Social care costs 'need capping'

4 July 2011 Last updated at 14:58 GMT By Nick Triggle Health correspondent, BBC News Andrew Dilnot: "The government will be picking up a hefty bill"

Social care costs in England should be capped so people do not face losing large chunks of their assets, an independent review says.

Council-funded home help and care home places for the elderly and adults with disabilities are currently offered only to those with under ?23,250 of assets.

The Dilnot report said the threshold should rise to ?100,000 and a ?35,000 lifetime cap on costs would be "fair".

But the Treasury is known to have doubts about the expense of the plans.

Just over ?14bn a year is spent by councils on social care.

However, the changes would cost an extra ?1.7bn a year if they were implemented now - and this figure could rise by 50% as the "baby boom" generation begins to retire.

Insurance

Last year the coalition government asked economist Andrew Dilnot to look into how the system of funding social care in England could be changed amid concerns it was getting harder for people to get access to state support.

The ageing population and squeeze on council budgets have led councils to impose stricter criteria on who can get help.

Continue reading the main story Ben Geoghegan BBC Political correspondent

"Now Gordon Wants ?20,000 when you die".

That was the Conservative campaign slogan in 2010, the last time there was a serious attempt to sort out social care.

Then as now, the main political parties were talking about cross-party consensus.

Then as now, they insisted reform was needed so that old people didn't have to sell their homes to pay for their care.

However, their attempt to reach agreement failed and led to what Ed Miliband today described as "political bickering".

Might things end the same way this time round?

In Whitehall, officials are warning about the difficulties that lie ahead.

They insist this issue will "absolutely not be long-grassed", but politicians don't need reminding that - as one source put it - this will not be nice and easy.

It means while 1.8m are getting state funding, another 1m-plus either have to pay for support themselves or go without.

Mr Dilnot's commission has ruled out calling for care to be free.

Instead, it has recommended a partnership between the state and individual whereby the high costs are covered by the government - one in 10 people aged over 65 faces care costs of more than ?100,000 over their lifetime.

But the individual should be liable for the first tranche of care with a cap in costs set at between ?25,000 and ?50,000, the report said.

It went on to suggest ?35,000 as the ideal figure - a third of over 65s face sums above this amount.

Below the age of 65, the cap should be phased in. For young adults below the age of 40 to 45 it should be free - although in reality this makes little difference as hardly any pay now because those with care needs at that age have often not had time to accrue savings or buy property.

After that age, the cap should be gradually phased in by ?10,000 each decade.

The hope is that with the state paying for the high-cost cases, the insurance industry would be encouraged to develop polices which would cover any care costs below the cap.

The cap will not include so-called "hotel costs" for food and accommodation. However, the report said there should be a standard charge which could be around ?7,000 to ?10,000 per year.

Means-testing should remain so that the poorest would not have to pay, the commission recommended, but the threshold increased to ?100,000 for residential care to better reflect the rise in property prices seen over the last two decades.

The commission believes the cap and rise in the threshold will mean no-one will lose more than 30% of their assets paying for care.

Continue reading the main story Many councils in England have stopped providing support to those with low and moderate needsThe Dilnot Commission was set up in July 2010 to establish how to achieve an affordable care system for adults in EnglandWales and Northern Ireland both have means-tested systems which are similar to EnglandScotland provides free personal care, but in recent years has tightened the eligibility criteria for the same reasons as in EnglandMr Dilnot said the money would have to be found by making cuts elsewhere or raising taxes and he said any tax rise "should be paid, at least in part, by those of retirement age".

Launching the report, he added: "The issue of funding for adult social care has been ignored for too long.

"The current system is confusing, unfair and unsustainable. Individuals are living in fear, worrying about meeting their care costs.

"Putting a limit on the maximum lifetime costs people may face will allow them to plan ahead for how they wish to meet these costs."

The report also called for an end to the ever-tightening restrictions being placed on access, arguing there should be a national standard so everyone had the same access no matter where they lived.

The commission has already had talks with the Treasury about the proposals. It is understood that government officials voiced concerns whether extra money could be found in the current financial climate.

Social care is currently means-tested

Health Secretary Andrew Lansley acknowledged finding the money remained a challenge, saying such change would require "significant cost" and need to be balanced against other funding priorities.

