Your views on the recommendations made by the Commission on Funding of Care and Support

As part of the Caring for our future engagement process, we also want to hear people’s views on the recommendations made by the Commission on Funding of Care and Support and how we should assess these proposals, including in relation to other potential priorities for improvement.

a. What are the strengths and weaknesses of the Commission’s proposals in addressing the problems of the current system? What are the priorities for action coming out of the Commission’s report, including in relation to other priorities for improvement in the system?

b. What are the implications of the Commission’s proposals on other areas of care and support reform?

c. The Commission presented a range of options in relation to some of their recommendations, which would affect the balance between the financial cost to the individual and the taxpayer. These include:

  • the level of the cap
  • the contribution that people make to their living costs in residential care

What would be the implications of different options on the outcomes which the Commission hoped to achieve?

 

In Priorities: areas for discussion | Tagged ,

8 Responses to Your views on the recommendations made by the Commission on Funding of Care and Support

  1. Angela Emerson says:

    General Comment: You think the current funding system is broken but I have not followed your reasoning for this statement. Can you be more precise?
    I manage a council financial assessment team and although the regulations for charging for residential care and non-residential care could do with a few amendments to deal with several inequitable anomalies, on the whole, they require people with higher savings and income to pay more and people without such funds to pay less. Charges only apply to those who need services. In that sense, it is hard see how else the system could work. Of course, it could all be free to the service user and fully funded by taxpayers ( like the NHS) but this hardly seems fair to those who would have to pay higher taxes and who may never need such care themselves. In effect, one person would have to pay higher taxes now, in order to fund someone else’s relative so that they can inherit the family wealth. Where is the justice in that?
    Why is it seen as a good thing for family members to inherit their loved one’s wealth whilst the state (via taxpayers) pay for their care. Surely it is a good thing for people who can pay, to pay for their own care during their lifetime, any residual wealth can be inherited. Those who cannot pay must, of course, have a safety net funded by taxpayers, which is how the system works now.

    The main specific anomalies in the current system are :
    a) disregarding savings bonds with insurance
    b) disregarding compensation funds for future care needs – including disregarding trust funds
    c) Woolly and unhelpful guidance on “deliberate” deprivation of assets to avoid future charges.

    People who are aware of these anomalous rules can take advantage of the system.

    Comments on the points listed above:

    C) The “capping” rules seemed exceptionally complex and difficult to adminster and I have not understand how it was intended to work for “non-residential” costs such as home care and day and direct payments. The cap system may only be workable for residential care costs?
    A simpler solution may be to increase the capital threshold as suggested and leave everything else as it is subject to some tidying rules.
    Separating living costs for residential care is also very confusing and complex. Many people have their current living costs funded by pension credit, Housing Benefit and Council tax. These are generally ceased or reduced once in residential care. This proposal seems to have 2 means tests, one to assess how much should be paid towards “care” and another to determine how much should be be paid towards “living costs”. Payments mad for the first test count towards a cap but payments made for the second test do not. Someone will need keep a running total of payments made under test 1 but not under test 2. The majority of people we see are assessed to pay around £115 to £130 based upon their pensions and benefits. I would guess that around 25% are self funding because they have over £23,250 and/or property. The minority of people pay something in between because they have a private pension that exceeds pension credit levels. I cannot see how we can get the lower charge people to pay any more, but we could have a more generous savings threshold so that the self-funding group pay less. In my view, the people in between should stay as they are, paying more than the lowest payers and less than self-funders.

    I would make a more radical suggestion for those receiving non-residential care which could, perhaps fund the deficit resulting from an increased savings threshold. That is, the means tests could be equitable with regard to property ownership – eg: no property disregard for home care and no disregards for residetial care – legal charges could apply where people cannot immediately fund care costs and the debt then falls to the estate to pay after the service user has died.

    a) I think the only strength in the proposal is that it might possibly spark more financing from insurance companies if people will take the risk of funding their future care through insurance rather than hoping it will never happen to them! Or, thinking that the NHS will pay so they don’t need to fund it anyway.

    I think the disadvantages are:
    1. the cost to current taxpayers
    2. the complexity of two tier means tests
    3. the administrative burden of keeping a tally of expenditure and determining 4. when the cap has been reached
    5. the inequity of expecting today’s young people to pay extra tax so that somebody else’s relative can get free care whilst their own relatives might never need it.

  2. Mohammed says:

    How much consultation needs to be done! We’ve had several papers on this recently e.g. dilnot, law commission etc. What we need now is urgent action, the system is in crisis! We are just go rounding in circles!

  3. LIZ ROBINSON says:

    I have studied the Dilnot report and I think the recommendations on the future funding for the elderly is a step in the right direction for fairness of the system.
    Why should an elderly person lose all their inheritance, except £23,250, whilst others who have sometimes chosen to spend all their assets prior to needing care in later life, pay virtually nothing.
    our recent experience has seen our 92 yr old mother going into care as she is suffering from Alzheimer’s and we could no longer provide the care she needs in her own home.
    She has her own bungalow which she worked for all her life, lived a fairly comfortable but frugal existence, always saving when possible.
    this is a lady that served in the WRAF in the 2nd world war, yet the country she fought for is not prepared to ‘look after’ her in her final years.
    we are now faced with the possibility of
    1) continuing to pay the £1,000 top up fees from her estate (this is on top of the £1,500 she pays from state pension, 2 private pensions and attendance allowance)
    2) taking out an annuity costing a one off sum of £80,000 to assure she doesn’t lose all her estate in care costs.
    3) wait to see what the Govt white paper proposes in 2012.

