Care bill: there is still work to be done



As the bill reaches report stage in the Commons, campaigners are calling for a better settlement on funding care

MPs and peers have spent the best part of the past six months scrutinising the government's care bill. They have shaped a piece of legislation, which - in theory at least - promises to overhaul England's creaking care system. Now the bill is reaching its final parliamentary stages, what have we gained and what remains to be addressed?

Advocacy for people who need help to exercise their rights to social care was not in the bill when it was first introduced. It's thanks to the hard work of the Care and Support Alliance, which represents more than 70 charities, that civil servants and ministers came to be convinced advocacy needed enshrining in the bill.

Another surprising omission was any attempt to set up a system allowing people to appeal decisions about their care. So grave was the concern of the Care and Support Alliance, among others, that policy wonks at the Department of Health seemingly spent their Christmases drafting a new clause paving the way for an appeals system.

Given Independent Age's concerns about family members paying top-ups to fund their elderly relatives' care home fees (and in the process, subsidise cash-strapped councils) we were clearly pleased minister Norman Lamb committed to introducing clearer rules on charging for residential accommodation. We await improved regulations, which better serve older people and their families, in the next few months.

One of the losses is around the contentious area of precisely how an individual's personal budget should be calculated. This was debated at length, with Paul Burstow MP echoing the wider concerns of charities, including Independent Age, that any personal budget should reflect the cost of purchasing care from a local provider.

However, the government stood firm, restating again and again that personal budgets would be set at whatever the cost would be to the local authority to purchase the equivalent care. The concern among critics is that councils can often rely on block purchasing and negotiation to secure care at a rate lower than an individual could if they approached a provider directly.

Independent Age's call for local authorities to signpost people to independent sources of information and advice, as part of their legal duty to deliver a comprehensive information and advice system, met with similar resistance. Ministers cited localism, justifying that it was up to local authorities to decide precisely how they deliver their information and advice duties. More worrying still, we have grave concerns that a national minimum eligibility threshold, set at the equivalent of "substantial" in today's Fair Access to Care Services framework, will continue to shut hundreds of thousands of older people out from the care and support they badly need to remain independent.

While all the right noises were made about prevention and the new "wellbeing principle", prioritising individual wellbeing above all other considerations, the debates revealed cracks in the government's plans.

Independent Age and others remain concerned that offers of preventative services to arrest or delay the emergence of care needs may in reality boil down to the provision of basic information. We have long campaigned for a clearer, fairer social care system, in which adults with care needs can get the basic information and advice to make informed choices about their care. We have also lobbied hard for improved rules to better protect families against the injustice of paying unfair top-up fees when an elderly relative moves into residential care.

Much has been achieved this past year. The care bill will soon get royal assent. When the draft care and support bill was introduced to parliament in July 2012, HM Treasury had not even made a decision to implement the so-called Dilnot cap. However, there is still a great deal to be done.

Independent Age will continue to play its part in campaigning for a better settlement on funding care. The residential care sector is seriously underfunded, perhaps by £700m.

And those of us concerned about creating a better system from 2015 must now turn our attention to regulations and guidance, which local authorities will look to as the real guide for making improvements in care and support. Unless we get these important bits of guidance right, the fine aspirations set out in the care bill will soon ring hollow.

Source; The Guardian

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