The Government has published the long-awaited White Paper, Caring for our future: reforming care and support, on the reform of adult social care. It is a companied by a draft Care and Support Bill and a suite of other documents including a progress report on its response to the Dilnot Commission, summary of the Caring for our future engagement exercise, and response to the Health Select Committee's reports on these matters. The LGA has produced a briefing summarising the White Paper and highlighting our key messages.
The Care and Support Bill provides enabling legislation for these reforms. This is published for pre-legislative scrutiny. It will be introduced into Parliament in late 2013 with a view to completing its passage by Autumn 2014. Most changes requiring legislation will be implemented from April 2015 at the earliest.
The coalition's Programme for Government highlighted in May 2010 the "urgency of reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face". Andrew Dilnot's Commission on the Funding of Long-Term Care reported in July 2011, and the Law Commission completed its review of social care legislation in May 2011. In response, the Government launched an engagement exercise, 'Caring for our future', from September to December 2011 with a number of strands including integration with health, information and insurance. During 2011/12, the Health Select Committee published reports on funding social care and integration. A white paper and an update on funding reform were originally promised in April.
Andrew Dilnot called for a cap, suggested at £35,000, for an individual's lifetime contribution towards their social care costs, after which they would be eligible for full state support. He recommended an increase in the means tested threshold, above which people should pay full care costs, from £23,250 to £100,000. He proposed that national eligibility criteria and portable assessments should be introduced to ensure greater consistency and that younger adults should be eligible for free state support immediately, rather than be means tested. Implementation costs were estimated to be around £1.7 billion.
The Law Commission recommended a single, clear, modern statute and code of practice that would pave the way for a coherent social care system. Under their proposals, users and carers would have clear legal rights to care and support services and councils would have clear and concise rules to govern when they must provide services.
The commission recommended:
The LGA set out its expectations for social care reform in its recent publication, 'Ripe for reform: the sector agrees, now the public expects'. This was based on three key tests:
Test one – Does the white paper set out proposals for a reformed system that is likely to achieve our aims of:
Test two – Does the white paper set out a timetable for reform that recognises the urgency of the challenge and commits to immediate action where possible?
Test three – Does the white paper articulate a clear role for local government in a reformed system and recognise the importance of a local approach to care and support?
Today's announcements meet many of the expectations the LGA set out in 'Ripe for reform' but fall a long way short of the second test of confidence in seeing this through to conclusion.
In adopting all of the key recommendations of the Law Commission and framing draft legislation, the Government has taken significant steps towards bringing to life a new, modern social care system. We set out a vision based on community and individual assets, support for carers, and support to users and carers to make good decisions about their future care needs. This should be based on clear, national and portable entitlement to services, coupled with individuals having the flexibility to design support to meet their needs in their local context.
We wanted an emphasis on prevention, a more integrated approach to how housing and health contribute to good care, and on developing local markets and ensuring continuity of care provision. We also stressed the need to recruit, train and support an expanding workforce. The LGA has supported putting Adult Safeguarding Boards and requirements to cooperate on a statutory basis.
Our second test was about confidence; confidence that the white paper would pave the way for real action and confidence that the Government will indeed see this agenda through. We have a draft bill but it is unlikely to complete its passage before 2014. All the key funding decisions on implementing Dilnot reforms and addressing the true costs of a reformed care system are postponed until the next Comprehensive Spending Review. There are worrying signals that these issues may have to take their place in consideration of measures to stimulate growth and other public spending pressures.
The Dilnot proposals under consideration are mainly focused on older people. He recommended care and support for adults should be free. These groups are, therefore, disproportionately affected by councils' rationing services in response to funding shortfalls. Unless this wider issue is addressed the system cannot be considered fair or stable.
Our third test was that the reforms articulated a clear role for local government, that appropriate links were made with health and wellbeing boards, and clearly defined relationships for councils with key partners. There are clear new duties proposed that are intended to promote cooperation. The LGA will be keen to ensure that social care and health reform are not taken forward on separate tracks and that no opportunity is lost to develop integrated care and support and health responses to the needs of people and communities.
The Government has made much of the benefits of extending deferred payments. However, the ADASS budget survey 2012 showed that councils have already made deferred payments to around 8,500 people to a total value of £197million (an average of £23,000). Councils are not banks and the implication of this level of debt in an already overstretched system needs urgent attention.
The headline features of the white paper are as follows:
- National minimum eligibility threshold.
- The entitlement will be portable if users and carers move to another council area, with councils required to maintain services until a reassessment is completed.
- Extend the right to an assessment to more carers (currently only those with substantial caring responsibilities) and give carers a clear entitlement to support for their own wellbeing.
- People will have a legal entitlement to a personal budget.
- Provide clarity on ordinary residence.
A Care and Support Transformation Board and Care and Support Implementation Board will oversee the reforms. The LGA expects to be represented at both levels and to play its part in the working groups proposed to work through the details of implementation.
The separate progress report on funding accepts the following principles of the Dilnot Commission:
The Government will not commit to a new funding model at this stage. That will be considered as part of the next Comprehensive Spending review. As part of this the Government wants to explore further options they believe are consistent with the Dilnot report but at a lower cost namely:
A working group will be set up with the financial and insurance sector to consider the requirements of a new system, tax implications and how to help people plan.
£100 million in 2013/14 and £200 million in 2014/15 to be transferred from NHS to councils under Section 256 with similar conditions to previous transfer. Ten per cent likely to be for reform implementation costs £200 million capital spread over five years for specialist housing schemes Start-up funding of £32.5 million from 2014/15 to develop local online information services Investment by NHS in end of life care pilots to be doubled from £1.8 million to £3.6 million
The Care and Support Bill is now open to consultation and pre-legislative scrutiny. The bill will be formally introduced in the third session of Parliament in 2013. There will be the opportunity for councils to comment in detail on clauses on line, which is a first for Government.
Membership of the proposed boards will be confirmed shortly. A number of working groups will study the detailed implications of the white paper and the bill between now and 2015 when much of this is expected to take effect.
The white paper refers to the LGA's Efficiency programme that is supporting 44 councils with a range of themes.
The LGA will provide further briefings at key stages of the legislative process and will continue to lobby Government on funding through our 'Show us you care' campaign.
For further information please contact Kirsty Ivanoski-Nichol, Public Affairs and Campaigns Manager on Telephone: 0207 664 3125 or Email: email@example.com
16 April 2013