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A Green Paper and grey expectations - is the 'Big Care Debate' big enough?
23 July 2009
In a Green Paper, 'Shaping the Future of Care Together', the
Health Secretary Andy Burnham has invited 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, with a consultation which
is open until 13 November 2009. Whatever the outcome, it will have
profound implications for all providers and commissioners of health
as well as social care.
Entitlement to care services?
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 – an assessment process
which is consistent throughout England
- Joined up services – a system where all
services work together smoothly
- Clear information and advice – a care system
that is easy to understand and navigate
- Personalised care and support - services that
are based on personal circumstances and need
But the real focus of the proposals is on how this 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.
There are three key proposals for funding the National Care
Service:
- Partnership - the cost of care would be shared
between the government and each person who has care needs, 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 will be £20,000 to £25,000)
- Comprehensive – effectively making top up
insurance compulsory, so everyone who can afford it would pay into
a state insurance scheme
The problem is that this focus on funding means that some
fundamental questions may be overlooked.
Where does social care stop and health care
start?
The dividing line between healthcare and social care is often
unclear, but it is critically important while health care is free
of charge but social care is not (and will not be, whatever funding
model is adopted). This fatal combination of a vital but obscure
distinction inevitably leads to lots of confusion, complaints and
litigation. For all the emphasis on the need for ‘joined up’
service provision, the Green Paper does not take the chance to
tackle this issue head on. Instead, the Green Paper’s focus is on
care and support.
“The activities, services and relationships that help people to
stay as independent, active, safe and well as possible, and to
participate in and contribute to society throughout the different
stages of their lives”.
It accepts that there are significant variations in the standard
and quality of care and support offered by different local
authorities, and implicitly recognises that the lower the standards
of quality and care offered by a particular local authority, the
higher the likely demand for NHS services in that area.
The law
With its focus on reforming the funding model, the Green Paper
has not taken the opportunity to address the underlying statutory
framework for entitlement to care, which remains the “confusing
patchwork of conflicting statutes enacted over a period of 60
years” described in the Law Commission’s scoping report on adult
social care published in December 2008. The Green Paper only
mentions this report briefly, when it could have contemplated a
coherent and comprehensive reform of the piecemeal and labyrinthine
law in this area.
Expectations and entitlement
The Green Paper emphasises ‘choice’ and ‘entitlement’, echoing
the recent policy approach to delivery of healthcare, and the
language of the NHS Constitution. Our experience is that this
consumerist approach can, and will, have consequences for service
user expectations, invariably increasing complaints and
litigation.
The future?
As public service budgets tighten, and public expectations rise,
there will be more pressure than ever on the issues of entitlement
to care and funding. Complaints and litigation will increase across
health and social care. The extremely complex and piecemeal law
underpinning entitlement to social care, and the lack of clarity
over the vital distinction between health and social care, can only
be good news for the lawyers making a living from these disputes.
While the funding model needs to be addressed, these underlying
issues are far too important to be left as such a grey area.
The government encourages everybody to take part in the Big Care
Debate. It recognises that those on the front line of care and
health services delivery have a huge part to play. Browne
Jacobson’s health and social care team is considering a response to
the consultation and would very much welcome your views on the
opportunities and challenges the Green Paper raises.
talk to us
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