  4. Sue Garwood says:

    I have worked in social care for many years and am now an independent consultant specialising in care and housing for older people and those with dementia. I have never been one to advocate that social care should be free, unless the country was awash with money. It has always felt more important to me that the availability of a diverse range of good quality, personalised care and support to all who need it is more important than the care being free, so long as the charging regime is fair and reasonable. There is growing evidence that low level activities and services provided to promote health and wellbeing, often by the housing and voluntary sector can reduce spend on more intensive services, if there is sufficient investement, integration and information out there. So there are many aspects which need improving.

    However, to my mind inadequate resourcing is at the root of many of the problems within social care. It takes money to give people the training, support and leadership needed to provide a good quality service. It takes money to recruit and select staff and volunteers. It takes money to pay people at a level sufficient for an often challenging job, that they don’t choose to stack shelves at Tesco instead. It takes money to avoid spreading a service so thin that it cannot possibly give people the quality of experience they need, warmth, caring, human contact. Thus whilst we could definitely do more to make better use of the resources we do have, as my previous paragraph suggests, it is critical that with the burgeoning older population, we address the issue of long-term funding and don’t kick it into the long grass because it is difficult. If we cannot at this point get a sustainable solution and hobble along as we are, I can see a situation where even those in critical need will not get a service and many older people will live their lives in misery, fear and anxiety. I think Dilnott’s proposals make good sense. I am not an economist, so I cannot judge the accuracy of his forecasting and financial modelling. Nor do I feel qualified to state where the cap should be. But I feel strongly that the principles of his report are sound, that there are no easy answers, and it is imperative that we grasp the nettle now.

    I am not sure that this would achieve what I think is needed – i.e. more money in the system – though it may do if affordable, attractive financial products come into play. I have misgivings about the notion of a fixed cost for hotel services in residential care – that simply doesn’t mirror people’s individual lifestyle choices. I believe the mega-rich should contribute more than those less well-off. But at the end of the day, we do need to improve on what we have now and Dilnot provides an excellent starting point. And I believe him when he says that we can afford to implement his proposals. When you compare the health spend to the social care spend, surely some of the health money could be diverted into social care, housing-related and voluntary sector support, given that evidence suggests that investment upstream is likely to reduce costs downstream. Also some of the expenditure on universal benefits such as the winter fuel allowance which goes to all pensioners irrespective of means. However, I would not like to see the Attendance Allowance removed. That is one of the few benefits which older people who need support can access, without being subject to FACS eligibility criteria.

    So please Messrs Burstow, Osborne, Cameron and Clegg, please don’t duck this issue. Deal with it as constructively and generously as possible.

  5. Jon Higgins says:

    All of the above comments put the point well, but they all forget that there are others in care apart from the elderly. The younger adults who are active and wish to remain active for as long as possible. They need a truly personal budget or personal care, the various government bodies seem to want to close all residential care, private, voluntary or charity. The local authorities are for the most part the primary care provider who farm out the care to these sectors, it is they who set the prices for care not the providers who have to juggle their funds available. I for one would like to see either the local authorities having to set real fees for all services or for the care sector to be amalgamated into the NHS with residential homes being directly under the NHS, staff would then be trained up to the standard of nurses, the money would be there to fund the care and support required.
    I run a residential care home for younger adults with learning disabilities and challenging behaviour, we are struggling financially with the very low fees that the local authorities deign to give. It would appear from recent press releases that care providers are not going to be helped out financially and will therefore go to the wall, but the people in care will be looked after – how. Yet if a local authority is struggling financially, as the primary care provider, they will of course be bailed out.
    We need a bench marking process for care and for fees not to be allowed to fall below this benchmark. Different groups will need different benchmarks and some will of course need additional funding dependent on their various needs. The local authorities use a fair pricing tool, this is only fair for the LA’s, to use it for real the care providers have to commit fraud in order to give all residents a slice of the pie. All service users should be classed as having a personal care package yet the fair pricing tool suggests that the money for care should be split between the number of service users in each home. It is even worse for Domicillary.

  6. Tom Cooper says:

    At the risk of sounding like a scratched record the imperative is to get more money into the care system. Accordingly, a far higher slice of the country’s spend needs to be allocated. The Commission’s proposals might help but will certainly not solve the problem. A real crisis is fast approaching as the baby boomers start coming into the picture and I detect very little political will to deal with it, despite the platitudes about promoting respect and dignity spouted by every politician and planner. Where is the sense of urgency to push this issue up the UK priority list?

    To quote Pete Townsend “Hope I die before I get old”. I used to think that line was just a pose but now I reckon Townsend’s crystal ball was working well because unless they have a big pension lined up, preferably of the final salary scheme type now being phased out of existence, my generation is likely to have a grim retirement in this country. Won’t get fooled again? I should coco.

  7. David Argall says:

    I am fully in favour of those who can afford to pay having to pay for their own care. What concerns me is that as usual people with money are allowed to keep it and those in need suffer inadequate care due to government cuts and everything looking good on paper but being impossible to deliver in reality.
    For certain individuals who are in desperate need of increased funding and support but whose funding is gradually being whittled away and not even keeping up with inflation.

  8. web editor says:

    Hi there. You can access the Commission’s recommendations at http://www.dilnotcommission.dh.gov.uk/

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