Under the UK’s National Health Service, health care services are free at the point of need. However, this is not the case for social care provision which is assessed on the ability to pay and severity of impairment.
Social care encompasses a very broad portfolio of services including meals on wheels, support in day care centres and care provided in people’s homes. Many people are shocked to discover that care services – such as help with washing or eating – are means tested and not available free of charge.
“The ‘artificial distinction’ between health and social care services makes integrated care more difficult to achieve” a report by the parliamentary health select committee stated, “A well-funded, fully integrated system of care, support, health, housing and other services is essential, not just to provide high-quality support for individuals, carers and families, but also to provide good value to the exchequer and the taxpayer.”
If the govt are to be believed that the NHS will remain “free at the point of delivery” for health related issues, why then, shouldn’t the same apply for social care.
The long-term costs of failing to invest now will be far greater for the millions of people who rely on social care at present and those who will in the future. Without good quality support, many people will see their physical and mental health deteriorate.
An e-petition has been started by a local person who is personally experiencing the additional care costs that have (and are) being introduced. To find out more about the person behind the petition, please visit https://5newsukgreatfan.co.uk/. The petition details are:
Service charges for social care to be abolished in England and Wales – If health care such as medicines are free at the point of need then so should social care needs. It is the disabled person’s poll tax.
Link: https://epetitions.direct.gov.uk/petitions/34411
Please support this e-petition to campaign for a free national care service that meets people’s needs equally and fairly, and is funded out of general taxation.
The government’s approach to welfare reform seems to be based on the assumption that you can make people and problems go away by cutting services and support, rather than – as social care clearly demands – by increasing investment. With such assumptions, it is perhaps no wonder that the government seems to see social care as a marginal political issue that can safely be left to those in need to deal with.
Most, if not all of us, are aware that the UK has an ageing population and this demands that new solutions are found. However the fact is hundreds of thousands of sick, disabled and elderly people in England and Wales who need social care are not getting any support from the state or the private sector. At its most simple, social care helps people to perform basic but essential tasks such as cooking, washing, shopping and living in a dignified way and helps people develop greater independence – through working or volunteering, for example.
The long-term costs of failing to invest now will be far greater for the millions of people who rely on social care at present and those who will in the future. Without good quality support, many people would see their physical and mental health deteriorate. Already, far too many are not receiving the support they need, and are struggling as a result. The irony is that we should be celebrating: we need more funding because of the progress made in helping older and disabled people to live longer, more active and independent lives.
The anti-cuts movement is advocating “there is an alternative” and Trade Unions are demanding “a fair future for all”. So at the same time as fighting to keep a public National Health Service “free at the point of delivery / need”, we must campaign for a free national care service that meets people’s needs equally and fairly, and is funded out of general taxation.
Facts and figures about the current system:
To be entitled to social care in England, an individual is judged on two criteria – means and needs.
There are four thresholds – low, moderate, substantial and critical. It is up to councils to decide which standard they want to set depending on their finances.
Those who qualify for help through means-testing are then assessed for need. Councils are obliged to provide care only if applicants meet a certain threshold. In recent years, many councils have stopped providing support to people with low and moderate needs.
Six years ago, half of councils provided support to people with moderate needs, but that figure has now dropped to 18%. Currently more than three-quarters of local authorities allow access to help only when a person’s needs are deemed substantial or critical. Effectively, this means that if a person does not need help throughout the day, they do not get any state help for things such as washing, dressing and bathing.
Once inflation is taken into account funding has hardly changed in the past seven years but demand for services is increasing by 3% a year from older and disabled adults.
Nearly 500,000 people are paying their own costs. Another 800,000 are estimated to go without formal care despite being in need of help and this figure is set to top one million within four years.
Cuts to council funding led to a £900m reduction in budgets for social care last year – a drop of more than 6% – despite government assurances there was enough money available to avoid services being affected.
Everyone with more than £23,250 has to pay for support with washing, dressing and eating at home. Below that threshold, they contribute to the cost – with the amount paid based on means-testing of both savings and income.
Those with savings and capital of between £14,250 and £23,250 have those assets taken into account when their contribution is assessed. Below £14,250, only a person’s income is considered.
If an individual needs a care home place, the £23,250 threshold also includes the value of their property unless they also have a partner who will continue living in the property.
The rise in the value of property over the past few decades has pushed many above the means-tested threshold, forcing them to pay for their care if they have to go into a residential home. For some – an estimated 50,000 a year – the only option is to sell the family home.
