In this section
iMPOWER's blog
Will Dilnot work? - Forget the national debate about the long term, it is up to local councils right now
Andrew Dilnot's report on the future funding of social care is published today. It has already started a frantic scrabble of response by politicians and other interested groups. Questions that will be hotly debated will include:
- how will we ensure equal access across the country?
- will a national contribution threshold work?
- what would an insurance market look like?
- should councils really become mortgage providers like Northern Rock?
- who should benefit and who loses?
- what about localism?
All acknowledge the unsustainable present situation has been ignored for too long, and there seems a genuine willingness to find a solution - but will it be possible to stop this turning into a debate about whose taxes pay for what can be seen as a several billion pound investment for the middle classes? Will we get another "pause and reflect" (which is basically what we have been doing since Labour decided the problem was too hard in 1999 and 2009)?
There will be no shortage of opinion on where this is going long term - but what does this mean for Council Chief Executives and Directors of Adult Social Care now? The big test will be how this national debate feeds in to budget setting for next year. Can the maturing of understanding of adult social care through the national debate be used to make good local decisions - or will it just be a diversion?
A billion has been taken out of adult social care budgets this year and probably another billion next year. Dilnot might not have a working system to change in 2014 if we don't act sensibly now!
Jeremy Cooper, director, iMPOWER Consulting
Have your say
David Welsh
Up here in Scotland personal and social care has been free at the point of need for several years - a policiy which is undeniably popular but continues to be controversial. It probably goes to the heart of how an increasingly devolved Scotland might behave in the future. Although the publication of the Dilnot Report has no direct bearing on the care of older people here, it was interesting that the Convention of Scottish Local authorities (COSLA) is again questioning "free" personal care, largely on how sustainable this policy can be given demographic changes facing the country. For example, our statisticians estimate that in the next 15 years the number of people aged 85 and over will double, and those aged 90+ will rise by 200 per cent. Their intervention however is part of a wider theme being developed by COSLA questioning the universality of service provision in Scotland and a perceived need to means test much more of what our public services provide up here. Its Chief Executive argued a few weeks ago that the wealthiest "0% of Scots need relatively little from the public purse and that our efforts and energies should instead be devoted to the poorest fifth. It is fair to infer from this that a 'national contribution threshold' for care could be considered here too? On the other side of the debateare the SNP Government, implicity supported by senior Labour Party figures in Scotland, who retain a commitment to free personal care(and universal benefits more generally). Their belief is that more ould be achieved if provision was more cost-effectively delivered. Indeed, the idea of an integrated National Care System is perhaps more openly in play in Scotland than in England. Either way, the issue won't go away. Our view must surely be that a 'pause and reflect' response by our politicians is now inappropriate: continued reviews, commisions,reports and inquiries merely exacerbate the problem. Instead, we must grasp the nettle (or thistle up here) and accept that significantly increased care costs become a conscious and routine part of our planning for the future, eitheras individuals or as taxpayers.
11:33am on 06 Jul 2011Olly Swann
Dilnot or Dilbert? The jury's out.... As the press coverage & social media reaction has proved, this is clearly a very emotive and complex topic, and as is usually the case with any proposed government policy, there are winners and losers behind the recommendations. Whilst the coalition should be praised for not adopting the ostrich-style approach previous governments have embarked upon, have they really gone far enough in terms of the scope of the commission? There appear to be too many "what-ifs" and unanswered questions; the most poignant being where the additional £1.7bn will be raised from, and understanding what other socio-economic impacts this could have. Taxing the elderly? On what, their dwindling pension pots? It's just one example (but perhaps the biggest) that highlights the need for a fuller and further-reaching review. Social care departments are already being stretched to the extreme for cashable savings, and whilst further delays won't necessarily help local authorities with their planning for next year, is another papering of the cracks a viable alternative? They're facing the most radical service delivery transformation since the abolition of the Poor Law, and all of this on the back of the personalisation agenda, and having to bear the brunt of public sector funding cuts. Ideally, they'd be given time to incorporate the implications of the commissions' recommendations into their plans, but this simply isn't going to happen. They need to act now, and part of the solution may therefore lie within the improved health and social care integration recommendation. A genuinely preventative model based on admission avoidance and the early identification and intervention of long-term conditions, are both key components of a modern and proactive system, that could make significant in-roads to the estimated cost of the recommendations. Existing plans on this topics rarely go far enough, and usually equate to academic concepts rather than tangible changes that both deliverers and recipients buy in to. However, as with most transformational cross-sector change, there is likely to be a wrestle for benefit ownership and a need for up-front investment, and I wonder whether the government have the stomach and purse for the fight? Dilnot has started the debate admirably, but what happens next could be pivotal for UK politics and society as a whole. Dilbert famously stated "Change is good, you go first", but leaving the next steps to be determined by misguided politicians and self-fulfilling think-tanks would be criminal; this requires a full and extensive debate involving health and social care professionals, economists, service users, carers, charities, and the third and voluntary sectors. Get this right, and the coalition will be rightly credited for tackling one of the most thorny issues modern UK society has faced. Get it wrong, and they won't be afforded the luxury of waiting until 2015 for the next General Election.
09:25am on 06 Jul 2011Catherine Park
Quite aside from the nuances of whether future funding (and indeed services themselves) should be locally or nationally co-ordinated, I think we need to consider whether current spending on care for the elderly is effective. Well-co-ordinated early intervention strategies can help prevent hospital or residential home admission, reducing unnecessary expenditure and improving the life of the service user. The voluntary sector can also offer invaluable support; befriending services, for example, can help people remain in their own homes for as long as possible. Although the Dilnot Review briefly mentions prevention, it fails to emphasise fully the importance of it, or outline the measures that local authorities can take now to spend their budgets more effectively and improve the quality of life of the service user. Ensuring fair funding in the future is crucial, but we shouldn't forget the policy changes which could help reduce the cost burden on both councils and service users in the shorter term.
05:05pm on 05 Jul 2011Caroline Throssel
With nationally applied eligibility, assessment and contribution policies - is there a role for local authorities at all in administering social care? After all, if we are sick we rely on the National Health Service, and if we are out of work we turn to the nationally administered Jobcentre Plus - what makes social care so different that it needs to be run at a local level? The Commission emphasises the important role of councils in planning, providing, commissioning and arranging services that meet the specific needs of local populations; the needs of an affluent rural population are likely to differ significantly to those of an inner city. Under Dilnot's proposals local authorities would continue to refer to local markets when setting the cost of care packages. But how does this fit with a national cap on contributions of £35k? If we acknowledge that the cost of care varies across the country, shouldn't we also be setting a variable cap on individual expenditure? After all, £35k will buy a whole lot more support in Leicester than it will in London. Why not admit that the time has come for a radical rethink in the way that social care is delivered? A National Care Service would ensure a guaranteed standard of service, irrespective of where you live, with assured portability of care packages and a better hope of tracking individual's assets and spend on support. After all, Dilnot's recommendations hinge on the assumption that cumulative care costs can somehow be tracked over a person's lifetime. This would only be possible on a national level. When people become elderly and infirm they do not distinguish between their health and social care needs and neither should we. The report's final recommendation is for "improving the integration of adult social care with other services in the wider care and support system." For me, better outcomes for individuals and value for money for the state can only be achieved by integrating at a national level.
01:12pm on 05 Jul 2011Alastair Thompson
Good summary here: http://blog.lgiu.org.uk/2011/07/dilnot-report-summary-and-comment-on-areas-of-particular-interest-to-councils/
iMPOWER standards & awards
