We’ve all known for some time that radical changes are needed in the way that social care is funded and commissioned by local authorities and for those individuals who don’t qualify for state aid for their social care. The LGiU has produced a series of reports showing that social care, and home care in particular, is edging ever closer to the precipice most recently with Paying for It: The human cost of cut price care where we recommended a series of sweeping reforms and additional funding for social care.
Before the General Election was called, the Spring Budget announcement promised a green paper sometime later in 2017 to finally tackle the well-known problems to social care funding. This promised an end to the delayed Dilnot proposals which included an asset disregard and a cap on social care costs. But given there’s a General Election in the offing, it’s worth taking a look at each of the party’s key proposals for tackling the social care crisis.
The Conservatives have drawn some difficult press lately over first their social care proposals which featured no cap on social care costs and then changes (or no change at all depending on who you believe) to social care proposals introducing a cap – making it look, in some ways, a lot like Dilnot proposals.
The plan, apparently, is still to produce the green paper to allow for fulsome consultation on funding social care, where one has to assume the end result will be a reasonable generous asset disregard (the £100,000) and some kind of cap on lifetime care costs.
The biggest change however, is that people who are house-rich and cash-poor will no longer be able to disregard the value of their homes in order to qualify for home care assistance. Deferred payment or perhaps private sector equity release schemes may be used to pay for home care. This could potentially remove thousands of people from state-funded home care, at least until assets have depleted.
The Tories are also making some proposals around carers’ rights, although there’s no real extra money in it. There will be a new statutory entitlement to carer’s leave and a toughened-up framework around flexible working rights for those with caring responsibilities either for the young or old.
In addition, there are promises to look at loneliness and the use of technology to promote independent living and funding for dementia research.
Labour have promised the introduction of a new National Care Service (NCS), and billions of pounds more in funding – about the amount that’s probably needed under current projections. Although it’s not entirely clear how this will be paid for. Suggestions include a wealth tax and a social care levy and employer contributions. But Labour is also proposing a lifetime cap on care contributions, so it seems like there is still room for social care means testing and self-funding of care. The proposed NCS will be structured alongside existing NHS organisation and will have required joint commissioning.
From these proposals, it sounds like councils may have little or no responsibility for social care, which misses a rather big opportunity. Care at home is important, but equally important to staying within the community is the community building aspects of social care and the councils convening power to not only bring together formal care but a mix of provision across the voluntary and community sector.
Labour is also making promises to raise the national carer’s allowance, but there’s not much else specific about supporting family members of those who need care.
Liberal Democrat proposals include a cap on care costs and some strides toward regulating the care workforce. They also propose to liberalise some of rules around carer’s allowances, meaning individuals can earn more before losing benefits and the qualifying threshold of hours of support is lower, too.
Caps, carers and planning for a rainy day
Both Labour and the Liberal Democrats have made explicit promises to cap care costs and the Conservatives may or may not have made the same promise. While capping care costs sounds great in principle, in practice it becomes mired in tricky accounting and eligibility. If I can no longer clean my home, that’s probably a social care need, but it’s unlikely to contribute toward the cap if I hire a private cleaner and don’t meet some kind of wider substantial need. And if we’re trying to promote a more outcomes-focused mixed economy of voluntary, state and private sector what counts toward the cap and what doesn’t? When do people get assessed and when does the clock start ticking? These are all important details that need to be hammered out and that’s also likely to delay the much needed funding support and fundamental re-design of home care in particular.
All of the three main parties have made some interesting and probably needed proposals for carers, but none of them have quite gone far enough. Additional cash to those who qualify for the allowances or loosening qualification criteria would certainly be welcomed. But real and largely unacknowledged need is help for people who are ‘just about making it’ in work and earning reasonably well, but who can’t afford to take considerable time off to look after ageing parents or ill spouses. Help for these people would not only support individual families, but keep them economically active which helps everyone in both the short and long run.
Finally, none of these manifesto promises address the most pressing need for most families – if self-funding remains an important part of paying for care, then people need a way to save or plan ahead for care costs. And self-funding almost certainly should remain a part of the mix not least because of issues of inter-generational fairness. The financial services industry has yet failed to come up with good or indeed any products for paying for care, but this largely to do with uncertainty about whose responsibility care costs are. Until there is a stable policy platform, this is unlikely to happen. While reducing the social care budget shortfall and more generous terms for carers are welcome, the real need is certainty.