Dilnot: Adult Social Care Funding
Dilnot: extra £1.7bn needed to overhaul care funding
Community Care, 4 July 2011
Ministers have been urged to find £1.7bn to implement plans unveiled on 4 July 2011 to overhaul the care funding system.
The commission on funding care and support, chaired by Andrew Dilnot, said: "Care costs should be capped and means testing reduced to improve the system's fairness and sustainability.”
Key proposals include:
- Capping lifetime care costs at £35,000. This would cover care at home and in residential care, but not bed and board.
- Raising the means test threshold, below which people become eligible for state funded residential care, from £23,250 to £100,000.
- Introducing a national system of assessment and eligibility initially set at the substantial threshold.
- Retaining disability benefits paid to people with care needs but rebranding attendance allowance.
The commission believes the reforms would mean that no one would spend more than 30% of their assets on care compared with 90% now.
"The current system is confusing, unfair and unsustainable,” said Dilnot. "Under our proposed systems everybody who gets free support from the state now would continue to do so and everybody else would be better off.”
Speaking yesterday to the BBC the health secretary Andrew Lansley said the government welcomed the proposals and that they would form the basis for consultation. However, he said issues including the size of the cap on costs and the threshold for means testing would be up for debate.
Peter Hay, president of the Association of Directors of Adult Social Services (ADASS), said the social care sector now needed to maintain unity in the drive for reform. "Social care is a system worth the repair - it has the ability to change lives,” he said.
He added: "I don't just want assurance that what waits for my old age is a guarantee of basic standards. I want to know that I will be supported and enabled to add quality to the gift of long life expectancy.”
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Dilnot: adult social care funding reform
Community Care
The Commission on Funding of Care and Support, headed by Andrew Dilnot, set out its blueprint for reforming social care funding on Monday 4 July. Its proposals, which would add £1.7bn to the costs of care in England, include:-
- Capping lifetime individual contributions to care at £35,000. This would cover care at home and in residential care, but not board and lodging costs within care homes.
- Providing free care for those who develop needs before they reach 40.
- Raising the means-test threshold for savings below which people become eligible for state-funded residential care from £23,250 to £100,000.
- Standardising contributions to board and lodging costs in residential care at between £7,000 and £10,000 a year.
- Introducing a national system of assessment and eligibility, initially set at substantial need.
- Retaining disability benefits paid to people with care needs, but rebranding attendance allowance
The commission believes the reforms would mean that no one would spend more than 30% of their assets on care, compared with 90% now.
Health secretary Andrew Lansley said the government welcomed the proposals but has warned they may prove too costly to implement in full. A full government response will not be made until a White Paper next spring
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Dilnot care funding reforms 'to face hostile public reaction'
Community Care, 28 June 2011
The Dilnot commission's proposed reforms of care funding will face a hostile reaction because many people still believe social care should be entirely state-funded.
That was the warning today from housing and care provider Anchor, who found that 44% of Britons believed the state should fund all their care costs in a survey of over 2,000 people.
This option has been ruled out by the Dilnot commission, which delivers its recommendations on reforming care funding in England next Monday. Instead, the commission will call for social care costs to be split between the state and the individual, probably by calling for individuals' contributions to be capped at £50,000.
However, just 11% of respondents to the Anchor survey thought care costs should be split between the state and the individual.
"We know that care funding is facing a black hole, but our research suggests that the Dilnot commission's findings will be met with a hostile reaction from members of the public," said Anchor chief executive Jane Ashcroft.
"The government needs to acknowledge that the findings will not be the end of the road, but just the first step on the journey toward a sustainable new model for older people's care."
Anchor also found that just 6% of those aged over 45 had started saving for their social care needs in older age.
The not-for-profit provider is calling for the government to appoint a minister for older people to ensure their views are better represented in public debate
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Dilnot reforms could prove too costly, warns Lansley
Community Care, 5 July 2011
The Dilnot commission's £1.7bn proposals to reform social care funding could prove too costly to implement in full, health secretary Andrew Lansley warned today.
In a statement to the House of Commons, he welcomed today's report, which called on ministers to cap lifetime social care costs for individuals at £35,000, and said that the government would "take forward consideration of the commission's recommendations as a priority".
