Alzheimer's Society briefing on Green Paper for funding adult social care in England

Green Paper on reform of the care and support system

This document provides:

Information about the Green Paper on reform of the care and support system, including key proposals
Alzheimer's Society initial response to the Green Paper
Ways in which people with dementia and their carers, staff, volunteers and members can get involved in the consultation.

1. What is the Green Paper?

On 14 July the Government published the Green Paper 'Shaping the Future' which explains proposals for changing the current system of delivering and funding social care in England and how the cost might be met. It focuses on all adults with disabilities although there is strong emphasis on older people and people with dementia because this is where the majority of the care cost comes from and where the growth in need and cost is going to come from too.

2. What is the consultation?

The Government wants to hear the views of the public about the proposals during the consultation period which runs from now until 13 November. A key priority for Alzheimer's Society over the coming months will be responding to the consultation. We will encourage and provide opportunities for people with dementia and their carers and Society volunteers, staff and members to get involved in what the Government are calling the Big Care Debate.

3. What does the Green Paper say about the current system?

It states that the current system is broken and needs fixing
There is not sufficient money in the system to provide enough care to meet need or to provide quality care
There is a need to increase funding available for care services
The system is regarded as complex and unfair and penalises people who have saved all their lives.

4. What are some of the key elements of the Green Paper?

4.1 National Care Service

'The Government's vision is for a system that is fair, simple and affordable for everyone, underpinned by national rights and entitlements but personalised to individual needs. In the new National Care Service, everyone should be able to get really good care wherever they live and whatever they or their family need'.

Extract from the Green Paper 'Shaping the Future.'

At the heart of the Green Paper is the proposal to create a National Care Service to end the postcode lottery in care and introduce a universal minimum care entitlement so that everyone gets some support from Government.

Key aspects of the proposed National Care Service are:

National assessment of care needs. This means that wherever you live in England you will have your care and support needs assessed in the same way. People assessed as needing care in one place should be able to get the same level of care, and the same proportion of their care costs paid by the state, even if they move somewhere else in England.
Joined up services between social care, health, housing services and the benefits system.
An emphasis on prevention services to help people to stay well for longer, so care and support needs do not get worse.
Improved information and support so people can navigate their way through the care and support system easily.
Personalised care and support to give people greater choice and control.
Fair funding. Everyone will get some help from the Government to meet the costs of their care and support needs.

To make this vision a reality, the document identifies 3 key changes:

1) More joined up working, as described above.

2) A wider range of care and support services

3) Better quality services and innovation

4.2 Paying for the cost of care

The Green Paper points out that the numbers of people needing care will increase in the future and the cost of care and support is currently high:

By 2026 there will be 1.7 million more adults who need care and support
A 65 year old can expect to need care costing an average of £30,000 during their retirement. While some people will pay less, others will pay more: 20 per cent of people will need care costing less than £1,000 during their retirement - but 20 per cent will need care costing more than £50,000.

The costs of care are particularly punitive for people with dementia. This is because the majority of their package of care comes from social care, arranged by the local authority, which is means tested. This essential care includes help with washing, eating and using the toilet. In addition, people with dementia will need help for a long period of time.

The Government has said it will need to increase funding available for care services to pay for a better system in the future.

Current funding

One of the ways it proposes to bring more money into care and support is to merge the money currently spent on Attendance Allowance - a non-means tested benefit for disabled people aged 65 and over - with care funding. It also sets out a number of different funding options.

Funding options proposed

Three models of payment are proposed for consultation where both the state and individual makes a contribution:

1) A partnership model

The state would pay for a proportion of the care costs of any individual - for example, a quarter or a third - ensuring that everyone gets some support free. People would have to pay towards the rest of the cost dependent on means. Under this option, people might need to pay around £20,000 - £22,250 towards the rest of their care costs. While some people will pay less than this, other people with high levels of care would expect to pay far more.

2) An insurance model

The state would pay for a proportion of the care costs of any individual - for example, a quarter or a third - ensuring that everyone gets some support free, just as in the Partnership model. In addition people could choose to pay into a private insurance or state insurance scheme that would cover the rest of the costs. This could be paid in instalments, as a lump sum on retirement or after death if preferred. As an indication someone at 65 might on average have to pay around £20,000 to £25,000.

