A Caring, Sharing Bill?

In 2010, economist Andrew Dilnot was commissioned to solve the problem listed above. His final report proposed a lifetime cap on care costs with the expectation it would bring certainty to financial services firms and spark new products to help people pay for care.

After clearing its latest Parliamentary hurdle in which a government amendment was passed to introduce a system to handle appeals for council care decisions, the Care Bill is heading for the statute books. The bill was also amended to enforce the pooling of health and social care budgets through the Better Care Fund (BCF), which will oblige councils and clinical commissioning groups (CCGs) to bring together £3.8bn in 2015-16 to integrate care.

The Care Bill is likely to come into force in April 2015, and will have a significant impact on the sector. The Bill comprises the Government’s response both to the Francis Inquiry into the Mid Staffordshire scandal and the Dilnot Report into care funding. It introduces Ofsted-style ratings for hospitals and care homes, and a cap of £72,000 on the amount that any individual will have to spend on care in their lifetime.  

A Cap on Fees
According to research by analyst Laing Buisson, around 160,000 people go into care homes every year and 70,000 pay their own fees, with the average bill around £82,000, or £97,000 in London and the South East. Once an individual reaches the cap, the Government will meet the care costs, but basic living costs set at £12,000 per year are excluded from the calculation, and will still need to be paid by the individual after the cap has been reached.

The Bill grants significant freedom to individual Local Authorities to decide how much care costs and therefore how quickly care users will reach the cap. There is concern, however, that this localised approach will encourage care users to move to Local Authorities which have higher care costs in order to reach their cap sooner.

Another change allows Local Authorities to charge fees for arranging care at the request of self-funders. Local Authorities are likely to treat this as an attractive option for raising revenue, and therefore actively promote the service, which would increase the number of self-funders on lower fees, and further threaten the financial stability of independent providers, and their ability to deliver care.

A single, legal framework
The Bill also consolidates previous social care legislation into a single legal framework. One amendment currently attached to the Bill would grant all care users the power to challenge their providers under the Human Rights Act. Currently, only those in taxpayer-funded care are protected by the Human Rights Act; as it stands, the Bill would extend that protection to include those who pay for their own care.

Another potential issue, as Nick Kirwan of the International Longevity Centre UK has argued, is that the Bill makes it compulsory for Local
Authorities to arrange care for self-funders if they ask for it. This could present a problem, as Local Authorities use their buying power to command cheaper rates when they contract independent care providers – often at or even below the cost of that care. Those providers make up the shortfall by charging higher prices to self-funding care users for identical care – cross-subsidisation. Because the Care Bill allows self-funders to access those lower Local Authority rates, it has the potential to drive some independent providers out of business.

Drowning in paperwork?
Care homes have to regularly complete more than 100 separate items of paperwork, often duplicating the same information. In the recent Joseph Rowntree report entitled Is Excessive Paperwork in Care Homes Undermining Care for Older People? researchers visited care homes and spoke to staff who felt they were judged more on their ability to produce paperwork than deliver care. The research recommends that the sector rethinks its priorities and makes changes to the way it deals with administration so older people can be given more compassionate, personalised care.

The research examines the practical impact of paperwork in care homes and makes suggestions for its improvement. There is little co-operation or co-ordination between different regulators and commissioners and duplication arises when they ask for much the same information, but tailored to their individual needs. From their point of view, what is requested is reasonable. However, the impact of several commissioners asking for similar but slightly different information places an extraordinary burden on the home. This composite impact is often what homes are describing when they complain about a ‘paperwork burden’.

Many interviewees felt that this issue reflected deeper system-wide uncertainty about what should be valued in care and what high-quality care should look like. Without this understanding, it is unlikely that agreement will be reached on the things care homes need to do, not just to comply with regulatory and commissioning requirements but to raise the quality of care.

Care homes have a list of core ‘must-dos’ based on key legislation and embodied in 28 standards of quality and care. Yet different agencies also make requests of care homes and these requests have different emphases across the country. In addition to this moveable feast of ‘must-dos’, views about how guidance should be interpreted to meet funding or regulatory requirements also vary.

Additionally, some requests made by inspectors and regulators are seen by care homes as bearing little relation to the quality of care provided.

Government Business will continue this article on the Care Bill in the next issue, due out in May.

Further information
The Care Bill – Parliamentary progress
Paying for Social Care – Beyond Dilnot
Joseph Rowntree Foundation report