However, he warned that the cost of the reforms, which would be £1.7bn a year if introduced now, would need to be weighed against other priorities and that "trade-offs”, would have to be made.
"In the current public spending environment, we have to consider carefully the additional costs to the taxpayer of the commission's proposals against other funding priorities," said Lansley.
He pointed out that the commission had produced a range of options for consideration and said the government could choose from among the less costly proposals put forward "to manage the system and its costs".
This would involve going for a cap of £50,000 as opposed to £35,000 on individual care costs, which would reduce the bill for the reforms to £1.3bn.
Lansley also said that the government's response to Dilnot would not be produced until next spring, in a White Paper, with legislation following "at the earliest opportunity". The previous timetable was for the White Paper to be issued this year and legislation produced in 2012.
Campaigners have warned that it would be "indefensible" for reform to be delayed beyond next Easter.
The White Paper will be preceded by a period of "engagement" with stakeholders and the Labour Party, based around the Dilnot proposals, and Lansley said any reform would need to meet six tests:-
- Promoting closer integration of health and social care.
- Promoting increased personalisation, choice and quality.
- Supporting greater prevention and early intervention.
- Promoting a viable insurance market for care and a more diverse and responsive care market.
- Achieving a consensus that additional resources for care should be targeted at capping costs for individuals.
- Ensuring a fair and appropriate method of financing the costs.
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Social care report threatens to leave people vulnerable
The Guardian, 5 July 2011
There's big money to be made for private equity and venture capital companies and insurers under Dilnot's plans, says Ray Jones; but where will it leave vulnerable people?
The Dilnot report suggests that most elderly people would need to meet around the first £35,000 of their care costs.
The Dilnot report on the future funding of social care unveiled this week is the third attempt in recent years to create a fair and affordable future for older and disabled people who may need personal care and practical assistance. The Dilnot proposals are for a shared financial responsibility between the individual and the state. It is suggested that most people, following a financial assessment, would have to meet around the first £35,000 of their care costs, with public funds then picking up any continuing bills. For older and disabled people in residential care and nursing homes, this means that they would pay for about the first one and a half years of their care.
The Dilnot report recommends that there be a system of voluntary insurance to cover care costs for which people would be personally responsible. Putting aside all the exclusions that exist within private health insurance, the history here is not reassuring. Just think back to the mis-selling by the finance industry of private personal pensions, endowment mortgages and mortgage insurance policies. All of them promised security for the future, but left people stranded at the point of vulnerability and need. Of course, those who set up these schemes did very well, with big payments to their boards, senior executives and shareholders. It was those who paid into the companies, often for 20 years and more, who found that their returns were pitiable, and in some instances valueless.
Private equity and venture capital companies are hovering to make a killing off the Dilnot proposals. How do I know? While I was commenting for the media about Southern Cross and how its flawed business model has left older people in its care homes and their families anxious and insecure, I was contacted by a journalist writing for a European private equity magazine. He wanted a briefing about the potential opportunities from the Dilnot report for the international private equity and venture capital market.
We should not be surprised when in 10 and 20 years' time the encouragement to pay into these schemes, no doubt poorly regulated on the basis that the market regulates itself, has generated windfalls for rich investors, but anxiety and angst for those of us who need the care for which we thought we had been paying in advance.
It does not, of course, have to be like this. We could have care when needed funded by general taxation. This would really share the risks and costs, and it would share it fairly. At all the consultation meetings I attended when the previous Wanless report proposals were being considered, this was what many people wanted. It is not, despite the political and rightwing press rhetoric, unaffordable. After all, the government found money very quickly to bail out the banks and bankers in one year at about 40 times the year-on-year care costs that will build up over the next 20 years. There could also be a system of earmarked national insurance to meet the costs of future care needs.
Instead, the money movers who got us into the current sorry financial mess seem to be about to be given the opportunity to do it all over again.
• Ray Jones is professor of social work at Kingston University and St George's, University of London, and was formerly director of social services in Wiltshire.
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MPs to hold post-Dilnot review of adult social care
Community Care, 6 July 2011
MPs are to hold an inquiry into adult social care in the wake of this week's Dilnot commission report, it was announced on 6 July 2011.
