Yes – back to that old chestnut – crisis in social care. I am beginning to think there has never been a time in the last ten years when social care has not been in crisis.
And what is the key ingredient for every social care crisis – funding.
In fact you may remember that at the general election – there was emphasis on NHS but no mention of social care. Now once again with the spending review there are no extra funds from the government. Local councils have now been given permission to raise council tax by 2% to pay for social care – but will it? Will enough money be raised in this way to cover all social care needs in the borough? What about those boroughs with high populations of older people – will there be enough money? What about those boroughs which are in areas of high deprivation? The Council tax will be likely to be much lower than some richer areas such as the South West – how much will the 2% increase raise in those boroughs?
Once again the left hand of government does not appear to know what the right hand is doing. What is the sense/logic of putting more money into the NHS then cutting local authority budgets by 6.7% and allowing councils to raise only 2% locally? If there are no community services then there will be delays in hospital discharge. Simple. Obvious. But why can politicians not see this?
There is constant talk about integrated care – but until you have integrated budgets which are ring-fenced – you will never get integrated care and in ten years time we will still be saying the same things.
The other major concern is the workforce – already there are high vacancy rates often filled by people particularly outside the EU. If the numbers of these workers are restricted as some proposals are suggesting and if those that are allowed in have to pay extra for their NHS care – another proposal – and of course they will hopefully be on the living wage – how attractive is that to fill the vacancies? Would those sorts of conditions attract you to work in the care industry? At present there is the prediction that there will be a shortfall in the care workforce of over 200,000 by 2020. Has the government any plans to cover this? Or are they hoping that family and friends will provide care that they refuse to provide? Hard luck if you have no family!
The other worry is the provision of residential and nursing care. Although it is mandatory for staff to be paid the living wage there has been no discussion with care home providers as to how they will implement the living wage. There is considerable concern by all providers of residential and nursing homes – big companies and small as to how they are going to be able to continue providing services. Care homes have not had the best press in the world following the abuse and neglect highlighted in the media. A high percentage of homes have been classed as ‘inadequate’ on various fronts by the CQC Inspectors. Councils cannot afford to pay the care homes the going rate for people who have no savings and are on pension credit and the council’s responsibility. Although these people pay their pension credit and a large part of their pension towards their care – the care is not covered. In the past – people were allowed to keep £25 per week from their pension to pay for hairdressing, clothes, cards and presents for family especially grandchildren, toiletries and any extra little treat. In many places – people are expected to pay for any activities they join. Although hopefully it is now more than £25 per week, I am sure the allowance is not generous. It is said this maintain a person’s dignity and independence – really? I would like to see how well government ministers and politicians coped on this pocket money.
So what of those people who have saved all their lives and who have assets including their home of more than £23,250 (well in London you would be lucky to get a garage for £20,000). They are classed as self funders and as such have to pay the full amount which varies depending on the borough – in Richmond, Surrey, it is around £850 a week. Apparently the average cost for care homes is around £32,000 per annum. This does not necessarily cover the costs of nursing care but only the hotel or accommodation costs. The amount that is paid by self funders is not only covering their own care home costs but almost half in some cases goes on subsidizing the residents paid for by the council. Did you know you were paying a substantial amount towards the cost of another resident? Were you ever asked or informed? Do you think it is right that you should be paying for someone else as well as yourself? And what happens to you when your savings run out? Usually you are moved into a cheaper home – nobody subsidizes you. But even with this rather unfair system of overcharging self funders – care home providers are very concerned as to whether they will be able to continue to keep open and in fact have made serious representations to government ministers for help. We are told older people are well off but when fees rise by an average of £299 last year – 54% more than the average income/pension gain older people received and with around zero interest on savings – wealthy may not be the appropriate description for long.
Yes – there are things home owners can do to pay for their care such as equity release against property and this may be very sensible as it will reduce inheritance tax but will there be any care homes available? Will there be any community services available in the future?
Many people are very concerned as to how will they pay for their care in future whether in a home or in the community and the danger is that if people feel they are going to run out of money – they will not ask for help or care which could lead to disastrous results and end up costing the NHS far more.
Although late in the day it is urgent that all government departments – health, social care, housing, environment, transport and all aspects of community living get together and have a joined up conversation about the future of care. Only when there is ‘integrated debate’, ‘integrated funding’ will there be true ‘integrated social care’.
Your thoughts please.