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The social care Green Paper wish list

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Q. With the announcement of another Green Paper on the future of social care due later this year, what would the sector like to see in the document?

A. Professor Martin Green, Chief Executive, Care England.
Colin Angel, Policy and Campaigns Director, United Kingdom Homecare Association.
Matthew Wort, Partner, Anthony Collins Solicitors.

An opportunity to get a truly final solution for social care

Professor Martin Green, Chief Executive, Care England

The announcement that there was to be yet another Green Paper on the future of social care, on one level filled me with the feeling that I was participating in the sequel to ‘Groundhog Day’, but on another, I felt it was an opportunity to influence the debate on the future of long-term care and to get a truly final solution.

I hope the Green Paper will build on the previous work done on this issue. We must not go down the road of endless research into the question. What this Green Paper needs to do is frame the answer, and frame it in a way that will be both sustainable and long-term.

It is now 20 years since Tony Blair asked Lord Sutherland to Chair the Royal Commission on the future of long-term care. There are people who are currently being supported by care services, who, if they had known 20 years ago what the current position would be, would have been able to make provisions for their care. One of the greatest challenges for citizens is to know how to plan for the future when the Government constantly changes the baseline and develops short-term policy for a long-term issue.

The new Green Paper must set forward a bold vision for the future of care and it must be a vision that looks to the future, rather than just reconfiguring what we have had in the past. Demographic change is already upon us and it is clear there are going to be many more people who need care and support, but the workforce to deliver it is not keeping pace with demand. If you look at the gap in the workforce supply, it already is quite clear that we might have to craft different solutions and challenge the way in which we deliver health and care in the current silos.

I hope that the Green Paper will also acknowledge that most people who receive social care do so because they have a health condition. The Green Paper must set out a vision for integration which is about the outcomes to citizens, not focus too much on the sustainability of organisations. The biggest challenge any government will face is that they are going to have to move resources across the system from the NHS and into social care.

This will require a radical change in what we do, and previous attempts to reapportion money, such as the Better Care Fund have only tinkered around the edges. What we need is a fundamental reappraisal of government spending, in the knowledge that the challenge of the 21st-Century is helping people to live well with long-term conditions.

The current system was fit-for-purpose in 1948, when we diagnosed an issue, sent people to hospital, cured them and when life expectancy was 66. The 21st-Century system must support people to live well with several long-term conditions, and enable them to manage their own health in ways that support them to have independence and choice.

I sincerely hope that the Green Paper acknowledges many of these realities because if it doesn’t, it will be yet another missed opportunity and will represent wilful political neglect.

It can’t just be a quick fix

Colin Angel, Policy and Campaigns Director, United Kingdom Homecare Association

Given that we have an ageing population, many more people are increasingly likely to fund their own care. A social care Green Paper must not just confine itself to the current crisis in state-funded care, it must also consider options for people who fund their own support. It can’t just be a quick fix.

Green papers are discussion documents, intended to test reaction to a range of policy options. This one needs to describe the balance of responsibility for funding social care between the individual and the State. Successive governments have ducked this issue, but it is no longer an issue in the distant future; people born at the start of the baby-boom are already in their 70s.

The Green Paper needs to set out options for what the public will need to fund, whether this is through higher central government taxation, increased local government taxes, or a requirement for people to fund themselves through insurance or savings. The Green Paper should consider: tax breaks for self-funders, other financial incentives to release money from property assets, and salary sacrifice schemes.

In relation to state-funded care, the Green Paper should consult on giving more teeth to the Care Act 2014, which has no independent policing of whether councils genuinely comply with their statutory responsibilities. Councils can, and I believe do, make decisions on whether to comply with the Act based on whether they are likely to be challenged through judicial review.

Government should consult on whether a regulator – such as the Care Quality Commission – should play a role in overseeing how councils spend public money intended for social care, and whether they are effective in shaping their local care market – as recommended by the Communities and Local Government Select Committee.

The Green Paper is also an opportunity to ask whether the current responsibilities between councils and clinical commissioning groups are appropriate or effective; reducing duplication could represent significant savings for the public.

The Green Paper must also present options for better ways to get money to frontline services. The Social Care Precept has been criticised for helping councils in deprived areas the least, while the Better Care Fund has been bureaucratic and used to increase capacity, rather than stabilise markets.

A relatively straightforward solution to support providers would be for Government to change the VAT status of regulated care, to cushion the effects of low council rates by allowing providers to reclaim their input tax. As the UK prepares to exit the EU, this becomes a more practical option.

Social care providers will be looking for the Green Paper to ensure that councils and the NHS understand (and fund) the real costs of care, particularly as an incentive for greater long-term investment. Providers will also hope to see some practical approaches to the labour market, to ensure that recruitment problems are not exacerbated by Brexit.

The success will depend wholly on the outcomes it achieves

Matthew Wort, Partner, Anthony Collins Solicitors

It is a huge relief that Philip Hammond has finally recognised the need for a long-term systemic change to the UK health and social care sector. A Green Paper, set for release later this year, is tipped to outline recommendations for an overhaul in the way services are funded, commissioned and accessed.

While this is a tentative step in the right direction, the success of such an initiative will depend wholly on the outcomes it achieves. From the better integration of services, the introduction of new legislation, providing more funding that can be directed towards best-value outcomes and encouraging individuals to plan for their own care needs, the Government must act now to address urgent concerns in the sector, or endanger its very existence.

Announced by the Government in June 2013, the £5.3bn Better Care Fund was lauded as a revolution in health and social care integration, creating a single pooled budget to encourage the NHS and local government to work together more closely. Nearly four years on, there is little evidence that large-scale integration is working. In 2014, The Barker Commission proposed merging the NHS and social care in England, with a combined budget, on the grounds that the NHS is free at the point of need, while social care support is means-tested. An integrated budget under a single commissioning body may seem challenging to implement, but is exactly what the sector needs – eliminating the incentives for patients to stay in hospital, while ensuring the focus is placed on reaching the best-value outcomes for individuals based on their specific care requirements.

With the NHS under unprecedented pressure, current efforts to reduce the burden of elderly care on the healthcare system are not working in many places, and it is time to explore legal intervention. One possibility is making local authorities legally obliged to provide sufficient services to prevent delayed transfers of care, and subsequent penalties if they fail to do so. If patients can be moved into suitable community or residential facilities, or provided with homecare, this would release significant NHS resource. However, this will only work if local authorities are allocated sufficient funds to provide the required level of support and NHS and local authorities are put under legal duties to deliver integration.

The Green Paper must find ways to incentivise individuals to anticipate and plan for their own elderly care needs. Delayed until April 2020, after initially being planned for introduction in 2016, the ‘care cap’, which limits the total costs an individual will pay for their own care to £72,000, could provide a basis for individuals to plan for their future, especially if such costs could also be insured.

Attitudes towards long-term social care provision need to change. We are actively encouraged to plan for our pensions, why shouldn’t it be the same for our care? Attractive incentives to invest in care insurance, perhaps in the form of tax breaks, should be introduced to encourage individuals to make such plans. The Government needs to work alongside the insurance industry to ensure that a suitable suite of products is available to meet this demand.

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