Adult Social Care 2019: An overview
The status of the green paper
The social care paper was first announced by the Conservative government in the March 2017 Budget and was subsequently reaffirmed as a manifesto commitment during the 2017 general election campaign. Since that time, however, the publication of the green paper has been delayed several times. Originally due to be published in “summer 2017”, this was changed by the Conservative government to “the end of the year ” following the general election. In November 2017, the government offered a revised publication date of 25 July 2018 and when this deadline was passed, the date changed to “before the end of the year .”
In January 2019, the Health and Social Care Secretary, Matt Hancock, announced his intention to publish the paper “before April.” Currently, the paper is to be published “at the earliest opportunity” and several media outlets have claimed that it will be delayed until “Brexit is resolved.”
In a speech on 20 March 2018, Jeremy Hunt, then Health and Social Care Secretary, forwarded the “seven key principles” that would guide the thinking and formulation of the upcoming green paper:
· Embedding quality and safety in care provision
· As much control as possible to be awarded to those receiving care
· The integration of care with the NHS and social care systems operating as one
· Developing a valued workforce
· More practical support for both families and carers
· The creation of a sustainable funding model which would be supported by a diverse, vibrant and stable market
· Greater security for both those who have developed a care need early in life and older people who do not know what their future care needs will be
“Innovation”, Hunt said, would be key to these efforts, adding “We will not succeed unless the changes we establish embrace the changes in technology and medicine that are profoundly reshaping our world.”
These intentions were reaffirmed by the current Health and Social Care secretary, Matt Hancock, during a debate on social care in October 2018.
Although concrete details have not been released, three key proposals have been identified and mentioned by government, focusing on how individuals will pay for social care. These will likely factor into the final publication.
A more generous means-test
Currently, local authorities only contribute to the cost of an individual’s care needs if their assets are below a certain threshold. For care home residents, this level is set at £23,250 which may include the value of their home. For those receiving care in other settings, each local authority sets its own limits but this may not be lower than £23,250. In this instance, the value of the individual’s home is always excluded.
In the Conservative’s manifesto for the 2017 general election, they proposed changing this level to “a single capital floor, set at £100,000.” They also proposed that the value of the individual’s home would be taken into account no matter where they received care while ensuring care payments could be delayed to ensure no-one would have to sell their home to pay for care.
A cap on lifetime charges
The proposal to impose a cap on total payments has been met with conflicting statements. In 2017, the proposal was not included in the Conservative manifesto but less than a week after the election, Theresa May said “an absolute limit” on how much an individual could pay would be set. In January 2018, the government stated that the green paper would include “consulting on a limit on the care costs that individuals face.” As of now, it is unclear whether this proposal is still in consideration.
An insurance contribution model
In October 2018, Matt Hancock stated in the Commons that he was “attracted” to an “insurance and contribution model.” This contribution, described by a joint select committee report as a “Social Care Premium” would likely be paid by both individuals, over the age of 40, and their employers. Despite Hancock’s statement that he was “attracted” to the proposals, the government are yet to issue a formal response to the idea.
The social care sector more widely
Beyond the issue of how individuals will pay for social care, the government have also confirmed a number of areas that the green paper will seek to cover.
· Market stabilisation
· Future shaping of the market
· The integration of health and social care
· The role of carers
· The care workforce
· The potential links between care for older people and children
· Social isolation
· Developing technology
· The preference for domiciliary care
· Domestic and international comparisons
Jeff Wilton-Love – Chapter Care
Chapter Care operate in North Devon and provide domiciliary care and support to users throughout the county, including to many in hard to reach places. According to 2017 census data, 25 per cent of people living in North Devon are over the age of 65, making it an interesting example to demonstrate the effect of increased demand on care services. We spoke to Company Director Jeff Wilton-Love who puts forward an innovative method to solve the care recruitment crisis and calls for care services to become VAT exempt.
Kathy Coe MBE – Pathway Project
Pathway Project is one of the UK’s leading charities helping to support victims of domestic abuse. The charity was founded by Kathy Coe who has since been awarded an MBE for her services to the community. As a more specialist provider of care, they are able to offer insight that shows both the depth of the care sector and the importance of considering all aspects of care when considering future policy.
Christine Alexander – Carers Trust East Midlands
Carers Trust East Midlands provide a variety of care services across England having recently expanded beyond their East Midlands base. As well as providing care themselves, they also work to support carers and offer respite services free of charge. In the UK, 4.27 million people juggle work and care and the majority of these carers are aged between 50 and 64. CEO Christine Alexander highlights the issues facing the sector and explains how promoting and supporting volunteers can help to ease budget pressures.
Eleanor Smith MP
Eleanor Smith is the MP for Wolverhampton South West and co-chair of the All-Party Parliamentary Group on adult social care. Following her question during PMQs, she powerfully explains the issues the care sector faces and calls for the introduction of free personal care.