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Social care white paper published

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Care services minister Paul Burstow has suggested that the government will fund councils for their new duty to provide loans for individuals’ social care costs, introduced in the long-awaited social care white paper.

Under the measures, there would be a “universal deferred payments” system in which councils would lend money to individuals that needed care, and would recoup the money when the house was sold after the person’s death.

Asked at a press briefing this morning whether the government would subsidise the scheme or expect councils to use reserves, Mr Burstow said: “We would intend that there will be resources for them to provide that scheme.” He said he would discuss this with the LGA, and that he anticipated the scheme would become self-funding in the long term.

The white paper says the government will transfer a further £300m from the health budget to councils, to “support better integrated care and support.” It says £100m will be made available in 2013-14 and £200m in 2014-15.

The proposals commit the government in principle to the Dilnot Commission’s proposals, but do not address funding for the reforms or for the long-term demographic pressures on social care funding.

Health secretary Andrew Lansley said on Wednesday morning: “If it entails public expenditure consequences, it has to be considered in the context of all the priorities across government which include the substantial demographic pressures on the social care system itself.”

However, a “progress report” on funding reform published alongside the white paper said “there are a number of important questions and trade-offs to be considered”. A new funding model will only be based on the Dilnot principles “if a way to pay for it can be found”.

It says: “The government is unable to commit to introducing a new system at this stage. Funding reform needs to be considered alongside other priorities and the right place to do this is at the next spending review. A final decision will be taken then”. The next review is expected in 2015.

The Dilnot Commission suggested care costs be capped between £25,000 and £50,000 per individual. But the progress report says: “There was a discussion of the level of the cap, with some people suggesting that a cap could be set at the top of the commission’s range – or even slightly higher (eg at £75,000) – without undermining the principles of the system.”

The report says the financial services industry had said the most appropriate level for the cap might be higher than the Dilnot recommendations. “Others recognised, given the fiscal circumstances, that a higher cap could provide a more affordable way to implement reform,” it says.

Mr Lansley said a higher cap than that proposed by Dilnot was also being considered because it would “reduce the cost and increase the incentive to take out insurance.”

Ministers are also considering an “opt-out approach” to the scheme. The report said: “One approach would be to implement a voluntary scheme which people could opt into or out of.”

Mr Lansley said under the proposals individuals would “be asked whether you want to pay a premium to opt into a cap on care costs.” Asked whether he was confident that people would opt to do this, he said: “People opt into insurance all the time, because they don’t want to be subjected to catastrophic costs.”

The white paper, and a draft bill on social care, introduce a range of new roles and duties for councils. These include:

  • A duty to make information about local care provision more easily accessible online. The government will provide £32.5m in “start-up funding” for this.
  • A “national minimum eligibility threshold” for access to care, and a similar threshold for support for carers. At present councils do not have to provide support to a carer even if they have identified a need. Asked about the level of the threshold, Mr Burstow said it had not yet been decided.
  • A requirement to meet the assessed needs of people who move into their area immediately, “until they carry out a new assessment of their own”.
  • A duty to “develop and maintain a diverse range of high quality care providers” locally.  
  • A requirement to incorporate preventative practice and early intervention in care services.

Asked how councils would be funded for the new duties, Mr Burstow said: “There will be a robust examination of any new burdens being imposed.” He referred to the extra £300m for integration, which he said would be taken from the savings made under the NHS’s QIPP programme, under which the health service aims to save £20bn by 2014/15.

The white paper also announced a new £200m fund for specialised housing for older and disabled people.  

Reactions

Sir Merrick Cockell told the Today programme this morning that 9,000 individuals already used deferred payments. “We haven’t got time to tinker around,” he said. “We’ve got to look at radical change.” The LGA has said there is a £1.4bn gap this year between the money available and the cost of maintaining services.

It has called for the government to commit to a “concrete timescale” for reforming – and funding – social care.

Leading figures in social care policy reacted to the likely announcements with a mixture of disappointment and hope.

Richard Humphries, head of social care at the Kings Fund, said that if the government supported the principle of a care cost cap, as advocated by Andrew Dilnot’s commission last year, but made no commitment to when it will be introduced, then councils will be left in an invidious position.

“I don’t think there’s anything substantial that hasn’t been said,” he said. “It’s a big disappointment. It won’t scratch the surface.

“I’m depressed rather than surprised. The Treasury is burying its head in the sand.”

LGA adviser Andrew Cozens said social care would “join the queue” of issues waiting to be considered in the spending review.

“If there aren’t enough additional resources, councils won’t be able to reinstate activities just because there’s a national framework,” he said. “We’re looking at 2014 or 2015 before there’s a chance of reform.”

But Sarah Pickup, president of the Association of Directors of Adult Social Services, said a commitment-in-principle to the Dilnot proposals would be relatively more than was expected.

“Endorsing the Dilnot principles but pushing the funding [issue] into the long grass is actually marginally more than we expected,” she said. “We didn’t know they would endorse the principle.”

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