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Fixing Care

Below is the response by the NPC Health & Social Care Working Party on the proposed plans for Care Services.

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This briefing is a response to the Prime Ministers statement on the ‘plan’ for Care Services in the House of Commons on 7th September 2021.

The historical background of care has always been a means-tested service delivered primarily through Local Authorities and private/equity funded provision. This is significantly different to the National Health Service (NHS) funded through taxation and publicly owned/accountable.

Successive governments, over the last two decades, made decisions on budgets and funding cuts to both the NHS and care services driving forward the privatisation and marketisation agenda inside the NHS and care provision. The most damaging of these is the Health & Social Care Act 2012 with Andrew Lansley as the Secretary of State (commonly known as the Lansley Bill), followed by the 2014 Care Act which, through lack of proper funding, never did what it was supposed to – improve care and the lives of carers.

Operation Cygnus in 2016 showed how cuts to funding in the NHS had adversely impacted on its ability to deal with emergencies like a pandemic. Decisions were made that bringing equipment and staffing up to the standard recommended would cost too much and therefore the Conservative government of the time continued slashing budgets and opening up the NHS to more tendering for contracts from private providers. We know the price we paid for that.

In terms of care, year on year cuts to Local Authority budgets, and changes in law, made it extremely difficult for them to continue to fund care in their own residential and home care settings to a high standard. Very few councils run care in-house, becoming commissioners of services instead of hands-on provision by staff employed on public sector contracts. The services commissioned in the private sector are themselves underfunded, with savings often made on the back of terms and conditions for staff. The crisis deepened and now Local Authorities are only able to care for those with substantial/critical health conditions. This means that 1.8 million people are not receiving the basic care they need, impacting on their health and well-being on a daily basis. There are also many situations where much of the care is provided by a low paid, undervalued and mostly unqualified workforce.

The NPC, health professionals and care home providers consistently raised the ongoing chronic under funding of care and the inevitable happened as the pandemic struck.

The Prime Minister was elected on a mandate of ‘fixing care for good’ and made a speech on the steps of 10 Downing Street in 2019. We have waited and waited; argued and argued for a better deal and hey presto a plan emerged on 7th September. Except it’s not really a plan, it is a vague description of caps and costs with nothing for carers, care workers and certainly not a plan to reform care in accordance with the needs of the who fund it deserve. The quality of care will still be relative to a person’s ability to pay for it. Therefore, equality of access is not addressed and the unfairness of funding care remains in place.

All of this is set against the backdrop of the NHS Reform Bill, which, if implemented in its present form, subsumes care into an ill-conceived model purported to protect the NHS with no specifically identified funding other than the proposed care levy. It also comes with the promise of yet another white paper at a future date despite having had 12 consultations and 5 reviews over the last 20 years – all of which changed nothing.

Current system v 2023 model:

Making sense of what will happen in 2023 is still a bit of a muddle in respect to the writings in the ‘plan’. It does not change the fundamental way in which people access care – it is still means-tested. It also does not change the fact that the ‘housing’ element of care home costs still have to be met by the individual and may require the sale of their home to pay those bills. Self-funders pay different rates to Local Authority which means in effect the cost is more and it subsidises the Local Authority rate.

There is also the unfairness of those suffering cancer receiving their care from the NHS free whilst those suffering dementia and other health conditions, are means-tested. It is not clear how the Prime Minister’s statement to make care more fair will operate.

Depending on your care package and where your care home is, here are some average costs.

How does the new system to be implemented in 2023 compare to the current means-tested method of today?

In England now:

· Assets less than £14,250: care is funded by the state, but depending on income, an individual may find themselves paying ‘housing’ costs if in a care/nursing home. Currently care homes can be paying as little as £2.15 for a day’s meals for a resident, but in reality housing/hotel costs applied often reflect a much higher sum being paid at the moment.

· Assets between £14,250 and £23,250: care is means-tested, and contributions made from assets accordingly.

· Assets over £23,250: care is self-funded.

· Many figures were proposed as a ‘cap’ on care ranging from £35,000 to £72,000 – this being the maximum anyone would pay in total for their care before the state took over payments. Just as the £72,000 cap was about to be introduced, the Conservative government abolished it in 2015.

In Scotland the assets level is £28,000; in Northern Ireland £23,500 and in Wales £50,000 for care home fees and £24,000 for home care.

Personal care (on assessment) is free in Scotland; home care is free for over-75’s in Northern Ireland; and Wales caps costs at £90 per week for home care services.

In 2023, the system changes to:

· Assets less than £20,000: care funded by the state.

· Assets between £20,000 and £100,000: care is self-funded with some state help after means-testing.

· Lifetime ‘cap’ on care costs: £86,000 (considerably more than the original proposal of £72,000 and less than Theresa May’s proposal of £100,000). We remind you that this is for the care element of costs only, other costs will still need to be paid but do not count towards the ‘cap’.

Assets include income, savings, value of your home if you own it, the contents of your home, stocks and shares, private income – literally anything that comes into your bank account.

Scotland, Wales and Northern Ireland are said to benefit by an extra £5.7 billion. It is not clear whether this is a total figure for each nation or whether some sort of sharing formula will be in place.

In terms of the £86,000 cap to be implemented in 2023, this is not back-dated, so any costs for care accrued at that point will not count.

The government will most likely increase the use of Deferred Payments Agreements. This is a system by which Local Authorities set up a ‘loan’ for individuals who own their own home to pay the cost of their care. It is means-tested and attracts interest and administration fees. The loan has to be repaid either at the point at which the home is sold or on the death of the individual. It is similar to ‘equity release’ schemes with the ‘loan’ no more than 90% of the market value of the home. However, should your home devalue over the time of the agreement, the agreement does not change in terms of paying back the loan. In effect, there is always the possibility that the value of the home at sale will not cover the costs of the agreement.

Carers/Care Workers:

The contribution made by the 5.4 million unpaid carers bridging the gap in care in the UK is valued at around £132 billion a year. Many carers are themselves in poor health, experience poverty along with the stressful responsibility of caring. There is little more than a vague promise from the Prime Minister to ‘take steps’ to help unpaid carers to get ‘support, advice and respite’. Under the Care Act, carers were entitled to an assessment in their own right (independent of the assessment for the person cared for) and offered a range of services intended to support physical and mental well-being. But, as usual the funding for this got lost along the way of funding cuts and just getting an assessment is, in many cases, a search into the unknown. So, the idea of recognising and respecting the huge army of people saving the government billions of pounds has largely been buried.