3) A comprehensive model

Everyone over retirement age would be required to pay into an insurance scheme depending on means and care would all be free once this requirement is met. The insurance could be paid during their working life, during their retirement or after they died. As an indication someone at 65 might on average have to pay £17-20,000, although the amount paid could be varied according to what people could afford.

Two funding options have been ruled out by the Government:

They have ruled out everyone paying for themselves because they think it would be unfair
Care funded by general taxation has also been ruled out on the basis that it places a heavy burden on adults of working age.

Accommodation costs

It is important to note that these funding options would cover costs of care services received in someone's own home or a care home. It would not cover housing and living costs in a care home. The Government argues in the Green Paper that there will always be a role for the state to play in helping people with local income and assets, but that they believe it is fair to expect the majority to meet accommodation costs themselves The Green Paper includes a proposal for a deferred payment scheme to help people meet the accommodation costs of residential care.

4.3 National consistency and local flexibility

The Green Paper proposes that the Government would set the level of need at which someone qualifies for state funding. The Government would also set nationally what proportion of someone's care package would be funded by the state. Beyond this, the Government are consulting on whether local government should decide how much an individual should have overall to spend on care and support, or whether national government should decide.

5. What is Alzheimer's Society initial response?

Alzheimer's Society welcomes the debate on a new care and support system that is fit for the future. People with dementia are among the biggest users of social care and the numbers living with this condition will double in a generation. Any new system will fail if people with dementia are not at the heart of the solution. We will examine all the options presented in the Green Paper and will consult people with dementia and their carers everywhere.

It is vital that the voices of people with dementia are heard in this important debate. Alzheimer's Society has long argued that the current social care system is complex, unfair and fails to deliver good quality care. People with dementia are hit hardest by the charging system in comparison to people with other medical conditions, such as cancer, because the majority of their care needs are classed as 'social care' (means tested) and not health care (generally free of charge on the NHS). They are also likely to need this support over a long period of time, meaning many years of high care bills.

Alzheimer's Society has argued for a new system that is simple and transparent, guarantees good quality care at a fair price and ensures that payment for care does not penalise people with dementia. We support the principle outlined in the Green Paper of sharing the risk of paying for care across society and beyond those who are unfortunate enough to develop a medical condition, like dementia.

We need to carry out more analysis of the different funding options proposed and the impact on people with dementia; however our initial response is that people with dementia would be protected from some of the higher costs of care. We will be asking people with dementia and their carers their views on the different funding options.

Alzheimer's Society is concerned about the proposals contained in the Green Paper on Attendance Allowance. Our research with people with dementia and their carers identified significant opposition to the proposal of moving money from benefits into care services. Our current position is that people will react very strongly against the proposal unless a cast iron guarantee is given that access to good quality care will improve.

The Green Paper emphasises the need to improve quality of care; however, we are concerned that it does not make clear whether the funding envelope of care per individual will increase as a result, allowing better quality care to develop.

6. What are some of the key questions in the Green Paper that Alzheimer's Society will need to consider?

What people's views are on the proposal to give everyone a national care entitlement?
Out of the three funding options for social care that the Government suggests, is there a single option that would deliver a better deal for people with dementia?
Whether the Green Paper proposals meet Alzheimer's Society's principles for a new care and support system that is simple and transparent system; delivers good quality care at a fair price; and where payment doesn't just hit people with dementia?
Whether people agree with the proposal to shift the cash benefit Attendance Allowance into the care system?
Whether political consensus can be achieved on reform of care and support system?
Whether the proposed increase in funding for social care will be enough to increase the quality of care that people receive?
What could be done to make the general public realise that it is very likely they will need social care in the future and that it is a very important service that needs a proper level of funding?

7. How can people get involved in the debate?

The publication of the Green Paper marked the launch of the Government's Big Care Debate that will run until 13 November.

People can get involved in a number of ways:

Through contributing views via the care and support website and facebook site.
Via leaflets with specific consultation questions, which will be distributed via GP surgeries, pharmacies and other outlets. These can be sent back to the Department of Health freepost.
Through taking part in one of the 36 Department of Health stakeholder events which will be held throughout the summer across England.
By holding their own consultation events. A toolkit to help set up an event is available on the care and support website.