The health select committee probe, which will take place this autumn, will look at the development of a long-term approach to the funding and provision of care and support, including examining alternative models of commissioning and provision of health and social care.
This goes beyond the remit of the Dilnot commission, which focused on adult social care funding.
One option that the committee could consider is the full integration of health and social care, something that committee chair Stephen Dorrell is in favour of.
Dorrell said: "There are few more important issues in health and social care policy than how we pay for adult social care. The work of the Dilnot commission has provided a valuable start. The government has announced that it will publish a White Paper in the spring of next year. This inquiry is intended to contribute to the development of a broad based policy in this area.”
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Supreme Court Rules Against Former Ballerina
http://www.independentliving.co.uk/, 06/07/2011
In a ruling that will be studied with great interest by cash-strapped local authorities around the country, former ballerina and stroke survivor Elaine McDonald has lost her appeal against Kensington and Chelsea for withdrawing provision for an overnight carer to help her use a commode.
The council replaced overnight care with incontinence pads, arguing that in this way they were still meeting her needs - a position which the Supreme Court ruling endorses.
This precedent will make it easier for other councils to withdraw care provision from people with disabilities.
John Wadham, group director at the Equality and Human Rights Commission, described the ruling as a "significant setback for people who receive care in their home".
He said "Ms McDonald is not incontinent. However, this judgment means she will be treated as such. Local authorities will now have greater discretion in deciding how to meet a person's home care needs and will find it easier to justify withdrawing care. This means that older people's human rights to privacy, autonomy and dignity will often be put at serious risk. The court has missed a significant opportunity to interpret the law to protect some of the most vulnerable people in society."
Elaine McDonald had argued that as she was not incontinent, being obliged to use incontinence pads rather than being helped to use a commode was an "affront to her dignity".
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Carer battle over as ex-ballerina loses supreme court fight
The Guardian, 6 July 2011
Elaine McDonald loses overnight carer ruling as critics fear councils 'warehousing' people at home to cut costs
Elderly care assessment Unit at Birmingham Heartlands hospital. Stroke victim Elaine McDonald has lost her Supreme Court battle with Kensington and Chelsea for an overnight carer, prompting claims that councils will 'warehouse' people at home to cut costs Photograph: Christopher Thomond for the Guardian
A former prima ballerina left disabled after a stroke has lost her supreme court battle for an overnight carer to give her "dignity and independence".
Justices at the highest court in the land dismissed an appeal by 67-year-old Elaine McDonald in a majority ruling.
Last October, McDonald, who was once a star of Scottish Ballet and received the OBE in 1983, lost her case at the appeal court in London and suffered a further defeat on Wednesday.
She was left with reduced mobility after a stroke in September 1999 and needs to use a wheelchair outdoors.
She had argued that the care package she received from the Royal Borough of Kensington and Chelsea, to cover her assessed needs during the day and night, should include assistance at night to use a commode.
John Wadham, group director (legal) at the Equality and Human Rights Commission, said: "We are disappointed with today's ruling which is a significant setback for people who receive care in their home.
"Ms McDonald is not incontinent. However, this judgment means she will be treated as such.
"Local authorities will now have greater discretion in deciding how to meet a person's home care needs and will find it easier to justify withdrawing care.
"This means that older people's human rights to privacy, autonomy and dignity will often be put at serious risk.
"The court has missed a significant opportunity to interpret the law to protect some of the most vulnerable people in society.
"The commission's inquiry into care in the home has already highlighted some of the problems with the current system of home care. This judgment will only fuel those problems."
McDonald said she is not incontinent and has a horror of using incontinence pads, which she considered an "affront to her dignity".
Her plea was for help to use a commode at night.
She had challenged the borough's decision to reduce the amount allocated to her weekly care.
Age UK believes McDonald's human rights have been breached and that there could be "extremely adverse and devastating consequences for many thousands of older people if other councils take similar decisions to save money".
After the supreme court ruling, Michelle Mitchell, charity director at Age UK said: "Today's decision is shameful. Older people have a fundamental right to dignity and forcing someone to sleep in their own urine and faeces could not be more undignified.
"This judgment opens the door to warehousing older people in their own homes without regard to their quality of life.
