ADASS concerns over Free Home Care

Over the weekend, a few news reports emerged regarding a statement from ADASS (Association of Directors of Adult Social Services) which raised questions about the government’s speedily announced plans for ‘free personal care at home’ and particularly about some of the sums involved.

According to the ADASS survey the true cost of the policy could be a minimum of £1 billion, with the overall cost to local authorities rising to more than twice the £250 million originally calculated by Central Government.
Calling for an urgent meeting with the Department of Health to help clarify these issues, ADASS President Jenny Owen said: “Government assumes that personal care needs can be met through an average package of 6.54 hours of care per week at £15.75 per hour amounting to £103 per week.

“However our research shows that local authorities have estimated a much more expensive average care package for a user with high needs. Information we have received from 61 authorities shows that the average cost of care is about £200 per week.

“Also, the number of existing self-funders in any given area is often unknown, as is the number qualifying as eligible under the Fair Access to Care eligibility criteria.”

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My first reaction to the statement is that if the government truly believe that most ‘critical’ care needs are met through packages of care of 6.54 hours per week, they have some very dodgy figures that they are going on – in my very humble and perhaps limited personal experience.

‘Free’ also sounds so good. Perfect for building an election campaign on. Everyone likes ‘free’. Free however needs money and funding. Free is likely to create far more problems than it solves if all the money is channelled solely to those who are at the very edges of the ‘critical’ band of need.

I was discussing this with a colleague from a neighbouring borough last week at a forum we attended. She commented that she had always been able to manipulate the FACS (Fair Access to Care Services) criteria according to how she determined need as she assessed them and that it can be as flexible as one wants it to be. I can see her point to an extent in that it is fairly easy to interpret the bandings in different ways and something that might be ‘critical’ in the view of one person – could be ‘substantial’ or even ‘moderate’ in the eyes of another.  This will be of vital importance as if it is to be a method of determining whether care is free or not, it will become more tempting to assess upwards those that might completely refuse care if they have to pay for it (who are frequently not the people with the least amount of money, for the record).

I have no problem with ‘free’ but where I feel uncomfortable is that those who are fully able to pay are going to be the more vocal and assertive in demanding the rights to ‘free’ and those who have fewer means will be excluded from lower level services in order to fund the more critical needs of people who are more wealthy.

A critical need is a more immediate difficulty but a moderate need not attended to or managed can become a critical need fairly rapidly. I also fear a system as complex and controversial as the current continuing care system which is as inaccessible and confusing as it is possible to make any kind of system at present.

Continuing Care is currently ‘free’ as it is care provided by the NHS to those whose primary needs are health-based rather than social care-based which to all intents discriminates against older adults and particularly those with dementia (as it is seen as a social care need rather than a health need). The arguments can and do go on.

How the new proposed system will add more expectations of entitlement, we will just have to wait and see. The ‘free’ care will have to come from somewhere. It is likely to be minimal when it is provided. A  few 30 mins visit here and there isn’t enough to meet social care and health needs appropriately in the community.

I also wonder how it will tie in to the push towards Individual Budgets. Will the free care be provided through Individual Budgets? I think it’s going to have to be  – as, before long – all care will be provided through Individual Budgets,  This may increase the level of human hours needed to support and assist which is no problem as far as I’m concerned. I’d love to spend many more hours supporting people putting together individualised care packages however the time taken by the workforce and the costs of staffing have to be taken into account at some point.

Ideally, I’d love to drop the cynicism and embrace the policy with open arms. I am just so sceptical that the electioneering is taking the place of consultation and common sense and the government have just jumped on this issue without an understanding of the implications.

Social Care is an easy target for swift government promises. Helping Vulnerable People is A Good Thing. No thought of where the additional money will come from and rather about what will be lost from the preventative and early invention work to provide free care to those who are very well able to pay for it – can only lead to poor legislation.