Initial thoughts on the Dilnot Report on Funding of Care and Support

Scheduling and exhaustion meant I didn’t have time to look at the Dilnot proposals in detail yesterday so this morning I have fired up my browser and am going to make a few initial comments on the baseline main recommendations and hopefully over the next few days can look at some of the details.

The Dilnot Report on Funding of Care and Support runs at 82 pages.  It attempts to forge a solution for the currently antiquated and inequitable system of care funding that is currently in place. Much talk has been made of the current threshold of £23,250 of assets, at which people currently become responsible for paying for their own care services but little made of the current discounting of homes in certain circumstances and the ability to raise a charge on a property to postpone payment of costs for care services. Nevertheless, this threshold was deemed as being too low. People who own houses like to keep houses for children. People don’t like those who ‘haven’t worked as hard’ or ‘saved as much’ getting something for free.

The system is broken though, don’t get me wrong, I just think the focus of the discussion has been too much around middle class fears of actually paying for something they believe should be free. Now, I’ve got that off my chest, back to the report.

The main recommendations are

– to cap lifetime costs of care between £25,000 and £100,000 – with a suggested threshold (which is used throughout the report for ease) of £35,000

– means-tested assistance will be extended to those who have between £23,250 and £100,000 of assets.

– Those who ‘enter adulthood’ with support needs will not be means-tested and care will be provided free.

-Universal disability benefits will continue but may be some differences in names regarding Attendance Allowance. (erm.. DLA?).

– There will be a cap on so-called ‘hotel costs’ in residential care between £7,000-£10,000

-There should be a national, portable eligibility framework which is more transparent.

– A government awareness campaign about planning ahead and preparing for potential age-related disabilities. And their costs.

– There should be a new information and advice strategy to help people through the confusing forest of knowledge.

– Better carers support and information.

– More health and social care integration

Of course, these recommendation run alongside the Law Commission’s report for changes in adult social care law. Together they could create a much better and clearer system than we currently have.

The ‘lifetime cap’ allows for insurance policies to be generated and probably very profitable ones too for the insurance companies. Most people do not need high level social care provision but the fear generated by the media is enough to drive right minded people into the arms (those who can afford it and who have substantial assets) into the arms of the insurance companies. I’m not sure how comfortable I am with the lifetime cap on care costs. It means the more wealth someone has, the more they are protected. I understand the logic behind it in that noone chooses ill-health and disability but the more than government spends on those who do have substantial assets, the less there is for those who cannot afford it and the higher the criteria to access support rises.

I just have a few queries which may be answered in the details. If Mrs Smith has a house worth £300,000 and she lives alone with no other substantial assets – say, for example, she has savings of £10,000 – is her house sold to release the asset worth up to the cap of £35,000 – assuming she doesn’t have an insurance policy? If she chooses to live in a care home which is private, but then the money runs out, will the local authority still move her? Will she ‘top up’ the local authority fees, paying above the ‘cap’ to do so? What is she lacks capacity and has no family?  I suspect all these answers are in the report but they will be questions I will be looking for.  The system of deferred payment is mentioned and I’ll hunt around for clarification.

The cap though, seems to be there to protect middle class votes.

I do, however wholly support the increase in the level of means-testing. I think it is entirely right to continue to means test up to £100,000 and I’d even go further than that. I don’t have a problem with mixed funding, I am just not entirely comfortable with the capping.

Again, the clarity of the coverage of those who ‘enter adulthood’ with care needs is entirely right. There is a necessary distinction between working age adults with care needs and older adults with care needs but quite rightly it is wrong to have a distinction fixed at a specific age. Indeed, Dilnot proposes that those who develop long term care needs before the age of 40 should continue to have a zero cap and costs should be met fully by the state. Above the age of 40 there will be some kind of tapering of the cap up to retirement age where the full proposed £35,000 cap would be reached.

Regarding the accessibility of universal disability benefits, Dilnot clarifies that he does not propose any reform that would lead to anyone losing their disability benefits and that attendance allowance will continue. I do wonder though how this ties in with the government plans to remove 20% of DLA claimants.