Many disabled people, often on very low incomes, have to pay for their own care, which increases the likelihood of them living in poverty.
Figures from a survey conducted by the Association of Directors of Adult Social Services (Adass) showed that in the past two years social care budgets had lost £1.89bn in funding. While Adass says three-quarters of the savings have been achieved through what the report describes as “efficiencies”, almost £200m has come through increasing charges or reducing services.
The type of support every disabled person receives should be a decision for individuals themselves and this should be focused on the principles of independent living which has been one of the most liberating aspects in many disabled peoples’ lives. It has transformed individuals from being recipients dependent on services which have not always met their needs, to becoming active citizens in the community and at the same time employers of our own personal assistants and support workers. Independent Living is a less costly option in the long term, as opposed to an expensive one. It is key to improving the quality of life and health of many disabled people, and puts them in control. If you compare the delivery of direct services in the community, in most cases there is financial savings to the State because living independently does not incur additional costs such as building maintenance, office, power, IT technology and additional related costs of a local social services department.
There are 6.4 million carers in the UK caring for ill, frail or disabled loved ones. Many are paying the price of a care system in crisis – being forced to give up work to care and often pushed in ill-health, financial hardship and debt because of a lack of support to help them care.
It can be concluded that too many disabled people can miss out on the support they need because of tightening eligibility criteria, informal carers are not well enough supported, charging policies can provide an active disincentive to work and keep disabled people trapped in poverty, local variations in services can leave disabled people unable to move house for fear of losing their support.
There is also concern about the outsourcing of care assessments to private companies. This is portrayed as an extension of “consumer choice”. But service users and their organisations have repeatedly highlighted their fears about private provision and increased reliance on private money in social care because they have experienced the resulting unreliability and poor quality services.
All this provides the reality and misery of a system in crisis, a system that constantly denies individuals and families the support and investment that a relatively wealthy country is capable of providing. A crisis matched by the erosion of disability rights and supports fought for by disabled people over the past 20 years in a regime that is severely impacting on the lives of disabled people now, and that will impact negatively on future generations.
The Dilnot Commission
In July 2010, the govt launched the Commission on Funding of Care and Support, an ‘independent’ body tasked to review the funding system for care and support in England. It is commonly known as the Dilnot Commission (after the Chairperson). It was to build on the extensive body of work already done in this area and carry out new analysis before providing advice and recommendations on how to reform the system. The key proposals released in 2011 were:
i) At age 65 people will pay a proposed £35,000 for their ‘care’ costs</span>
ii} Private insurance is being mooted as the solution for individuals to pay for their ‘social care’ in later years</span>
iii) A national eligibility framework is proposed starting at ‘substantial’.
Portability of assessments rather than ‘care packages’ from one local authority to another
iv) Means testing remains but the threshold is set to increase to £100, 000
Extra payments from those entering residential care of up to £10,000 per year proposed
v) Deferred payments encouraged but local authorities to charge interest
Conclusions on Dilnot
The Dilnot proposals, although a slight move in the right direction in some areas, do little to allay the fears of people who rely on social care and raises more questions than answers:
i) At the age of 65 the individual pays a sum of money for their ‘care’ until they reach the ‘cap’ of £35,000. The ‘cap’ is a suggested amount by the Dilnot commission. This is where the suggestion of a partnership with private insurance companies comes in, although those on low incomes can apparently protect ourselves through paying an insurance company, and unsurprisingly some were involved in discussions with the Dilnot commission, so the ‘independence’ of the report itself could be considered to be compromised.
The ‘cap’ of £35,000 is still not guaranteed to be accepted by the govt and even if it is; we all know governments could increase this on a regular basis. The figure of £35,000 was arrived at on calculations of the cost of care for a 65 year old person and the costs over an average further 20 year life span; eighty-five is the predicted life expectancy. The Dilnot report has suggested a figure at which they hope we will pay our own costs and then die, allowing the state to appear overtly helpful but avoid any cost. It seems more a solution for government than disabled people or those with long term health issues.
Other questions are raised: What happens if an individual who hasn’t opted for private insurance becomes disabled or encounters long term health issues before the age of 65? What happens to those already disabled or with long term health problems?
ii) The report proposes that those who are disabled or encounter long term health issues before or at the age of forty will be entitled to no cost support. This appears promising and a recognition of the limitations on building up savings and assets. Yet this will require proof of ‘eligible need’. So it will be on the basis of what different local authorities identify as ‘eligible need’ an increasing difficult thing to reach. As we know this is currently framed by a postcode lottery based on where you happen to live rather than need.
