The growing care gap and the impact on people, particularly older people, who are ‘lost to the system’ and not getting the help they need, has been described most eloquently by the Commission for Social Care Inspection (CSCI) in its recent annual report. The report provided a historical snapshot for 2006-7 – it was bad enough then; it is worse in 2007-8 and will get even worse in 2008-9 as local authorities tighten their eligibility criteria and restrict the help they provide to fewer and fewer older people, despite our ageing population.
So the case for urgent and radical reform is clear. Where do we go next as we move towards the green paper on the funding of care in the coming year? Here are three areas for discussion.
First, what kind of care do we want and what is our vision for the future? Counsel and Care’s vision is that it needs to be simpler, fairer, consistent, transparent and flexible. Of course that will require more funding and I will come back to that. One of the key debates is around what is the core offer or universal entitlement. What can an older person or their carer expect to get, wherever they live in the country?
There seems to be agreement that we need universal information, advice and advocacy whatever their needs; everyone should be able to get a proper assessment of needs; and there should be effective regulation. Personal budgets will give everyone the same choice and control as self-funders. What else? How about making the universal offer of a free home safety check? Checking that homes are warm, safe, secure and tackling risks like falls, fire, crime, delivered by services working together. The future will rely not just on care services but heavily on unpaid carers. We need better universal support for carers in their caring role and to help them lead the life they want to – which brings me to my second point.
This debate is bigger and wider than social care. We need a new approach to family policy recognising both multigenerational families and the different caring roles families have across generations as recently recognised by Harriet Harman. It is not just about social care but about all the services and support that affect older people’s quality of life and their neighbourhood. Local area agreements must engage health in the debate about how better care and support will help keep people out of hospital and give them a better deal as well as well as save and redirect resources. The third sector has a crucial role in delivering services that go towards creating caring neighbourhoods – for example befriending to tackle loneliness.
Housing and telecare and effective planning are all key to creating places that are good to grow old in – the forthcoming housing strategy for an ageing society is crucial. We need these services to work much closer together in local neighbourhoods, easier to access through a single gateway if possible, intervening early and reaching out to isolated people – delivering real prevention as described by the Sure Start to Later Life model. Once we are clear what the offer is, we need a good distinctive brand like Sure Start – this is key to getting wider recognition and support.
Third, that wider support is also key to how are we going to pay for care in the future. We need to make better use of existing resources, divert funds from acute NHS spending to care in the community, and by LAAs pooling resources. We need to help individuals make better use of their own resources, for example through equity release schemes to pay for home care as well as care homes. Better advice and information are key to helping people accept this and universal support will encourage families to make better use of own resources.
But we also need to face up to the fact that care is woefully underfunded and that funding gap will only grow with the demographic pressures. Proper funding in the future will require a bigger share of the tax cake which is also why the debate must reach out way beyond social care. How about a hypothecated care duty on lifetime transfers alongside inheritance tax? It has been estimated by the Nursing Home Fees Agency that a 2.5 per cent ‘care duty’ – 2.5 per cent of lifetime transfers and estates between £10,000 and the old inheritance tax threshold – would raise around £1.5bn. The framework for collection is already in place and such a care duty would provide instant funding, keeping up with demographic change and increases in the older population. It offers a fair and just way of delivering the funding needed to provide long-term care for older people, both now and in the future.
Finally, it is great that people are talking about the future of care but we all need to keep the pressure up. Over the next two years Counsel and Care is campaigning with Help the Aged and Carers UK so every older person gets the right care and the right deal.