However, he said despite this social care was still a "priority for reform" and the commission's report would be "carefully considered" before the government put forward its proposals next spring.

Labour leader Ed Miliband said he would be willing to have cross-party talks to try to reach a consensus on the issue.

The recommendations already have widespread support among charities and campaigners with many arguing it provided the blueprint for reform.

Michelle Mitchell, of Age UK, said action was long overdue: "Social care is at crisis point. Vulnerable people are going without care and that means their conditions are worsening and they are ending up in hospital and costing the government more. We cannot go on as we are doing."

Any overhaul of the system would take about four years to introduce.

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Thousands 'lack social care help'

30 May 2011 Last updated at 01:32 GMT By Nick Triggle Health correspondent, BBC News Ministers are looking to revamp the social care system in England Hundreds of thousands of older people in England who need social care are not getting any support from the state or private sector, campaigners say.

Age UK says 800,000 people are excluded from the system - and the figure is set to top one million within four years.

It said budgets had hardly risen in recent years even before the squeeze, despite the ageing population.

The charity renewed its call for an overhaul of the system, something ministers are looking at.

Funding rise

Social care in England is means-tested, which means those with savings of over ?23,250 are excluded.

But councils have also been making it more difficult for those who do meet the income threshold to get care, by tightening the eligibility criteria.

Six years ago, half of councils provided support to people with moderate needs, but that figure has now dropped to 18%.

Michelle Mitchell, Age UK: "People are suffering in silence"

It means only 1.2 million are getting formal care either at home or in a care home - although some of these are being forced to pay for the services themselves anyway, as they exceed the income cap.

The report - based on previously published data by government bodies and independent researchers - pointed out while the NHS had received significant budget rises in recent years, social care increases had stalled.

Once inflation is taken into account, funding has only been rising by 0.1% a year since 2004 - equivalent to ?43m. By comparison, the NHS budget rose by ?25bn.

Mounting problems

Michelle Mitchell, charity director of Age UK, said: "The figures we have uncovered beggar belief. Care and support in England has reached breaking point, putting older people at risk and their families under intolerable strain."

The charity has been calling for means-testing to be scrapped so that a universal system could be created, guaranteeing everyone a certain level of support if needed.

The government has set up a review of the system and is expected to publish plans for reform later this year.

Other parts of the UK are also looking at how they provide social care amid mounting problems.

A Department of Health spokesman said: "The government recognises the urgent need to reform the social care system - an ageing population and rising expectations make the current system completely unsustainable."

He added the plans to be put forward later this year would "put in place a lasting and fair settlement for social care".

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Social care law revamp proposed

11 May 2011 Last updated at 08:12 GMT By Nick Triggle Health reporter, BBC News Ministers are looking to revamp the social care system in England A major revamp of adult social care law in England and Wales is needed to ensure fairer access to services, the Law Commission says.

The government advisory body said the current framework, covered by more than 40 laws, was "outdated and flawed".

Instead, it said there should be a single piece of legislation so people were clear about their rights.

The report is the first of two reviews ministers will use to reform social care in England in the coming years.

An independent commission has also been set up to look at how social care - which is currently means tested - should be funded.

It is due to report in July and will be followed by a white paper at the end of this year and legislation in 2012.

Wales is looking at its social care provision separately.

There is almost universal agreement that social care needs reforming, as councils struggle to meet rising demand because of the ageing population amid cuts in funding.

'Dog's breakfast'

Frances Patterson QC, the law commissioner leading the review, said she wanted existing laws and regulations "swept away" and replaced by a single adult social care statute.

She told BBC Radio 4's Today programme: "Our role is to produce a clear, consistent and comprehensive legal framework to reform the way adult social care is delivered across the country."

Continue reading the main story

This report provides foundation for the most significant single reform of social care law in 60 years”

End Quote Paul Burstow Care services minister She said the Law Commission also wanted to introduce a code of practice which local authorities would be required to follow "unless there was good reason not to".

It would be down to individuals to enforce their rights through the courts if they felt their care was insufficient, she added.

The Law Commission report has been widely welcomed by charities, who say it provides a good blueprint for reform of the system.

Michelle Mitchell, of the charity Age UK, described the recommendations as a "one-off opportunity to replace this dog's breakfast with a clear, logical and consistent framework".