There are some recommendations though to change Attendance Allowance (AA). Firstly to change the name to something more understandable and an appreciation that many who are eligible for it do not claim it. That absolutely reflects my experience.  People who reach the cap when the government takes over payment will not continue to receive Attendance Allowance (or whatever it will be called) because the government is fully paying for their care needs – which makes sense to me.  The Personal Expenses Allowance (PEA) is proposed to continue – this is the payment that is made to people whose costs are met by the government in residential care and is currently about £23 pw – there is a suggestion that it should increase but not a recommendation.

The cap on hotel costs is excellent news in my view because I saw this as a potential ‘get out’ clause for residential homes. I do want to know how some of the private homes will adapt to these new systems though and what the cap will mean for overall quality of care provision.

The idea of clearer, portable assessments is a good one and long overdue. Eligibility criteria interpretation can differ wildly and there needs to be more transparency.   The minimum threshold would be applied at the ‘substantial’ level of care so I wonder how this portability will work for those who live in areas that meet lower levels at present.  It seems that there is some kind of recommendation to do away with FACS over the longer term.

Can’t be soon enough – a new assessment framework will be developed ‘with experts’. Please please please can front-line practitioners be involved in these developments – not just people who professionally develop policies and have never needed to use assessments in their lives. This is why we end up with unusable systems. There is also a way of building self-assessments into these new models. That’s the idea anyway.

The last recommendations about building awareness and improving quality of information seem to be sound all round. Nothing to argue about there.

I am interested in the recommendations as they relate to carers. As far as I am concerned, I want more than just an assessment for carers, I want the provision of more services. Supporting carers very well both financially and with practical and flexible support is probably the one aspect which can potentially save the government more money in the longer term than anything else – but more than that, it is an issue of ethics and morality. I know that doesn’t often come into government services but it’s something I feel very strongly about.

There is more commentary about the details of Dilnot in Community Care, the Guardian has extensive coverage (including an article I wrote before the details were known).

I also recommend Arbitrary Constant for links and discussion about Dilnot.

Means Testing and Social Care Funding

Community Care reports that  Dilnot who is chairing the latest in a long, long line of consultations into care funding has heard overwhelming opposition to retaining the £23,000 savings threshold before people have to start paying towards their social care needs.

Charges for social care are a delicate political issue so not content with one report, each government seems to want to commission a dozen until they find one that says what they want to say politically.

As someone who doesn’t have any ideological issues with means-testing, I find the constant pushing of limits hard to understand.

If someone has money, surely they can and should pay for a service and if someone doesn’t have the money, the state should subsidise. Seems quite a good system.

That’s not to say there aren’t problems with the system as it is at the moment. There are lots. It is overcomplicated for a start. There is an element of the ‘postcode lottery’ about it.

The costs are increasing rapidly and, this is the rub, no-one wants to pay for social care. No-one. Whether they have £50 in the bank or £5000 or £5000000 – people have become used to receiving health care free and seem to make assumptions about the provision of social care on the same basis until they are actually made aware of the costs involved.

One of the most perfidious arguments I come across is the ‘I/my mother/my gran worked hard all her life so why should she pay when Mr Brown who has been on benefits all his life doesn’t?’.

Perhaps because you/your mother/your gran actually have the money to pay and Mr Brown doesn’t.

There is a lot of righteous indignation around in this country with people measuring what they have against what others have and what they get against what others get and seeing things as ‘unfair’. Unfair is a government that gives those who ‘have’ a free ride even if they have assets in the hundreds of thousands and restrict access to services for people who have the same and higher needs and fewer assets to pay for them.

Maybe you would prefer Mr Brown’s life of poverty on benefits or in a low paid job to your life where you’ve received a dignified wage and been able to save?

Or does it all come down to stamping ones’ foot and wanting to save your children’s inheritance?

I know this isn’t a popular view. Certainly Dilnot is going to reject it. The thought of – gasp – having to pay for social care if you have savings is such an anathema to the middle classes who have the loudest voices in the political process that it seems already to have been summarily dismissed out of hand.

The thought of having to sell the home to pay for care has been put up as the massive failing in the current system. Is it a failing? I’m not sure. The houses are are discounted from the sums if there is a partner who is disabled or over 60 living in them.

A charge can be put on the home by the local authority so the sale can be delayed until after the death of the person in question. Rental charges can be used to pay towards care fees if the family doesn’t want to sell the home.

Anyway, that’s likely to change because the home-owning electorate don’t like to pay for care for their parents when Mr Brown-on-benefits my be getting something for free.

