social care that the issue of who actually pays for it can be sorted.

We have a new Ministerial team in the Department of Health and they must put the care of the most vulnerable in society at the top of the list otherwise the crisis in care will only continue and lead to a greater crisis in health provision.

The Ageing Process Does Not Stop to Wait for Politicians

Just 55 days after the publication of the Social Care White Paper, “Caring for our future: reforming care and support”, social care is once again in a situation of not really knowing what the future is.

The White paper was short on details on funding, after its publication Richard Humphries of the Kings Fund said “Despite its commitment in the “programme for government” to the urgency of reform, the government has failed to produce a clear plan for how care should be funded or a timetable for how these decisions will be considered.” (click here for full press statement).

Then in mid-august we start getting press reports that Prime Minister, David Cameron “has pledged to end the heartache of tens of thousands of elderly people who are forced to sell their homes to fund long-term care” (Daily Mail 16th Aug 2012) by introducing the Dilnot proposals and introducing a £35,000 cap on care costs.

What is unclear is the extent to which the Dilnot proposals will be implemented. The report by Andrew Dilnot applied the cap to care costs not stating that those in care homes should contribute to accommodation and food costs to the tune of £7,000 to £10,000 a year. Given that the current annual state pension is £5,587.40 pensioners in need of care home services would still need to find money from somewhere.

Because of this, as well as the increase in those who will be publicly funded and the greater overhaul of the system that will be needed if the full Dilnot proposals are introduced, the White Paper largely becomes redundant before its consultation period has even ended.

To top this all off the Ministerial architects of the White Paper and draft legislation, Andrew Lansley & Paul Burstow have been shipped out of the Department of Health, and the principle civil servant in creating the paper, David Behan, has now moved to the Care Quality Commission.

Where does this leave the thousands that need social care services, those who care for them, the thousands of workers providing care etc.

Whatever the political reasons for the change of heart about Dilnot and the reshuffling of Ministers we need, NOW, a statement from Number 10 on exactly what is happening, how things stand with the White Paper and draft legislation in order to reassure social care users and the social care sector that there will be no delay in implementing reform. Social care has become all too familiar with the prevarication of politicians and these changes in policy and the personnel delivering it must not be used as an excuse.

We have an ageing population with increasing need for social care services, the ageing process does not stop to wait for politicians so those politicians need to act now for the benefit of people who need care services now.

Why Care Can't Wait

Panorama has discovered a series of cases in which elderly people have been unsafe and unprotected in nursing homes. Instead of being looked after, vulnerable, elderly people were insulted, neglected, roughly handled or physically assaulted.

Sound familiar?

Yet it is not the episode aired on 23^rd April this year where Fiona Phillips exposed the treatment of Maria Worroll at Ash Court. It is an episode that was aired on 12^th February 2007. So, in five years, why has nothing been done to prevent these things occurring?

We have had other exposés in between most notably the abuse of people with Learning Disabilities at Winterbourne view but none of these seem to be able to make politicians care enough about social care to take real action on improving the lives of the most vulnerable.

We cannot solely blame the politicians, the national media must take some responsibility. Such events soon disappear from the news agenda and while Panorama will provide us with regular exposés they seem to lack the inclination to ask WHY is this still happening?

I was reminded of that Panorama episode when I was flicking through my copies of the magazine I used to write for. Ironically my column in that same edition focused on the success in care training that had been achieved as had been highlighted in that years “State of Social Care” report from the CSCI. At that point the National Minimum Standards required all care providers to have at least 50% of their staff with NVQ level 2 and real progress was being made on that. Unfortunately that requirement was dropped in 2010 and, in fact, there are no specific requirements at all for care providers to have qualified staff.

In that same column I also raise concerns about whether the level of success in training care workers can be sustained because of diminishing fee increase from Local Authorities and question the effect that proposed registration of care workers may have on the sector. Five years later those fees have continued to be lower than inflation (in the last few years there have been no increases at all) and the registration of care workers has evaporated into thin air.

My reason for looking through those back copies was to try and find when it was that Ivan Lewis faced a question from a backbencher on the practice of local authorities not raising fees to care providers or, if they were, at a rate below inflation. This was in March 2008 and he condemned the practice stating that care providers should, at the very least, expect an increase in fees that kept pace with inflation. Of course this has not happened and the amount being paid to provide care and support has fallen behind in real terms.

So, in essence, nothing has happened to tackle the issues facing social care over the past five years, now we face another delay to action on care.

In five years we still have Panorama exposes on care, we still have no actions on care worker registration and the amount paid to provide care and support to the vulnerable continues to fall behind and while we have had tinkering around the edges with changes in regulator etc no substantive political act has been taken in that time. 


We have had a consultation in 2008/2009 which led to a Green Paper in July 2009 followed but another consultation and a White Paper in March 2010. Then, with the change in Government, we had the Dilnot Commission launched in July 2010 and the Dilnot Report published in July 2011.


Surely we have had enough talking. 

This is why care can’t wait and we need action NOW not later