Social care law has developed "piecemeal" since the National Assistance Act in 1948, the Law Commission said. There are now over 40 separate laws and thousands of pages of guidance.

This has resulted in a system that is confusing for users, and at times contradictory, the report said.

For example, people with conditions that vary over time such as bi-polar disorder or dementia can, in theory, be excluded from care.

And while there is no law placing a duty on councils to support elderly people, they do have legal obligations to look after those with disabilities and mental health problems.

The recommendations call for a duty for councils to assess the needs of carers, and say the NHS and local government should work together more closely.

Care services minister Paul Burstow said the recommendations would be carefully looked at.

He added: "This report provides foundation for the most significant single reform of social care law in 60 years."

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Social care cuts plan is unlawful

19 May 2011 Last updated at 16:27 GMT Karen Ashton of Public Law Solicitors: "Disabled people have a voice"

Birmingham City Council acted unlawfully over a decision to reduce its provision of care for disabled people, High Court judges have said.

The judgement has implications for local authorities in England and Wales.

Thursday's ruling said local councils must abide by existing disability laws to eliminate discrimination.

It said councils must take account of people's disabilities, even where that involves treating disabled persons more favourably than others.

'Climate of cuts'

Across the UK there are 122 councils, as well as Birmingham, that currently only provide care to people with either substantial or critical care needs.

The judges said all public bodies had a duty to follow the disability discrimination law, while acknowledging that placed "significant and onerous" obligations on local authorities.

Continue reading the main story Nick Triggle Health correspondent, BBC News

The social care system is creaking at the seams. A combination of the ageing population and squeeze on spending means Birmingham is not alone in needing to make cuts.

One of the easiest ways for councils to do this is to raise the eligibility threshold at which people are entitled to help. There are four levels of need - low, moderate, substantial and critical.

Most councils are already at substantial - 116 out of 150 to be precise - leaving them with only one option - restricting support to only those with the severest need.

This, of course, excludes many people who have for years been relying on social services and raises the question whether their rights have been infringed.

Many believe this judgement tips the balance back towards the individual by suggesting that councils can no longer take it for granted that they can keep on cutting back on social care - a statutory service after all - just because money is tight.

The families of four severely disabled people fought Birmingham council's spending cuts decision and took legal action against the authority.

Solicitor Karen Ashton represented the families and welcomed the High Court ruling in London saying it gave disabled people a voice in law.

'No new money'

She said the council's proposed policy would have had "devastating" results.

"With consequences of this kind, then councils must look if savings can be made elsewhere," she added.

Birmingham City Council said it welcomed the greater clarity of its duties with regard to the Disability Discrimination Act 2005.

Peter Hay, the council's strategic director of adults and communities, said: "The original dilemma between reducing services in different areas remains.

"There is no new money as a result of the judgement and hard choices about meeting growing needs with fewer resources will have to be made by local authorities."

The Conservative-Liberal Democrat run authority had proposed the cuts as part of a plan to save ?212m.

In April a court sitting in Birmingham made an interim judgement that the council had acted unlawfully and this latest ruling is the full finding.

'Strong message'

In a statement Unison said: "The council should rightly be condemned for defending the indefensible. Thousands of vulnerable people in the city would have been put at risk if it were not for the intervention of the courts."

Deafblind charity Sense said the ruling should be a warning to all authorities.

Conservative leader Mike Whitby said the ruling should not affect Birmingham City Council's budget

Its head of legal services Kari Gerstheimer said other councils in England and Wales may be considering making similar cuts to social care.

"We hope that this judgement sends a very strong message to those councils, that we are in a climate of cuts.

"But even in a climate of cuts there are choices to be made and a civilised society does not choose to cut services to people with the greatest need - that's disabled people."

Previously the council said it had identified ?118m worth of cuts by 2014-15 from its adult and communities directorate and needed to save ?308m in total in the next four years due to the central government cuts outlined in the Spending Review.

It said only people whose needs were judged to be "critical" would qualify for council-funded care. Following the Adult social care judicial review on Thursday, the council said it would revise its plans and re-run the public consultation.

A council spokesman added: "It is important to point out that Mr Justice Walker has said that we were considerate and thoughtful of disabled people, in making our new offer, that our consultation was extensive but that it needed to be fully informed by impact assessment."

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