Free Personal Care?!


Gordon Brown

Image by lukemontague via Flickr

One of the surprises in Gordon Brown’s speech to the Labour Party Conference yesterday (to me, anyway!) was his proposal that from the middle of 2010 (election result nonewithstanding.. ) he would oversee a change to the provision of free care for people over 65 (and only those over 65 ) who live in their own homes (as this would not affect those in residential care) and who need to receive domiciliary care packages.

This would, in effect, mirror the situation currently in place in Scotland where personal care is provided free. However, this care would only be provided to those who meet the ‘highest needs’.

So we return to the dreaded, ‘Fair Access to Care Services’ – criteria brought in to determine a uniformity to determining who is eligible for care from local authorities and at what level of support– although to be fair, these  criteria are under review.

So, what to make of this announcement. I don’t want to be over-cynical but it’s quite hard not to be.

Firstly, I’m surprised. Currently ways of funding care at home is under review with the Green Paper ‘The Case for Change’ which, among many other things, makes it clear that the money does not exist to pay for current ways of funding social care services. So what does that mean for this policy which seems to offer more money? My worry is that the cuts which have taken place and are taking place to those who are on the lower scale of the eligibility criteria. It is those people with moderate and low needs who have not been offered any services and those with substantial needs who think ‘oh, this service is too expensive, I don’t think I’ll bother with the meals on wheels – even though I don’t have any other way to cook’ that I worry about.

For people with critical needs, there is rarely a choice involved based on finance – the service is essential so they take it. For people lower down the scale of need, they are more likely to refuse solely on the basis of financial burden.

There have, as long as charging policies have been in place by councils, been people who appear to desperately need and even want services who will turn them down purely on the basis of the amount that they cost. This, of course, means that these same people are likely to need to access higher levels of care sooner as no preventative work or support was able to be given.

That isn’t to say that ‘getting stuff for free’ is better than not getting stuff for free. Of course it is – but then, you see, I’ve personally never been opposed to the idea that those who can afford to pay for services, should. Those who lie below the savings threshold haven’t ever needed to pay for services.

If we look at the ‘critical’ banding of need which is the one that is likely to be switching to the ‘free’ part – it is generally very high needs that will be accommodated at very high cost.

The Department of Health issues the following guidelines for the highest band of need which is:

Critical – when
– life is, or will be, threatened; and/or
– significant health problems have developed or will develop; and/or
– there is, or will be, little or no choice and control over vital aspects of the
immediate environment; and/or
– serious abuse or neglect has occurred or will occur; and/or
– there is, or will be, an inability to carry out vital personal care or domestic
routines; and/or
– vital involvement in work, education or learning cannot or will not be
sustained; and/or
– vital social support systems and relationships cannot or will not be
sustained; and/or
– vital family and other social roles and responsibilities cannot or will not be
undertaken.

This obviously narrows down the amount of people that would be affected, although councils do interpret the guidelines a little differently in my experience.

I can’t help wondering if it would have been better to use that money to spread across the tiers of need to encourage those with lower needs to have some services which would and could be more preventative. For me, the pushing aside of those with ‘low’ and ‘moderate’ needs has had a massive effect of building up critical  needs for the future and paying slight attention to preventative work.

Whatever my misgivings though, it is bound to be a popular initiative. Just unusual in a time when the local authorities and central government are so pushed for money.

6 thoughts on “Free Personal Care?!

  1. Sounds, in the rhetoric being used, lile the long-care move we’ve had in 2009. The secretary of state was constantly saying: “Long-term care should be given back to those who truly need it.” What she truly meant was dropping a numbe rof grounds for care fromt he list of criteria, and thereby issueing massive budget cuts. Nowadays, only mobility impairments, impairments in memory, concentration or orientation (ie. dementia), impairments in judgment, cognition or perception (ie. severe mental illness or learning disability), severe behavior problems, or the inability to manage one’s own life will be grounds for support services. Community participation difficulties, emotional problems like depression, social isolation, and difficulty carrying out personal care or domestic duties, don’t count anymore (but for the personal care and domestic duties, you can get care through some other bureaucracy). This is again what the legal stuff says. Reality is that the local funding councils will just look at everyone’s provision of services, rip a lot off, and see whether people will appeal. Even people who “truly need it” (ie. people with complex, multiple disabilities), will have their care packages cut. Maybe your prime minister’s comments are meant to be uplifting and make it seem like care will be strengthened, but it wouldn’t surprise me if for the majority of people, care would be cut in fact.

  2. Of course, if it was as clear as stated, it would be a good thing – free is good. I’m just very worried it’ll mean cuts in other areas and a narrowing of eligibility criteria.
    That’s generally what we have seen with the introduction of these criteria in the first place. A lot of ‘low-level’ needs have been dropped from provisioning and that’s my difficulty with this pronouncement.
    I am sure Brown’s comments are meant to garner votes but like you, I am worried about the implications.

    • Indeed, and those with most critical needs (should) often qualify for NHS funded services anyway, particularly given internal reviews stemming from criticism regarding accessing CHC.

  3. What I heard was that ‘those with the highest care needs will receive free personal care’ my first thought was they already do. NHS Continuing Health Care. Of course I hadn’t seen the detail but it appears to be an announcement of a policy which already exists.

    This morning I hear the Tories have created an insurance policy for those over 65 who can pay in £8000 and never have to pay care home fees again and not sell their houses. Based on the fact that a significant proportion of those paying into the scheme won’t reach residential care for one reason or other and the scheme will pay for itself. Who knows…

    • Well yes, I remain cynical about both schemes as headline-grabbers with little thought to the substance.

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