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The Care Act cometh, but will it solve our care problems?
The Care Bill has completed its passage though report stage and now goes to the House of Lords to approve amendments before, probably, receiving Royal Assent in May. The Care Act 2014, as it will be known soon, will reshape the care map for many current users and potential users in future years. The Act will set the framework for some 20 sets of new regulations covering a raft of new rights, duties and responsibilities.
Much if what is contained within the Care Bill is to be welcomed, especially the promotion of individual wellbeing and prevention to reduce care needs. But reports published in recent weeks suggest that all is not as well as one might hope and that some of those aspirations will never be realised until the Government puts in place the necessary evidence gathering mechanisms together with adequate funding to implement the legislation.
I commented on the report of the National Audit Office (NAO) in my blog post on 17 March.
The news hasn’t improved for the authorities in the following week. A report by the Nuffield Trust and the Health Foundation issued on 26 March found that a quarter of a million older people have lost their state-funded help with carrying out everyday activities such as bathing, dressing and eating in the past four years as a result of cuts to local authority funding.
The Nuffield conclusions are not dissimilar to those published by the NAO just a week or so ago. The report warns that the NHS and Government are now “flying blind” in planning services for vulnerable older people because there is no way of assessing the true impact that social care cuts are having on their lives, and suggest that the lack of support is putting huge pressure on friends and family carers, and leading to unnecessary hospital admissions. Its final thought is that better information systems that track older people across services need to be developed, so that policy-makers have a clear understanding of the relationship between social care and the wellbeing and health of older people.
Furthermore, feedback from carers and social care users on the draft eligibility criteria published by Scope also on 26 March shows that the draft regulations as they currently stand risk not capturing some groups of disabled people, in particular those with social, communication and mobility needs. And for some who receive support, with an eligibility criteria set at “substantial”, help comes late. If care and support had been provided at an earlier stage, this would have prevented the condition from accelerating as quickly as it did.
Margaret Hodge MP, Chair of the Public Accounts Committee responded quickly to the NAO report findings and invited stakeholders to give evidence to a short inquiry on adult social care in England this Wednesday. Just one example of the strains that the new Care Act will place on finances was very clearly illustrated by Sandi Keene, President of the Association of Directors of Adult Social Services and Director of Adult Social Care Services, Leeds City Council. Carers have new rights within the legislation for assessment and support. Leeds currently has a relationship with about 12,000 carers but estimates that there are up to 70,000. Based on this figure the value of informal carers caring for over 50 hours a week would translate into a budget three times the total expenditure of adult social care services for Leeds. Whilst not all carers will come forward for assessment, this just demonstrates the scale of the issues that lie ahead and need to be addressed if the system is to be sustainable.
Posted by Steve Smith, Royal Voluntary Service Public Affairs Manager (England) at 00:00
Monday, 31 March 2014.
Budget for savers and pensions
At the outset of the Chancellor's Statement yesterday he pulled no punches by saying that whilst some taxes would be reduced, Government spending would fall too. Tough controls on welfare and public sector expenditure are here to stay for a few more years at least. This is of concern for those that rely on public funding or who work with welfare recipients. Anyone in the health and social care sector who thought the age of doing more with less was over should think again. But let’s look at what did happen rather than what didn’t.
The raising of the tax threshold to £10,500 in 2015/16 and an initiative around tax breaks for child care were both well publicised before the Statement. The big news grabbing headlines came with the announcement that the Chancellor was making changes to looking to assist savers and those accessing pensions.
The Chancellor has simplified the complex ISA market. From 1 July, cash and share ISAs will be merged into a single New ISA with an annual tax free savings limit of £15,000. Therefore, better off older people who don’t wish to gamble their savings in stocks and shares will be able to invest more in a cash ISA with guaranteed returns.
Further on savings, a new Pensioners Bond run by National Savings and Investments is being introduced in January next year which will allow older people over the age of 65 to invest sums of up to £10,000 into accounts offering attractive (taxable) interest rates over fixed periods.
There are changes to pension arrangements with a decision by the Chancellor to allow greater freedom and choice so people can access their pensions more flexibly, and provide them with financial advice about their investments.
The Budget confirms further details about the new class of VNICs, which will enable those who reach State Pension age before the 6 April 2016 to top up their Additional State Pension record.
Many will claim that these are measures to woo the older voter, and there may be some truth in that. We know that older people are the group most likely to turnout at an election as they generally view it as a civic duty. But for some time now older people who have a degree of savings have seen the interest that they hoped would supplement state and private pensions fall to very low levels and not keep pace with cost of living expenses. The changes to ISAs and the new Pensioners Bond might just help prompt some new innovative and attractive products from the financial sector.
Maybe there is another message here. We are an increasingly ageing society. One in three babies born last year is expected to reach 100. Given that the State, however wealthy, will not be able to cover all of our future and more complex needs, there is a real need for individuals to take some responsibility and therefore need to plan for those later years. Making savings less complex and more attractive, allowing people to top up NICs and making pensions assess easier and less scary may be a welcome step in encouraging us all to build that self resilience.
Posted by Steve Smith, Royal Voluntary Service Public Affairs Manager (England) at 00:00
Thursday, 20 March 2014.
National Audit Office asks, can the social care system cope?
On Thursday 13 March the National Audit Office (NAO) published its Adult Social Care in England report.
Much of the content of the report will come as no surprise to many who follow the health and social care agenda. It includes much talk about integration and social care being 'joined up'. In particular the finding the older people have experienced the greatest spending reduction in their care, down 12% between 2010/11 and 2012/13, is a stark one. Over the last four years, the number of adults receiving individual packages of state-funded services has fallen. But with 87% of local authorities having set their eligibility threshold to only provide support to those with substantial or critical needs paints a consistent and disappointing picture, especially with a growing government focus on prevention being the best and cheapest way to look after older people. Around a third of adults aged 65 and over report a need for help with at least one activity of daily living. Without this help they are at further risk of having a poor quality of life and becoming socially isolated with all of the negative health implications that brings.
The NAO indicates that greater spending on social care is related to lower delayed hospital discharge rates and fewer emergency admissions. At a time when A&E and other services are under severe pressure the continuing cuts in funding of front line support services does seem counter-productive. We know from Royal Voluntary Service research that a Home from Hospital scheme can reduce hospital readmissions by 50%.
Indeed, voluntary organisations are filling a much needed gap. In 2010-11 the NAO showed that the voluntary sector spent £2.9 billion from its own fundraising on care and provided a further £6.2 billion of care commissioned mainly by local authorities. This represents nearly a quarter of voluntary sector activity.
Self funders of care contribute 13% towards a total adult social care budget of £19 billion. There are fears expressed by the NAO that Councils know little about this group of service users and will struggle to plan for them. There are also criticisms that the commissioning and providing services which are the most cost-effective is based on weak evidence. The NAO concludes that national and local government do not know whether the care and health systems can continue to absorb the cumulative pressures, which includes increased demands of an ageing population, and how long they can carry on doing so.
The Public Accounts Committee chair Margaret Hodge MP, has been swift to swoop on the report findings. "The result is unnecessary stress and an unfair financial burden on those who need care and the 5.4m unofficial carers who already contribute £55bn worth of care every year.
"The fact the departments do not know how much longer the entire care system can cope under the mounting pressure makes for a worrying picture.” The MP meets with Government departments on 26 March when this will be discussed.