Personal Care at Home Bill


The Bill claiming to bring in the promised free home care for those with critical needs was introduced to parliament yesterday. There is a lengthy ‘impact assessment’ available at the Department of Health website that I don’t have time to trawl through before going to work this morning.

A brief perusal confirmed that the ‘critical’ needs to be included that will lead to the ‘free’ care will be restricted, understandably in light of the name of the legislation to ‘personal care’.

According to the document above, personal care includes

Physical assistance and prompting in relation to

-eating and drinking

-toileting

-washing or bathing

-dressing

-oral care

-care of skin, nails and hair

And to be eligible, as I read it anyway, there would need to be four aspects that would lie within the ‘critical’ band.

This obviously reduces the ‘access’ to the ‘free’ funding. I use inverted commas for the ‘free’ aspect as obviously there will be a payment through taxation and again, some local authorities may be attracting a higher cost than others – I am thinking perhaps of some traditional ‘retirement’ towns that perhaps might have a heavier burden on them than other districts.

The other concern about the legislation is that in an interview with The Times yesterday with Andy Burnham, the Health Secretary, who suggested that money to pay for the Personal Care at Home Bill will be diverted from funds for research into cancers and dementia.

This is hardly a popular move and one I can see the government fast back-tracking on but it goes to show how little consideration has been spent on these plans to reduce charges for homecare.

There is also to be a further focus on re-enablement and rehabilitation which, it is hoped, would reduce the ongoing care costs as it would reduce the need for interventions when more access to recovery is envisaged. This is definitely a positive outcome – I have long thought that there has been too little focus on lower level needs that progress into much higher needs if not addressed at the time. I could run off countless ‘scare’ stories about trying to arrange for some kind of rehab input when someone is discharged from hospital but they would probably not be believed. All I can say is that if it is to get better, that is no bad thing.

I still remain sceptical though. It seems like a sticking plaster to a haemorrage of a problem that noone seems to want to think through and that social care is being used as a toy to tempt voters terrified of sacrificing their childrens’ inheritance due to some kind of ‘entitlement’ to ‘things for free’ that has been created.

Whether that is the Tories and their hotchpotch policy of providing ‘insurance’ against the cost of residential care that no sensible person would take up – or the haphazard ‘free personal care for all with 4 or more critical banded needs under FACS’ that Labour are now proposing.

Personally, I can’t see the legislation being passed in the lifetime of this Parliament anyway so it is something of a moot point but if there is to be a more creative focus on re-enablement coming out of the debate, that is definitely A Good Thing.

I hope to spend a little more time reading through the proposals at length to give a slightly more cognisant appraisal over the next few days!

5 thoughts on “Personal Care at Home Bill

  1. I too remain sceptical. It feels more like an extention of continuing care and seems that the care system is going to be an increasingly tangled web of eligibility rules and means-tests without increasing entitlement for many people.

    The problem is – you are quite right – that policy is made on the hoof with considerations other than how things will work on the ground.

  2. I’m kind of confused about the extended focus on rehabilitation. Good that those who can be rehavilitated, will be able to access services more easily, but what about thos ewho cannot be rehabilitated, like those with stable or progressive conditions? Will they have to wait until they are so-called “critical” before they get access to personal care?

  3. That is a part of my scepticism to be honest. I mean we can all agree that where possible, rehab is positive but it also raises a lot of questions. I think we need much more information to decide about the overall good of the Bill but as I said, I think it is all a bit of a show in any case and unlikely to make it through the Parliament.

  4. Hi cb

    The old chestnut, Health redefined as social care coming up thick and fast now, especially where dementia patients are concerned, don’t think home care will work, surely the intensity (quantity) and compelxity ( quality) of need coupled with the unpredicability and the nature of the condition implies that social services will be exceedign their lawful limit!

    Or is it! according to the the HSJ release today, Social care will be integrated into the NHS responsibility.

    http://www.hsj.co.uk/5009380.article

    Amazing isn’t it, the last ten years since ‘Coughlan’ has seen some changes due to the fright the Govt felt when this case was won, along with the ‘Grogan’ judgement.

    Continuing Care was the only term, that is redefined now as social responsibility with Continuing HealthCare being posiitoned as a secondary service, when it is really the Primary Service and should be considered First, then ‘Care Home’ with….. from REs Homes or 24 hr Nursing Homes

  5. sorry didn’t finish rpevious psot, pressed the wrong buttons, to carry on:-

    …with res homes & 24 hr nursing homes, now redefinded as merely ‘care homes’ WITH………..
    all basically res homes, for charging.

    The only place to find continuing ‘care’ on the DoH website is under Social Care!

    Can I ask this, dementia patients kept in their own home!, to me at certain stages of this organic, degenerative brain disease, this would be ‘ultra vires’ and unlawful for social services to provide, due to:-

    Intensity – (quantity) of need required throughout the 24 hr period
    Complexity – (quality) of need throughout the 24 hr period
    Unpredictability – of need throughout the 24 hr period

    & finally the old chestnut, NATURE – the condition, presenting needs totally related & caused by Health Needs, not the actual ‘input’ required in a ‘need for health ‘care’ , would amount each time to fit the criteria ‘of a nature that the social services cannot place, provide and charge’ only if the accommodation is not available elsewhere, which it would of course, cos they ahve their own home, coupled with the ancillary and incidental scenario of quality/quantity.

    The registered nursing contribution is only equal to the nursing services that the social serices can lawfully provide for, charged back to the NHS, anything over and above this now very ‘wide’ remit is NHS continuing Healthcare, the RNCC was/is merely a gap filler, the law states, there is no gap, nhs is responsible for all needs, when a health need exists.

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