Tuesday, 5 July 2011

Heath & social care - time for a change

“We should be celebrating the fact that we are living longer and that young people with disabilities are leading more independent lives than ever before” said Andrew Dilnot launching the report Fairer Care Funding yesterday. On the eve of the 63rd anniversary of the creation of the NHS, Dilnot went on to point out that the issue of funding for adult social care had been ignored for too long by all parties.

The key recommendations are that:

  • Individuals’ lifetime contributions towards their social care costs – which are currently unlimited – should be capped. The Commission considers a gap of £35K to be appropriate and fair.

  • The means-tested threshold, above which people are liable to their full care costs should be increased from £23,250 to £100K.

  • All those who enter adulthood with care and support needs should be eligible for free State support immediately.

  • Eligibility criteria should be simplified, national and portable.

  • Carers should be supported and also are entitled to transparent assessment aimed to ensure that the impact on the carer is manageable and sustainable.

The Commission calls for a significant improvement in the provision of information and advice, and more joined up working across the whole care and support system – health, housing, benefits and adult social care.

There are stories to illustrate the challenges people face – losing homes or small inheritances, being unable to move to be close to relatives and using all their pension income and disability benefits to pay for care with no room for an occasional treat or fun. None of these specifically mention people on dialysis or those with advanced kidney care needs. They don’t need to, the stories are compelling and universal. The current system is confusing, unfair and unsustainable. People are unable to plan ahead and unable to protect themselves against very high care costs. This affects people with kidney disease the same as it affects the people whose stories appear in the report, with arthritis or stroke or severe chest disease, and it also affects their families and carers.

People are living longer, hence the increasing numbers with advanced kidney disease. In 1901, there were just over 60,000 people aged 85 and over in the UK. Today there are 1.5 million – a five-fold increase. Their and our expectations are rising and different from their grandparents’ view of care which they held when the Welfare State was founded. These demographic changes aren’t going away and the Commission urge action to be taken now. The report’s recommendations link with the Law Commission’s proposals that a new social care statute should place duties on local authorities to provide information, advice and assistance services in their areas; and to stimulate and shape the market for services.

Overall, the State spends around £140 billion on older people in England. Of this, social care represents about 6%; the NHS 35%; and Social Security benefits, 59% (including pensions and disability benefits). The spending requirement of £1.7 billion to implement Fairer Care Funding needs to be seen in this context. The Law Commission recently recommended that NHS continuing healthcare be put on a firmer statutory footing. The Commission on the funding of care and support go further and call for a fundamental rethink to align social care and NHS treatment where currently different funding streams can sometimes be a barrier to high quality care because of, not only in spite of the overlap between health and social care provision.

The Commission supports the integration of social care and the NHS and is also broadly supportive of the direction of travel signalled by the palliative care funding review. Reform of the social care funding system is long overdue. Taken together, the Law Commission’s report on social care, the Fairer Care Funding report by Dilnot and the Palliative Care Funding Review released 1 July provide clear advice consistent with the messages provided during the listing exercise on the Health and Social Care Bill. There is much chatter about long grass, but the issue of integration needs to be grasped sooner rather than later.

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