As the majority of authorities have now raised their eligibility criteria to ‘substantial’ and ‘critical’ then what counts as disabled may be something very different to current common-sense views of what it really means to be disabled . It is flawed and promotes greater inequalities rather than promoting a solution.
iii) The Dilnot report offers a solution to the postcode eligibility issue in the form of a national eligibility framework but this is set at ‘substantial’ following from this it becomes clearer that qualifying for ‘no cost’ support may become increasingly difficult if not impossible for most. This would also ensure that those rare local authorities with eligibility starting at ‘moderate’ join the majority of authorities to set the level at ‘substantial’ and ‘critical’ only.
iv) The Dilnot report does not suggest the ‘portability of care packages’ from one location to another called for by many disability groups. Instead, it suggests the portability of assessments which is something entirely different. The most likely outcome is that an individual presents their assessment and is reassessed by their new local authority. It is not clear how this can be considered an advance on the present system. It is no surprise that ‘means testing’ will remain.
The increase threshold of imposing means testing to those with assets of £100,000 instead of the current £23,250 appears at first glance an improvement; however, this may also point to home owners having their assets counted for services other than just for residential care, as at present. This would mean that home owners may in future be financially assessed not only on their savings but also on the value of their homes and be forced to release equity to pay for any local services they might need.
Those in residential care would be expected to pay what the Dilnot report implies is a ‘hotel charge’ with this extra charge being for accommodation and food. This is confusing as isn’t that what those in residential homes are already paying for through either the sale of their own homes or their family’s sale of their homes to pay costs and would this extra charge be a stand alone surcharge disregarded in respect of the ‘cap’.
v) Local authorities should offer loans to pay for care to those who could later sell their homes to pay the costs with interest to the local authority. What happens to those without homes to sell is unclear.
The much repeated govt mantra of ‘supporting those in the greatest need’ is constantly being proved false and no more than a euphemism for a series of ideologically driven ‘cuts’ by a government intent on removing the fabric of a post-war welfare state. Cameron argued in 2010 that ‘those with the broadest shoulders should bear the greatest load’ who’d have thought the shoulders of the sick, disabled and elderly were so broad.
Being or becoming disabled impacts negatively on ongoing income levels, with disabled people experiencing significantly greater levels of poverty compared to non-disabled people. Disability benefits are already under attack from Work Capability Assessments (WCA), Disability Living Allowance (DLA) being replaced by Personal Independence Payment (PIP) and the closing of the Independent Living Fund (ILF). In reality these are all cuts and analysts estimate up to 500,000 disabled people will have their allowance entirely withdrawn over the next four years as eligibility criteria is tightened.
Figures show that 75% of disabled women and 70% of disabled men are already at the bottom end of Britain’s income distribution scale living in poverty, the median level of total wealth for households headed by an employee is £217,500 compared to only £21,100 for households headed by someone who is sick or disabled, the average gross hourly pay for disabled employees is £11.08 compared to £12.30 for non disabled employees. A Demos report ‘Coping with Cuts’ found.
170,830 families where both parents care for a disabled child will lose £520m
516,450 disabled adults whose partner is a full time carer will lose £1.258bn
98,170 single disabled people will lose £127m
The above figures do not include financial losses due to the downgrading of Incapacity Benefit (IB) to Employment Support Allowance (ESA) or Job Seekers Allowance (JSA), nor the change from DLA to PIP which the coalition claims is set to knock at least 20% of current recipients off the system by 2015.
The Demos Report found that councils are making cuts to disabled people’s services without any knowledge of the number of disabled people or needs of people in their areas. There are no satisfactory impact assessments being made at local level which can be fed back to national level for any real and informed decisions to be made. The way cuts have been implemented varies between local authorities and there is no consistency in how services are being reduced to save money from local authority budgets.
It also found that funding for care and support services are not ring-fenced by councils in any way and so what is cut, how and when is entirely up for grabs with no real information available to either officers or councillors of what this means in real life for disabled people and their families.
A survey report by Red Cross revealed almost nine in 10 GPs (among 200 surveyed) said older and disabled people were being put at risk by a lack of social care support and 80% of the 2,200 members of the public polled said standards were being driven down. The charity released an economic analysis of its own home-based low-level care services by the New Economics Foundation think tank, which it said showed that a preventive approach to health and social care could save the NHS up to £10,000 per patient thanks to avoided hospital and residential care admissions.
The related source links for this article can be viewed by visiting https://bpacc.co.uk/time-to-end-the-disabled-persons-poll-tax/
Kevin Smith
