Is merger with NHS the answer?
by Paul Roberts www.caringforyourbusiness.co.uk
The long and tortuous search for a solution to funding long-term care in England is turning into the Holy Grail of social care. Millions of pounds have been wasted on Government green and white papers and endless consultations on ‘blueprints’ for the way forward that will never leave the drawing board.
Now, with the Coalition Government setting up a special commission to shape the future of adult care funding, an influential think-tank has put the cat among the pigeons by questioning whether fundamental reform is necessary.
In a new report, Policy Exchange has recommended that the commission investigate the possibility of merging health and social care budgets – with the NHS taking over responsibility for social care funding from local authorities.
Policy Exchange has suggested in Careless: Funding long-term care for the Elderly that the controversial proposal be considered with three other potential funding models:
A partnership scheme where the State funds 50% of everyone’s care and then matches £2 of contributions from the individual with £1 from the State
A compulsory social insurance scheme which would require everyone over a certain retirement age to make either a one off payment or regular contributions
A hybrid model under which the State would guarantee some level of care but people would be required to top-up for their long-term care through insurance or annuity backed products
The merging of health and social care budgets will appeal to our new cost-cutting government. It will delay – perhaps indefinitely – the need for radical reform of long-term care funding. It will be a cheaper option than the partnership or hybrid models and less controversial than a compulsory insurance scheme.
Many in social care will applaud the idea – particularly as the government has promised to protect spending on NHS front-line services while social care budgets are likely to be slashed by 25% or more in public spending cutbacks.
Policy Exchange say an obvious perceived conflict to delivering them as one service is that the NHS is free at the point of use while long-term care is not.
‘This is simply not true,’ they say. ‘The NHS is not completely free at the point of use. Those with relatively limited means already pay for prescription and dental charges, the so-called co-payments. In addition, top-up payments – where people pay for treatments (mainly cancer drugs) – are also permitted under
current NHS guidelines.
‘To ensure that health and social care provision continues to remain affordable for the State, we believe that it is more important to extend the principle of top-up and co-payment in the NHS, rather than free care at the
point of need into long-term care.’
Of course, being part of the NHS – inextricably linked with social care – will have its benefits. Plans to reform the NHS – with more decision-making being devolved to the GPs – offers an opportunity to look at whether a merger of health and social care is possible and practical.
Integrated care schemes being piloted throughout the UK are proving a success and offer an alternative way forward. But let us not lose sight of the potential complications and escalating costs of merging two care giants.
Cynics will see a joining of the two as a back door way to making people pay for all but emergency care and operations. Would a merger make a combined health and social care service more or less vulnerable to swingeing cuts?
The NHS is a huge organisation slow – and very often reluctant – to reform. Local authorities may be less than happy at losing social care – and its highly trained staff – to the NHS. Would social care be a poor or equal relation under the NHS?
The question is: who will be bold enough to make a decision on the future of long-term care funding?
What the Policy Exchange say…
Unrealistic plans: Labour’s plans for a National Care Service are unrealistic – with free personal care likely to cost the State an additional £106 billion a year. Funding care through general taxation should be excluded from consideration because it would be ‘unaffordable and unfair’. The Conservative plan for people to pay £8,000 to cover the costs of all future residential care are unrealistic, with care likely to cost as much as £40,000 a year.
Prevention works: Partnerships for Older People Projects (POPPS), funded by the Department of Health at a cost of £60 million, should be expanded across all local authorities and PCTs. Popps have been found to have a significant effect on reducing use of hospital emergency beds.
‘Oldest old’: The fastest population growth is among the ‘oldest old’ – those aged 85 and over. Significant increases in demand for social care in the UK are thought not to begin to arise until the mid-2030s, when the bulge of post-second world war Baby Boomers begin to turn 85 and are more likely to require care. There is no urgent demographic pressure to make hasty decisions regarding reform of the system of financing long-term care.
Financial advice: Financial advice should become an integral part of the long-term care system. This should be achieved by compelling local authorities to signpost people to regulated financial advisors once they have conducted an eligibility test.
Care funding: A new system of long-term care funding would be fair when: Access to care is uniform regardless of income; funding arrangements between health and social care are consistent to prevent local interpretations of what qualifies as a social care need; the responsibility of paying for care is distributed between the government and the public; and generations equally share the burden of paying for care.
December 28th, 2010 at 8:58 am
With thanks.