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Into Perspective
Free personal care – a possibility?

Kicking off a new series putting concepts, ideas and proposals into perspective, we are looking into the notion of free personal care for over 65 year olds. What’s the idea behind it? Who can it help? And what do our experts think of the proposals?

Free personal care for over 65 year olds has been much discussed since the start of campaigning for the General Election in December 2019.

But it was also a topic of conversation amongst adult social care peers well before this, with hopes that it might appear in the social care green paper as a suggested type of funding reform.

What does this entail?

Implementation of the concept would bring adult social care in England in line with regulations in Scotland, where any adult aged over 65 – and, more recently, working-age adults – whose care needs meet the criteria are offered help with washing, dressing and eating for free.

Specifically, personal care in Scotland falls under personal hygiene, continence, diet, mobility, counselling, simple treatments and personal assistance.

The system doesn’t take a person’s financial circumstances into account, so people who have a high level of capital are treated in the same way as those who might be in a worse-off situation financially.

This ensures that everyone who qualifies for support services from a care needs point of view is able to access personal care to help them to continue with their day-to-day lives.

However, the proposals would not mean that everyone over the age of 65 is entitled to free care generally.

Beyond basic needs, care would still need to be paid for, including accommodation costs for those in care homes.

It would not cover things such as help with housework, the use of telecare to ensure a safe home environment, or outings and activities in a care home for example.

Impact on the sector

As a subject that’s received a lot of attention, The King’s Fund, Health Foundation and The Institute for Public Policy Research (IPPR) have produced reports detailing how free personal care could be implemented, how much it would potentially cost and both the benefits and the downsides of the proposals.

If we take the estimations from A fork in the road, produced by The King’s Fund and Health Foundation, ‘Free personal care could require around an extra £6bn in 2020/21 and £8bn by 2030/31, compared with continuing levels of access and quality under the current [2018] system. This would increase the estimated funding gap to £7bn in 2020/21 and £14bn in 2030/31.’

However, projected benefits include easier integration between health and social care, fewer delayed transfers of care (therefore hypothetically saving money for the NHS) and potential earlier access to support, enabling people to stay in their own homes for longer, in line with the Care Act’s ambitions to help people remain independent.

Further into the future, people might have a better understanding of what social care is and how the sector can help, and this could lead to an improvement in the way it is perceived.

But do the benefits outweigh the cost implications and, with other potential options on the table, is this proposal for reform a viable answer?

Supports earlier access to care

Our mission at Independent Age is to make the world a better place in which to grow older. As we age, we all hope to live full and active lives, but this isn’t the case for everyone. Many experience long-term conditions, a reduced income, or caring responsibilities that can impact their later life.

One of the biggest issues people face is not receiving the right care and support, and spending vast sums of money when they do get it. Our charity recently uncovered that, since 1999, 330,000 people have sold their home to pay for their care costs.

We believe that introducing free personal care for everyone over the age of 65 will improve the situation. In addition, we recommend the Government explores options for a safeguard to protect those who need residential care from racking up catastrophic costs.

Free personal care isn’t a silver bullet, but it would significantly reduce the cost of care received at home and in a care home for older people. Alternatives such as a cap on care costs of £72,000 would only help one in 10 people after six years in care, despite the average stay in a care home being 2.5 years.

A simpler system, where people understand what they are entitled to, would result in more people accessing help earlier, and could enable many more older people to stay in their own homes for longer.

It’s also not as expensive as you might think. With a 1% rise in income tax, someone earning the UK average salary would only pay about £3 per week for the first couple of years.

Getting this right could also save the NHS money, as people would be less likely to end up in A&E, or stay in hospital longer than necessary.

People across the generations are supportive of this policy. Our September 2019 poll showed 78% of those aged over 18 support free personal care for older people, and 74% said they would contribute financially to make this a reality.

Independent Age and its supporters will keep campaigning until the Government reforms the social care system and introduces free personal care for all older people.

The more people who join our campaign network, the more effective we will be.

Morgan Vine, Campaigns Manager, Independent Age

 

Only part of the solution

Successive Governments of all political shades have promised to reform adult social care but have ultimately failed to deliver on these promises.

The General Election saw free personal care for over 65s being floated as a solution to the many issues faced by an underfunded social care. Free personal care is an instantly appealing policy idea – the word ‘free’ is itself enticing. However, while the idea of free personal care is good and proposals are welcome, it can only ever represent one part of a reformed social care system, not a comprehensive solution.

It provides support for practical tasks like washing, dressing, or preparing meals; yet it doesn’t cover the costs of buying food; doesn’t provide suitable accommodation, or secure living; and it doesn’t provide for people’s social and emotional needs. Despite the label, personal care would still come with a substantial price tag, and won’t help those whose needs are not met now but don’t have a house to sell.

It is also only relevant to those who are over 65 years of age; it does nothing for working-age disabled people, where often the needs fall more into the need for ‘support’ with participation and decision-making. And in failing to address the needs of working-age disabled people, we exacerbate the growing misconception that social care is only for older people, and compound unjust outcomes for disabled people.

Even if it were extended to all adults, we’d be at risk of creating a hierarchy within disability, whereby physical care needs are prioritised above social, psychological and employment needs.

At present, local authority care and support services are rationed on two grounds: needs and means, to ensure that those who need it most can receive the right support whilst taking their means into account. Free personal care removes the means test without altering the eligibility criteria; meaning that only those with the highest level of needs will continue to receive ‘free’ services.

Funding is only part of the adult social care conundrum. The new Government with its significant parliamentary majority has an opportunity to be bold. It is essential that whatever it proposes works for all of us, regardless of age, location, or disability. Free personal care would be welcome, but it would only ever represent a part of the solution, and does not negate the need for a long term plan for social care.

James Bullion, Vice President, ADASS, and Executive Director of Adult Social Services, Norfolk County Council

 

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