"Care should not be just about keeping people safe. It must enable them to live dignified and fulfilled lives."
Alex Rook, of Irwin Mitchell solicitors, who represented Age UK, said: "The submissions Age UK made to the supreme court in this case sought to ensure that local authorities follow the correct assessment procedures to establish an older person's needs and to then put in place a lawful package of care.
"While Age UK is acutely aware of the current difficult economic climate, the right balance must be struck between the rights of the individual and the interests of the community, and Age UK continues to find it difficult to understand how it can be rational or reasonable to expect an older continent person to use incontinence pads rather than to assist them to access a toilet."
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Judge 'troubled' by care ruling
The Independent, 6 July 2011
A leading judge said on 6 July 2011 she was "troubled" by the implications of a Supreme Court decision which campaigners say could lead to the elderly being "warehoused" at home "without regard to their quality of life".
Supreme Court justice Lady Hale - a member of the five-strong judges' panel which made the ruling - told of her fears that older people "might be left lying in faeces" because local authorities would be entitled to withdraw help.
Campaigning charity Age UK described the ruling as "shameful" and suggested that it could lead to the infirm being forced to "sleep in their own urine".
Lady Hale and four other Supreme Court justices had been asked to rule on a case in which a 68-year-old stroke victim argued that a council should provide a night-time carer to help her use a commode at her London flat rather than merely supply her with incontinence pads.
Four justices ruled in favour of the Royal London Borough of Kensington and Chelsea, and former ballerina Elaine McDonald's appeal was dismissed by a 4 - 1 majority.
Lady Hale disagreed with her colleagues and said she would have allowed the appeal. In her written analysis she raised concerns about the implications of the ruling.
The Supreme Court, which sits in London and is the UK's highest court, was ruling on the latest round of Ms McDonald's legal fight. The High Court and Court of Appeal had earlier ruled in the council's favour.
Judges heard that Ms McDonald, who was once a star of Scottish Ballet and received the OBE in 1983, was left with reduced mobility after a stroke in September 1999.
She had argued that the care package she received from the Royal Borough of Kensington and Chelsea should include assistance at night to use a commode.
The council said Ms McDonald should use incontinence pads or absorbent sheets - even though she is not incontinent - at night.
Bosses said incontinence pads would reduce the risk of Ms McDonald being hurt using a commode, provide independence and privacy and cut the cost of her care by £22,000 a year.
Ms McDonald said she was "appalled" at the thought of being "treated as incontinent" and considered the use of incontinence pads an "intolerable affront to her dignity".
Lady Hale said the case centred on a "really serious question" which could affect anyone - was it lawful for a local authority to provide incontinence pads for a person who was not incontinent but required help using a toilet?
"I am troubled by the implications of the (majority) view," said Lady Hale. "A person in her situation needs this help during the day as well as during the night and irrespective of whether she needs to urinate or to defecate.
"Logically, the decision of the majority in this case would entitle a local authority to withdraw this help even though the client needed to defecate during the night and thus might be left lying in her faeces until the carers came in the morning.
"This is not Ms McDonald's problem at the moment, but her evidence leaves one in no doubt that this is one of her fears.
"Indeed, the majority view would also entitle an authority to withdraw this help during the day. The only constraint would be how frequently (or rather how infrequently) it was deemed necessary to change the pads or sheets, consistently with the avoidance of infection and other hazards such as nappy rash.
"The consequences do not bear thinking about."
Lady Hale said it was "irrational" to characterise Ms McDonald as having a "different need from the one which she in fact has" and said it would not be "regarded as acceptable" to treat a hospital patient or care home resident in such a way.
She added: "In the United Kingdom we do not oblige people who can control their bodily functions to behave as if they cannot do so, unless they themselves find this the more convenient course.
"We are, I still believe, a civilised society. I would have allowed this appeal."
Michelle Mitchell, charity director at Age UK, said: "Today's decision is shameful.
"Older people have a fundamental right to dignity and forcing someone to sleep in their own urine and faeces could not be more undignified.
"This judgment opens the door to warehousing older people in their own homes without regard to their quality of life.
"Care should not be just about keeping people safe. It must enable them to live dignified and fulfilled lives."
