The second workshop took place yesterday and brought together the Caring for our future engagement discussion leaders and reference group members. Its aim was to provide an opportunity for participants to discuss the impacts of key Dilnot recommendations and how they might change under variants of the proposals. This note summarises discussions during the workshop. It does not represent a statement of Government policy.
The workshop consisted of two presentations, group discussions and plenary sessions. Richard Humphries, Senior Fellow at The King’s Fund, summarised the key Dilnot recommendations. Nick Kirwan, Associate Director of Health and Protection at the Association of British Insurers and co-leader of the financial services workstream, presented the key findings and emerging priorities from that workstream. These can be found on this website.
Richard Humphries then asked groups to consider and feedback on the following questions:
Impact of the Commission’s core recommendations:
• What would be the impact of a cap and extended means test on individuals, carers and their families?
• What would be the impact of national assessment and eligibility?
• What would be the impact of deferred payments?
Aligning costs to resources:
• What would be the impact of increasing the cap to £50,000 or higher?
• What would be the impact of including housing assets in the domiciliary care means test?
Main points from discussions
Cap and extended means-test:
• There was strong support for the introduction of a cap and extending the means-test.
• A cap will help people understand their responsibilities and plan for future care needs – though information on how the system works is also an essential ingredient.
• The cap is not a magic wand for social care. Though capping costs brings many benefits it should not be expected to address all areas of social care reform.
• A cap could help encourage prevention by helping people to plan for their care needs and encouraging them to spend earlier. On the other hand, a cap might weaken the incentive to spend on preventative measures, by reducing the overall care costs that people face.
• A cap will lead to a range of behaviours that are hard to predict. Consumer testing could help to understand them.
• Impacts would be different according to age cohort, gender etc. For example, different cohorts will have different levels of housing and pension wealth – future retirees may be poorer than the current generation.
• The level of the cap is important but so too is the point at which the metering of care costs starts.
National eligibility and assessment:
• There was strong support for national eligibility and assessment: it would help people understand their responsibilities and to plan and prepare; it would lead to greater consistency both within and across local authorities; and, depending on where the eligibility threshold is set, it would ensure councils don’t just target critical needs.
• However, there is a risk that with national eligibility set at ‘substantial’ a system could be created that is overly focused on high level needs at the expense of more preventative, universal services.
• Although national eligibility would give people clarity about what they are entitled to, it should not do this at the expense of local authority discretion and flexibility in the way it prioritises.
• National eligibility is likely to help the development of financial services by providing a clear basis for partnership between local authorities, financial services companies and the voluntary sector.
• Universal deferred payments would give people additional choices and flexibility in meeting their care costs and there was strong support for them. However, they have limitations: they would have minimal impact on the rest of the system – eg on prevention and personalisation; and while they prevent people from having to sell their homes to pay for care, they do nothing to protect the value of people’s assets.
• Some wondered whether deferred payments could be used to release small amounts of equity from the home to spend on prevention.
• A higher cap would place greater burdens on individuals and on their carers. Couples and those in poorer regions of the country would find it more difficult to save enough to cover the costs up to the cap.
• A higher cap could provide greater encouragement to people to save and engage in financial planning (eg buy insurance). But a high cap may be seen by some as unachievable and lead to disengagement.
• A higher cap could incentivise individuals to invest in prevention, because it would shift more responsibility to individuals. It could also have the opposite effect because it would mean that people would be more reluctant to start spending.
Home in the means test for domiciliary care:
• Bringing housing assets into the domiciliary care means test would, relative to the current system, incentivise local authorities to use domiciliary care. But for individuals the situation is reversed: relative to the current system, individuals would be disincentivised from using domiciliary care. It may lead to individuals not having care when they need it.
• Some thought that because of the power of the local authorities it was most important that local authority decisions were not affected by perverse incentives. Putting residential and domiciliary care on the same footing would create a level playing field.
• The important thing is that people make the right, unbiased, decisions about care setting.
• Some people would lose from the change – and this may make the policy difficult to implement.
• There would be impacts on dependents and other people living in the home.
• Agreement that the Dilnot model with a cap on costs was the right funding model and that there was no alternative, better model presently available.
• It was important to recognise that the Dilnot reforms and broader social care reforms would have impacts and could lead to savings across the wider system eg in the NHS – and these should be taken account of.
The following table sets out details of those people who attended the workshop, supported by DH facilitation and secretariat.
- Alex Fox, Chief Executive, Shared Lives Plus
- Andrew Kerslake, Director of Institute of Public Care, Oxford Brookes University
- Andrew Lansley MP, Secretary of State for Health, Department of Health
- David Brown, Partner, PricewaterhouseCoopers
- Des Kelly, Executive Director, National Care Forum
- George McFarlane, Policy Adviser, CBI
- Gill Ayling, Deputy Director, Older People and Dementia, Department of Health
- Glen Mason, Director of Social Care Leadership and Performance, Department of Health
- Gordon Morris, Managing Director of Commercial Services, Age UK Enterprises
- Helena Herklots, Services Director, Age UK
- Julia Skelton, Head of Professional Practice, College of Occupational Therapists
- Julienne Meyer, Professor of Nursing, Care for Older Adults, City University London
- Luisa Stewart, Deputy Director, Dignity and Safety, Department of Health
- Marije Davidson, Public Affairs Manager, RADAR
- Matthew Hibberd, Policy Consultant, Local Government Group
- Matthew Sowemimo, Head of Public Policy, WRVS
- Miranda Wixon, Managing Director, Home Care Partnership
- Nick Kirwan, Assistant Director of Health and Protection, Association of British Insurers
- Peter Barnett, Policy Adviser, House of Lords
- Peter Hay, President, ADASS
- Dame Philippa Russell, Chair, Standing Commission on Carers
- Richard Humphries, Senior Fellow in Social Care, The King’s Fund
- Sally Warren, Deputy Director, Social Care Strategic Policy and Finance, Department of Health
- Sharon Allen, Chief Executive, Skills for Care
- Shaun Gallagher, Director of Social Care Policy, Department of Health
- Sheila Bremner, Chief Executive, Mid Essex Primary Care Trust
- Sian Lockwood, Chief Executive, Community Catalysts
- Simon Lawton-Smith, Head of Policy, Mental Health Foundation
- William Vineall, Deputy Director, Policy and Legislation, Department of Health
(See the ‘Who’s who‘ page for more details of the non-Department of Health attendees listed above)