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Can care shed its poor law roots?

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The NHS celebrated its 65th birthday this July. It provides a chance to reflect on what might have been had social services been one of the pillars of the post-war welfare state.

I doubt we would have two such contrasting systems. One is a matter of national pride and a political totem, the other, recently deemed a shabby secret, is not far removed from its medieval antecedent.

Politicians are turning their attention to genuine reform of social care in England and to integration with the NHS.

What are the prospects of it shedding its Poor Law roots forever?

There is an unprecedented consensus across the sector about the case and framework for reform. Legislation is before Parliament and the detail of a reformed system is gradually appearing through debate and draft guidance for consultation.

We know it will still be needs and means tested, with an assumption that those who can should pay. The risk of catastrophic charges will be capped but the older better off will still pay quite a lot.

Everyone who can, will be expected to pay daily living costs and these will be in addition to your capped costs.

People will be able to defer the cost of residential care and pay from their estate. There are complex arrangements being worked on for younger working age adults and for carers.

The new system will have a national threshold of need for entry, ending the long shadow of the local board of guardians and the workhouse. But it will be set at substantial risk of loss of independence.

The legislation formalises some of the better bits of the system as it has developed.

Personal budgets, wellbeing, users’ and carers’ entitlements to assessment are guaranteed.

Ironically, as social care gains attention and edges closer to the NHS, there is a danger that its separateness is unintentionally emphasised by the reforms. Rather than focusing on the common cause of prevention and wellbeing, legislation could enshrine its position as for the most needy and not free.

Andrew Cozens, chair, Carers Trust

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