Yesterday’s confirmation by the Health Secretary revealed that the cap on social care will be set at £75,000 in England. This headline has received a cautious welcome from most quarters. However, the cap cannot be looked at in isolation and at the moment it is still difficult to see how many older people and those entering old age in the coming years will be affected as there are still a number of unknown factors. In addition, boarding and food costs are not included in the cap. The objective is to try and ensure that people living in their own home are not penalised unfairly as they are still responsible for paying their housing costs. These so called “hotel” costs will be capped at £12,000 a year.
The cap won’t take effect until April 2017 and the Government has stated that £75,000 in 2017 is in effect worth the equivalent of £61,000 in today’s prices. The current threshold over which support is not provided is rising from £23,250 to £123,000, a rise of nearly £100,000. This means that more people will be entitled to receive some support for their care albeit on a sliding scale.
The big element missing in all of this is at what level the national “eligibility criteria” will be established. At the moment councils are free to set the criteria at low, moderate, substantial or critical. This perpetuates something of a postcode lottery. As funding has become tighter, an increasing number of local authorities have set their criteria at substantial. At the last count well cover 82% of England’s local authorities were at a substantial level or higher. The level at which this is set will be important calculating how many people will be supported. The higher the eligibility criteria bar is set means that those with lower needs which may prevent or delay more intensive and expensive interventions may miss out.
But the response to Dilnot is not the full answer. Implementation of these changes and those proposed in the Care and Support Bill won’t take effect for over 5 year’s and there is already a shortfall in the funding of adult social care that will increase during this time as local authorities make further savings.
All of this goes to demonstrate that volunteers working within organisations such as WRVS are key in delivering the practical support that older people want, but without the huge bills attached, not just for now, but for the long term.
Paying for care in old age is a significant worry for many people. However, for a large number of people going into a care home is the last resort and most older people would rather live independently in their own homes for as long as possible. Supporting them to do this doesn’t have to have a large bill attached. Practical support provided by volunteers at crucial times, such as settling people back into their homes after a major operation, will be central to us managing demand for health services in lean times. WRVS volunteers bridge that gap through a whole range of practical services, such as supporting older people to continue do food shopping; making sure their houses are warm and cupboards well stocked when they are discharged from hospital or just a friendly face popping in to see them regularly. This support is relatively inexpensive but the rewards are considerable.
After months of waiting and delays, the Welsh Government last month unveiled its revised Social Services & Wellbeing (Wales) Bill – which will probably be the most wide-ranging piece of legislation which the Assembly will pass in the current administration.
As one of the biggest organisations delivering volunteer-led services for older people in Wales, WRVS wholeheartedly welcomes the principles and ambition of the Bill. The renewed focus on wellbeing is particularly welcome; the new Bill incorporates “domestic, family and personal relationships” into its definition of wellbeing, and this chimes with our own research that social interactions are seen by older people as the most decisive factor in defining their sense of wellbeing.
But improving wellbeing cannot just be a cosmetic change. It has to be underpinned by a social services system which helps give people a quality of life – there is no sense in having a generation of older people with working hip replacements, walk-in baths but nothing to live for. Our own research has found a tendency for public bodies in Wales to concentrate on services that focus on improving physical wellbeing, to the detriment of those which address emotional and social wellbeing.
So we also strongly welcome the duty on local authorities to provide preventative services and to promote the availability of voluntary sector preventative services. Preventative services boost older people’s independence and also save public money in the long-term. We strongly believe that a greater focus on prevention, if properly executed, can be a win-win scenario for Wales.
Yet the Welsh Government’s ambition comes at a time when local authorities are making it harder and harder for people to access low-level services. As the Welsh Local Government Association has noted: “Due to the intense financial pressures that councils are now facing, most local authorities have raised the eligibility threshold to ‘substantial’ and ‘critical’... The risk is that moderate need may escalate to substantial without appropriate or adequate community support.”
Because of this, plans within the Bill to standardise eligibility criteria could be a double-edged sword. They will only improve social services for people on the receiving end of they go hand-in-hand with a commitment that local authorities cannot use the change in order to raise eligibility ceilings and remove the very services which help older people to stay independent.
The Bill also needs to ensure that older people with low-level needs can get “that little bit of help” easily, without needing to go through a formal assessment or getting embroiled in the official social services system. Information, signposting and assistance should be independent and accessible to all – but even more importantly, it needs to be provided for free, even if the services to which it directs people come at a cost. Otherwise, older people are discouraged from even looking for help, which ultimately costs them their independence and costs the state more money.
The Social Services & Wellbeing (Wales) Bill has been a long time in the drafting – and that looks to have been time well-spent, given the scope and ambition of the Welsh Government’s plans. We welcome the progress so far, but with the note of caution that the Bill can only make Wales a great place to grow old if it is made more explicit about how it will help people to remain independent, active and socially connected during their older age.