One thing I am in favour of though, is the capping of care costs at a certain level if someone has very high needs. We used to have this in the local authority but as we’ve moved into more austere times, it has been abolished. While I think means testing is, by its nature, fairer, I don’t think anyone should be penalised if they have extremely high care needs.

The problem of course is that if people who have funds won’t and don’t pay – then who will? Why the state of course. Perhaps through the hideously conceived ‘insurance’ policies that the Conservatives dreamt-up pre-election which showed an ignorance of the details of care but could ‘insure’ someone with a lump sum payment (£8000 was suggested)  against care home costs in the future.  Another of Lansley’s gems. We really are seeing the measure of the man now.

I’ll be following Dilnot’s recommendations with interest. Just as I’ve tried to follow the very frequent and oft ignored proposals that have popped up again and again about the funding of long term care until the music stops and the government decides on the one that will win the most votes for them.

It’s a shame that so many games are being played in the name of ‘fairness’ where ‘fairness’ seems to only be referring to the wealthier, home-owning middle classes – but that’s where the votes are.

Cynical? Well, perhaps just a little bit!

From DLA to PiP – a consultation begins

Yesterday, the government published it’s consultation document regarding proposed changes to Disability Living Allowance (to be renamed Personal Independence Payment.. ).

At Arbitrary Constant there is a fantastic rundown of the details of the document which highlights some of the major points of concern and change from the current system.

So there is going to be a ‘rebranding’. Fair enough – of course a new and shiny ‘welfare system’ needs new names. I didn’t think DLA was particularly badly served and PiP sounds disarmingly chipper but no matter, in effect names are irrelevant.

The document emphasises the need to move to a system for ‘today rather than the 1990s’ again, all rather dull and obvious rhetoric.

The one blindingly obvious statement is that less people will meet the criteria for the new ‘payment’ than currently do. Marry this to the tightening upwards of local authority eligibility criteria for services and the stricter limits for Employment and Support Allowance which is means-tested and we can see that there will be a group of people who will slip away from ‘benefits and services’ completely. I fear that the barrier will be drawn reasonably high and that this has the potential to cause great hardship for some people.

There is no mention of Attendance Allowance at all – Attendance Allowance is the equivalent (but lower) benefit paid to over 65s. There is a note that a consideration will be made as to whether over 65s will be brought into the ‘new’ benefit.

I don’t want to pre-judge but I can’t see there is any possibility of attendance allowance carrying on in anything resembling it’s current form with these changes. I expect a convergence with PiP as differentiation between groups and entitlements on the basis of age is running close to the line as far as Equality legislation is concerned or an abolition of AA entirely.

I wonder at the ‘healthcare professional’ who will be conducting the assessments. This is currently the case with ESA and in some assessments of DLA as far as I understand (let me know if I’m wrong on this!)  and I feel very uncomfortable that the medical professionals who are involved with an individual –  that their own GP or consultant, cannot be trusted to provide relevant information rather than relying on a private company. I took a look at some of the job vacancy adverts for these ‘Disability Analysts’. Unsurprisingly ATOS are advertising for a fair few RGNS (registered general nurses). I was, however surprised that there was no adverts for RMNs (Registered mental nurses). Does that mean that all the ‘health professionals’ primarily have their experience in physical rather than mental health services? I’m willing to accept that maybe I’m putting 2 and 2 together and making 5 but one area I do worry about intensely is the way that decisions will be made for those who have fluctuating disabilities and primarily mental health difficulties. Firstly, the process itself seems to be an additional barrier to claim with many potentially saying ‘I can’t be bothered to make the application because I’ll be turned down’ or ‘I don’t want to be classed as a scrounger or doubted’ and thus a universal, non-means tested benefit eludes a certain group of people who have been terrified out of claiming that which is rightfully theirs.

My impression remains that the government fully knows that they are doing by stigmatising benefit claimants. They are scaring people who are fully entitled out of claiming what they rightfully could receive. That’s a very mean-spirited way of reducing cost.

There is a lot more in the document that I could and will, no doubt, consider over the next few days. I heartily recommend Arbitrary Constant for a much more thorough rundown of the main points.

I intend drafting a response to the consultation and I suggest as many people who are interested do. I am sceptical about the difference that these consultations actually make but it never hurts to try and help get our voices heard.