Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

1.1. The purpose of this paper is to allow Cabinet to consider and comment on the proposed County Council response to the Government's `Shaping the Future of Care Together' Green Paper. A summary of the County Council's views is set out at Appendix C with the full response at Appendix D. The deadline for submission of comments is 13 November 2009.

1.2. The County Council's response builds on Hampshire's public Commission of Inquiry into Personalisation held in 2008, the recommendations of which were reported to Cabinet in December 2008. We have followed this up with consultations on the Green Paper with service users and carers including a Service User and Carer Conference and presentations to Older Peoples Forums around the County. Many aspects of this funding Green Paper echo the findings and recommendations of the Commission. For example, ahead of the Green Paper, the Commission's report last year called for:

· A universal offer of help with information and advice regardless of where people live, how much money they have and whether they are assessed as being eligible for social care.

· Free social care for a set period for all those at risk of admission to hospital or those people being discharged from hospital, and in need of urgent social care.

· An increase in the threshold for means testing from the current level (now £23,000 at April 2009) to £50,000 for people with savings and capital.

· The replacement of the current charging regime with a personal contribution model that supplements the individual budget that a person will receive.

2. Contextual information

2.1. The Green Paper sets out the Government's vision for a new care and support system in recognition of the fact that the system needs to be made fairer, simpler and more affordable for everyone. Feedback in Hampshire confirmed overwhelmingly that local people feel the system is unfair, particularly penalising those people who have managed their money well and saved for the future. The three key areas covered in the consultation are:

· The proposal for a new `National Care Service' with feedback invited about how the service would work

· How to ensure that choice over quality and joined-up services are achieved in a new National Care Service, and what the barriers to success might be

· Options for funding the National Care Service and whether funding decisions should be made at national or local level

3. Summary of the Green Paper proposals

3.1 Vision for a `National Care Service'

The Green Paper proposes that everyone should be able to expect six things:

1. The right support to help people stay independent and well for as long as possible. People would receive free support to stay well and as independent as possible, eg six weeks' support for people leaving hospital and needing care and support for the first time in their own home.

2. Wherever anyone lives in England, they will have the right to have their care and support needs assessed in the same way, including having a right to have the same proportion of their care and support costs paid for wherever they live. People will be able to take their needs assessment with them wherever they go.

3. All the services people need will work together smoothly, particularly when their needs are assessed.

4. It will be easy to understand and find one's way through the care and support system.

5. The services individuals use will be based on their personal circumstances and need, so they will have much greater choice over how and where they receive support, and the possibility of controlling their own budget wherever appropriate.

6. Public money will be spent wisely and everyone who qualifies for care and support from the state will get some help meeting the cost of that care and support.

3.2 Finance: How care and support should be funded

The key financial issues in the consultation are included in Chapters 5 and 6 of the consultation document and highlighted in the response to Question 3. The Government suggests three ways in which the National Care Service could be funded in future:

· Partnership: the responsibility for care would be shared between the Government and the individual. Everyone who has needs that qualify them for care and support would be eligible to have a certain guaranteed proportion of their care needs funded by the state through general taxation. There would then be means testing of an individual's income and assets to determine the personal contribution. It is indicated that most people would receive funding for one-quarter to one-third of their costs, while those less well-off would receive more, and the least well-off would be eligible for fully funded care, as is currently the case. For example, if the average care costs during retirement are £30,000, the state contribution might cover £8,000-10,000. The affordability of the state contribution is not discussed in detail, although it is suggested that some funding might be drawn from integrating Attendance Allowance (a benefit for over 65s with disabilities) into the state contribution.

· Insurance: this builds on the Partnership model whereby the Government pays for one-quarter to one-third of the cost of people's care and support. However, the cost of the self-funded element would be covered through optional insurance premiums. The state would work with private insurance companies or establish its own scheme, into which individuals could pay in return for their care costs being met should they require care. The individual's contribution could be made as a lump sum or by instalments before or after retirement, or via their estate after death. The Government suggests the costs might be around £20,000 to £25,000 to cover the potential average cost of care in old age, estimated at £30,000.

