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Is the Big Care Debate big enough ?
8 August 2009
The Green Paper, Shaping the Future of Care Together, invites
everyone to join the “Big Care Debate” on what a National Care
Service should look like and how adult social care should be paid
for. In July 2009 Health Secretary Andy Burnham launched a
consultation on the Green Paper, open until 13 November 2009, which
is aimed at health and social care professionals. This two part
article summarises the key points and funding options presented in
the Green Paper and comments on those proposals and their likely
practical effect across health and social care.
The context is that care can be costly, but is
unpredictable:-
- 20% of people over 65 will need care costing less than
£1,000
- At least 50% of over 65 year olds will need care costing at the
very least £25,000.
- 20 % will need care costing more than £50,000.
People have no way of knowing which category they will fall
into.
The Green Paper proposes that everyone will get some care for
free. The consultation invites views on how the Government should
balance fairness for all against support for the few facing the
very highest costs. Whatever the outcome, it will have profound
implications for all providers and commissioners of health as well
as social care.
Entitlement
The Green Paper says that every adult should be able to
expect:-
- Preventative services – keeping people independent and well for
as long as possible
- National assessment – a process which is consistent throughout
England
- Joined up services – where all services work together
smoothly
- Clear information and advice – a care system that is easy to
understand and navigate; and
- Personalised care and support - services based on personal
circumstances and need
The concept of entitlement to certain standards runs through the
proposals. Our experience is that raising service user expectations
in this way can increase complaints and litigation. We discuss this
further in Part 2 but the real focus of the Green Paper is on how
care should be funded, and this issue has dominated the
headlines.
Funding of Care and Support
The Green Paper seeks to guarantee “fair” funding of care
services for everyone, making sure money is spent wisely and
everyone will get some help meeting the high cost of care. Free
long-term care funded from general taxation is ruled out. Instead,
three funding models are proposed:-
- Partnership – sharing the cost of care between the Government
and the individual, with the Government providing between a quarter
and a third of the cost (more for people on a low income).
- Insurance – the same as Partnership, but making it easier to
take out insurance to cover care costs (the estimated cost of
insurance is £20,000 to £25,000).
- Comprehensive – effectively making that top up insurance
compulsory, so everyone who can afford it would pay into a state
insurance scheme.
One problem is that this focus on funding means that some
fundamental issues might be overlooked - especially the key
distinction between “health” and “care” needs. In short, in looking
so firmly at how we pay for care, are we missing a chance for a
real discussion about what care we should be paying for, and how it
should be provided?
This article was first published in Primary Care
Today
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