Four justices - Lord Walker, Lord Brown, Lord Kerr and Lord Dyson - ruled in the council's favour.
"Ms McDonald has chosen not to take up the offer of assistive technology to help monitor her safety, has declined the offer of moving to one of the borough's extra care sheltered housing schemes and she has to date refused to consider incontinence pads as a means to manage risk when she cannot safely get to the commode unaided," said Lord Brown.
"I remain of the opinion that Ms McDonald's need to be kept safe from falling and injuring herself can be met by the provision of (pads or absorbent sheets)."
He added: "I am aware that she considers pads and/or sheets to be an affront to her dignity. Other service users in my experience have held similar views when such measures were initially suggested but once they have tried them, and been provided with support in using them, they have realised that the pads/sheets improve quality of life."
Lord Brown said Lady Hale was an acknowledged expert in social care law but he found her analysis "surprising".
"It seems to me, with great respect to Lady Hale's acknowledged expertise in social care law, particularly surprising to find her saying that logically, on the majority's view, the local authority could properly withdraw care 'even though the client needed to defecate during the night and thus might be left lying in her faeces until the carers came in the morning' or, indeed, 'withdraw this help during the day'," he added.
"The true position is that the decision is one for the local authority on the particular facts of the case and, on the particular (and undisputed) facts here, it is nothing short of remarkable to characterise the (council's) decision as irrational."
Lord Walker said: "Lady Hale states that the idea that anyone should be obliged to go into a care home in order to be treated with ordinary dignity is extraordinary."
He added: "I can see no evidence that the (council) is not well aware of Ms McDonald's right to have her dignity respected.
"She is a courageous and determined lady and (the council's) Adult Social Care Department have tried hard to find a solution to her problems."
He went on: "In 2008 they offered to put her in touch with the Home Share Scheme, under which someone such as a female student might have given Ms McDonald help at night in return for rent-free accommodation, but she declined because she did not want a stranger living in her house.
"In 2010 they offered her a move to one of (the council's) Extra Care Sheltered Housing schemes, but Miss McDonald did not want to consider this."
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Petition of No Confidence For Care Quality Commission
Same Difference, 29 June 2011
Workers in the residential care home sector have signed a petition of no confidence in the industry regulator – the Care Quality Commission (CQC).
Delegates at the National Care Homes Congress said they had no confidence the CQC could effectively "regulate” health and social care.
The issue was discussed after BBC Panorama alleged vulnerable adults at a unit near Bristol were being abused.
The CQC said no regulator "could stop all unacceptable behaviour”.
The Panorama programme showed secret filming of patients at Winterbourne View, a residential hospital, being pinned down, slapped and taunted.
The unit has since closed and the firm which runs it, Castlebeck, has apologised.
Staff representing the care home industry at the congress in Birmingham on 22 June included care home owners and managers, nurses and senior care assistants.
‘Tick box exercise'
Delegates said that "robust and effective regulation” of the industry was essential but they had "concluded that they have no confidence that the CQC is capable of delivering an effective system of regulation for health and social care”.
Congress delegate Andrew Larpent, who runs Somerset Care, which provides 31 residential homes in the West Country, said he had no confidence in the CQC.
He said: "The CQC have set themselves up as a compliance service and not as a quality service.
"Under the previous inspectorate, we had a real sense that we were all working together to try to continually to improve services.
"Now, we seem to just be doing a tick box exercise and it's not serving the public well.”
Dr Richard Hawkins, editor of the Caring Times magazine, which helped to organise the congress, said the petition was "significant”.
‘Stop abuse'
He said: "It's the first time anything like this has happened. I hope it's going to send a very powerful message to the commission and to the government.”
A spokesman for the CQC said: "No regulator can guarantee to stop all unacceptable behaviour – it is the job of the providers and staff to make sure it doesn't happen in the first place.
"No system of regulation, however thorough, can stop abuse. But you can build systems to identify risks of harm, based on information from a range of sources, and react to these risks to try to reduce the likelihood of poor care.
"This is what CQC is trying to do. When our systems work, people are protected. The most powerful tool to stop abuse is to ensure that people working in care – whether directors, managers, health professionals or care staff – do not tolerate it.”