Assessing the Care and Support White Paper: Is care reform being "thwarted by the Treasury"

The Government has published the much anticipated Care and Support White Paper, setting out ‘a new vision for reform’ that draws upon the recommendations of the Dilnot Commission, which concluded in July 2011. The Paper also takes on board research by the Law Commission, the Palliative Care Review and the All Party Parliamentary Group on social care that met in April but, notably, leaves out a commitment to a cap on individual care costs.

Originally scheduled for publication in April, the delay to the White Paper has drawn criticism from the opposition benches, with Shadow Health Secretary Andy Burnham accusing the Government of “going cold” on care reform. However, unlike the controversial Health and Social Care Bill, the Dilnot recommendations have full care sector support and also, so far at least, something of an all-party consensus, the luxury of which could nevertheless lead to more political discontent if a means of implementing major legislation is not found.

Addressing the House of Commons yesterday, Health Secretary Andrew Lansley began by defining the aims of the White Paper, saying: “We inherited a system that too often lets people down and is unfair, a system that is complex and confusing and which responded to a crisis but too rarely prevented it. For many years people have called for a system fitted around the needs of care users, not the preferences of the service; one that puts people at the heart of the service and delivers high quality care with dignity and respect.”

The health secretary went on to confirm support for key Dilnot Commission goals that care reform must live up to, including:

•the importance of early intervention in promoting independence and well-being

•support for establishing a ‘continuity of care’ so that individuals have no fears of moving between local authorities

•personal budgets to all service users who wish for more control over their provision, with the legal right to request deferred payments •confirmation of £200m of funding allocated for the development of specialist housing

•the setting up of a Universal Deferred Payments scheme to ensure that individuals needing care will no longer be forced to sell their homes for finance

•care workers will be expected to adhere to a national code of conduct and minimum training standards, in pursuit of which the Government is to provide funding for 50,000 more apprenticeships by 2017

•together with a pledge to make care, not the care provider, the central focus of reforms in order to protect service users’ well-being when providers go out of business, learning from lessons exposed by the collapse of the UK’s former largest care home provider Southern Cross Healthcare.

Lansley also confirmed support for the Palliative Care Review’s recommendation that everyone deserves to have the choice of where to end their lives, with data from eight pilot sites to be compiled in order to inform effective end-of-life care practice.

In response, Andy Burnham offered the opposition’s support on many of the key recommendations, saying: “We welcome many of the ideas published in the White Paper today: a universal deferred payment scheme would help spare vulnerable people the agony of watching savings and assets being washed away; national standards on eligibility could help bring some consistency to a care system in England which is today the ultimate postcode lottery; stronger legal rights for carers are overdue, as are improvements to end-of-life care.”

However, Burnham criticised the health secretary for coming up with no answers on the financing of long-term care, quoting the Alzheimer’s Society to label the Paper a “massive failure” and claiming: “There is one crucial difference between this White Paper and ours; despite the obvious political risks in doing so, we faced up to the difficult issue of how to pay for the issue of care and support in the century of the ageing society – this Government has failed to do so. With no answers on the money this White Paper fails the credibility test: it is half a plan.”

Burnham went on to criticise the Coalition for public sector cuts, saying that local councils would be looking on ‘in disbelief’ at the idea of extra costs right now; “There is no point in promising new ideas if it is on top of the crumbling foundations of care budgets”, and looking to characterise the Government’s handling of the Dilnot proposals as a ‘pick ‘n’ mix approach’.

However, the theme of ‘Care Reform vs the Treasury’ will almost certainly stand out as the key topic for on-going debate, as it remains clear that the primary concerns of MPs’ discussing the White Paper, and indeed within the national media in the run up to its publication, have been focused on one specific issue; the cap on individual care costs.

As rumours suggested last week, the issue of funding a ‘care cap’ has been delayed until next year’s Spending Review, with little impression that a solution is close to being agreed upon. Itself perhaps the overriding reason why the White Paper had published alongside it a ‘Progress Report’ and placing in further doubt the speed with which Parliament can proceed to implement or even effectively debate major care legislation.

The Dilnot recommendation was for a £35,000 cap, rising to £50,000 if the Coalition did not find this achievable, but despite this flexibility it is clear the cap has so far proven an immovable obstacle within government. Estimated as costing the treasury £1.7bn to support, as early as the autumn 2011 there were unconfirmed reports that Chancellor George Osborne felt such a cost could not be justified. Although unclear whether this was in the context of a poor economic climate, it remains certain that a poor financial recovery has failed to strengthen the argument against this position, and so Burnham’s summation of the Dilnot reforms being ‘thwarted by the Treasury’ might prove the most potent of Labour criticisms.

Also notably absent from the health secretary’s statement, was any mention of care insurance, as emerging service users are currently unprepared to source care without major upheaval. Last week Andrew Dilnot told a Health Select Committee on social care that “There is strong support for capping care costs; this would provide a major opportunity for behaviour change,” necessary to help the insurance market “facilitate a range of financial products”.

Published alongside the White Paper we also have a ‘Draft Care and Support Bill’, which Lansley was keen to be viewed as “a major reform in its own right”, perhaps being keen to show progress while the sector continues to wait for what is seen as the legislation’s most important addition. For an analysis of the Draft Care and Support Bill read Rachel Baker's article here: www.carehome.co.uk/news/article.cfm/id/1557481/draft-care-and-support-bill-puts-people-at-the-centre-of-their-own-care

Image: Andrew Lansley, Shadow Health Secretary, speaks at the 2009 Conservative Party Conference in Manchester, Monday October 5, 2009. (Photo by Paul Toeman)