· Comprehensive: this model would involve everyone receiving care free when they need it, in return for paying a compulsory contribution into a state insurance scheme. The amount payable could vary depending on an individual's savings or assets, or the amount could be set at a particular level so individuals were clear about how much they would need to contribute, with only those on very low incomes or with few assets paying less or nothing. As with the Insurance option, the ways in which people contribute could be flexible (via one payment, spread over retirement, from one's estate, for example). The Government estimates that individuals would have to pay around £17,000-£20,000 into the scheme. ¹

3.3 Although all three options are to be welcomed as offering `something to everyone', there are a number of questions that need to be flagged up and more detailed information is needed on how costs have been modelled and the impact on the public purse before a fully informed view can be given. It is also of concern that the paper does not appear to consider issues of eligibility for services and does not explain how the costs of prevention, safeguarding, universal services (such as information and advice) and crisis care would be funded if resources flowed only through a centralised model of assessment and entitlement.

A nationally or locally determined funding system?

3.4 One of the main questions in the Green Paper is the extent to which there should be a single national system or a system with local flexibility. The two choices put forward are:

· a part-national, part-local system: people would know they were entitled to have their needs met, and a proportion of their care and support package would be paid for by the state wherever they lived. But local authorities would be responsible for deciding how much an individual should be given to spend on overall care and support, giving them the flexibility to take into account local circumstances. The Government's view is that the advantage of this is that it increases local authorities' flexibility to effectively meet the needs of their own population. The disadvantage is that people would get different amounts of funding in different places, which might be seen as unfair.

· a fully national system: national government rather than local authorities would decide how much funding people should get, in other words everyone who had the same level of need would receive the same funding wherever they lived in England. Or, the national system could give people slightly different amounts depending on where they lived in England to take account of the different costs of care and support across England. The Government's view is that the advantage of this proposal is that it would be easy for people to understand and plan for care, and it is seen as fair if everyone gets the same amount of money. The disadvantage is that people who live in areas where care and support are more expensive to provide would not be able to afford as much care and support as others in less expensive areas. Also it would be more difficult for councils to be responsive to their local communities' needs.

3.5 The County Council's view, set out in response to Question 3 is that a fully national system of assessment and charging is inappropriate and impractical for care and support services which have personalisation, control and choice as their guiding principles. Indeed a fully national funding system would be detrimental to individual councils' abilities to respond to their own social care market and the wishes of service users and carers. It could also have implications for local government funding, particularly for authorities like Hampshire where approximately 65% of funding comes from local rather than national sources. There is, however, merit in a national Resource Allocation System, so that people's needs are assessed in the same way, regardless of where they live.

4. Other key issues

4.1 The Green Paper is largely silent on the care and support issues facing people with learning and physical disabilities and mental health issues. Although the population of older people is by far the largest of the care groups, hence the Department of Health's focus in this consultation on their needs, there are also significant demographic and cost pressures in Learning and Physical Disabilities. People in these care groups are living longer with much more complex care needs, and the paper does not adequately address how their care will be funded in the future.

5. Recommendation

5.1 That subject to the comments made by Cabinet, the attached summary and full formal response to the Green Paper `Shaping the Future of Care Together', be submitted to the Department of Health by the Leader.

Appendices

Appendix C - Summary of the County Council's response to the Green

Paper `Shaping the Future of Care Together'

Appendix D - Hampshire County Council response to the Government's Green Paper `Shaping the Future of Care Together'

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

Other Significant Links

IMPACT ASSESSMENTS:

Equalities Impact Assessment:

The needs of younger adults with mental health issues, learning or physical disabilities have not been adequately covered within this consultation. This is highlighted as an area of concern in the response to consultation question 1.

Impact on Crime and Disorder:

The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all the decisions it makes on the prevention of crime. The proposals in this report have no proven impact on the prevention of crime.

Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

No impact has been identified, since this report is a response to a Government consultation exercise.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

The Green Paper consultation document does not cover these issues.