Care Bill [Lords]

Written evidence submitted by Philip Spiers (CB 37)

Care Bill, Part 1, Clause 15

As a person who has been involved with advising older people and their families on obtaining and paying for care for over 20 years and, in doing so, experiencing the shortcomings of a grossly underfunded social care system, I cannot see how the changes to the means test for funding care can help solve the issues this country is faced with. The proposed reforms to the means test for funding care may be seen as diminishing and capping the catastrophic cost of care, however, it also raises more in questions than the answers it sets out to provide.

From the original Terms of Reference of the Commission it was agreed with Government that a new funding settlement should deliver and be:

§ Sustainable and resilient: ensuring the costs to the state are sustainable in the long-term, and the care and support system is able to respond to demographic, economic, political, and societal change

§ Fairness: for individuals, families, carers and wider society

§ Choice: offering an affordable choice to individuals, carers and families across a range of care settings, and helping people to prepare and plan for their future

§ Value for Money: securing the highest quality care outcomes with the available resources

§ Ease of use and understanding: making the system as clear and simple as possible for people, supporting people to take responsibility for their future wellbeing.

Although the recommendations , capping of care costs, national assessment criteria, portability of care packages and robust advice and information are all welcomed , it is difficult to see where it contributes towards putting an end to the present crisis of a failing social care system .

On sustainability it has not addressed the issue that we that we have an ever increasing older population and a proportionately reducing working population expected to meet an escalating cost. A high proportion of the present and immediate future generations of older people are property owners and as such can contribute a considerable amount of their accumulated wealth towards their care costs. It should be considered that this may not be the case for future generations less able to purchase property and accumulate wealth.

There still exists the opportunity for Government to be brave and come up with a sustainable funding solution where each generation pays for its own care through a two tier system. For the present and immediate future generations of older people through taxation of assets on death and for the younger generations who have time to accumulate a social care fund a compulsory insurance. In both the opportunity exists to create pots of money that can enable the means test to be scrapped, our social care system aligned with the National Health Service and care and support to be delivered to all regardless of age or means, where and when it’s needed. A brief outline of such a system ‘Funding Care: How can each generation pays its fair share? can be found at http://www.jrf.org.uk/publications/funding-care-fair-share

On fairness it keeps to the existing means test rules for home care which means that your home as an asset is disregarded if you are still living in it. If your other liquid assets are below the means test threshold then the local authority will help pay for your care and this contribution will count towards the cap. Is it fair that the state will contribute towards your cap if you need care at home because your housing asset is ignored whereas if you need residential care it is counted and you will have to meet the full cost of the cap from its value ? Is it fair that the cost of implementing the proposed reforms are met from general taxation of mainly working people?

On choice , individuals will be limited as to what they can afford. The commission proposes t hat local authorities will determine the weekly cost of care and this will be the figure used to notionally calculate when the cap has been reached. Typically this could take almost 4 years by which time the individual would have had a cost from capital of circa £60,000 . This being considerably higher if they are paying a market rate for their care rather than the arbitrary costs set by local authorities. Even if utilising a def erred payments agreement , homes will still have to be sold to meet this cost. Assuming , local authorities continue to set arbitrary rates for which they are prepared to pay for care considerably lower than the market rate choice on reaching the cap will continue to be determined by how much families can afford to top-up fees .

On value for money and securing the best outcomes with the available resources how can this possibly be achieved if the commission considers that care needs must be substantial or critical before the state steps in. Throughout the country older people with low or moderate care needs have to pay for their own care, rely on family and friends or, do without. This is a false economy and can lead to older people needs and dependency increasing more quickly than they would be if they were supported earlier. Intervention when people have low and moderate needs must prevent many reach ing more costly substantial or critical need .

Ease of use and understanding The commission cites that the current system is complex and difficult to understand. Retaining the existing means test rules , albeit with a higher capital threshold and then adding a cap to the cost , surely puts on another layer of complexity .

In conclusion , clearly the proposed funding regime do es not resolve the main issues which are that we have an underfunded, under performing social care system on the brink of collapse which cannot and should not be funded by future generations. A funding structure should look at the existing and future demand for care and support, look at unmet need, look at the failings and inconsistencies of the existing system and without the complexities of the proposed charging structure provide an equitable and sustainable solution whereby each generation pays for its own care collectively .

February 2014