All posts in Policy changes

All Change For The NHS

Do you realise what a momentous change takes place today, 1st April?  Our beloved NHS, as we know it, will be abolished, just short of its 65th birthday. The Health and Social Care Act comes into force with serious consequences for us all, especially older people.

Last year I watched with unease at the health and social care bill during its turbulent passage through parliament and became increasingly concerned about its affect on older people.

Unfortunately very few of us understand its implications and  it will affect us all more than any legislation passed in our lifetimes. It is the final stage in the dismantling of the NHS, a process that began around 25 years ago without most of us realising what was happening. Law pic

The Government’s case for change is largely based on the assumption that the NHS is no longer affordable, particularly in the current financial climate, and that it needs to be modernised. I believe this assumption is false. Of course things have to change but research overwhelmingly shows that the NHS performs well in comparison to other healthcare systems internationally. It is also cost-effective and highly valued by patients.

Key changes in the NHS

  • From 1st April, Primary Care Trusts (PCTs) and strategic health authorities will be disbanded.
  • In their place Clinical Commissioning Groups comprising of local GPs among others, will control about £60 billion of the NHS budget and commission local services.
  • A new body, NHS England will oversee the NHS
  • Responsibility for public health, will transfer to local authorities who will take the lead for improving the health of their local communities.
  • Commissioning will take place through competitive tendering and NHS contracts will be opened to the private and voluntary sectors.
  • There will be huge profits to be made for private healthcare companies who can’t wait to get their hands on our NHS.

The government claims private providers will improve standards through competition and choice. However experience of the NHS getting into bed with the private sector, whether through private finance initiatives (PFI) cleaning contracts in hospitals or the takeover of the GP out of hours service – has been disastrous so far. Privatisation has driven up costs and produced worse results.

Competitive tendering fragments healthcare. Older patients often have several chronic conditions. In future things like eye screening and dietary advice could be provided separately by different providers, making it confusing for the older person and more difficult for their GP to coordinate.

The government consistently claims the NHS budget is protected while in reality, it is being forced to make cuts under the guise of efficiency savings. Across the country, accident and emergency departments and other services are being closed and thousands of jobs are being lost. Older patients with chronic and complex diseases will continue to lose services essential for their care and receive insufficient and poor quality care on hospital wards.  As a result of these changes, people will die.

My heart sinks when I think about the impact of the changes on older people I know and love. Local campaigns are joining up to fight back and I will be joining them. The Government and others with a vested interest may think the fight is over, but the battle to keep our NHS has only just begun, so watch this space!

Long Term Care Fees – The Truth Part Two

If you felt reassured by Monday’s announcement about the £75,000 cap on long term care fees, think again. The more detail is uncovered, the more concerned I am becoming. The following information is based on an article I read by James Lloyd, director of the Strategic Society Centre that I would like to share with you.

He made the point that  the ‘cap is not really a cap at all because of the ‘living cost’ contribution of  £12,500 that individuals will be expected to make. This is higher than previously considered and will force more people to draw on their capital.

Furthermore the vast majority of the 125,000 older people funding their own residential care in England pay more than the rates paid by their Local Authority. Self-funders will therefore pay more than the value of the ‘cap’ before they reach it, and carry on paying for care after it. This will mean many having to carry on drawing on their capital beyond the ‘cap’.

Once people realise that they are likely to die before reaching the ‘cap’ what happens to the ‘peace of mind’ they were promised? This will mostly affect southern areas in the country areas where the proportion of pure ‘self-funders’ in residential care are the highest.MC910217019

It is confusing as to why ministers keep going on about how the reforms will lead to a pre-funded care insurance market. This is absolute nonsense. The consensus view in the insurance industry is that the ‘capped cost’ model will not result in an insurance market.

I believe the reforms will never actually be implemented in the way they are described today and a great deal of thought and attention will need to be paid to the way it affects individuals, the means test and standardised ‘living cost’ contribution.

Finally, the reforms do nothing to address the serious shortfall in funding elderly care, leaving social care the only public service that we have to pay for ourselves. We are a modern society that can send satellites into space and explore Mars yet we can’t look after some of the the most vulnerable in our society, older people. So forget about  not worrying about funding care fees in your old age. One in three of us will need significant care as we grow older and most of us will get no support whatsoever from the state, so don’t put away your ”For Sale’ board yet.

 

Long Term Care Fees – The Truth

After months of number crunching the Government has set the cap for social care fees at £75,000 which is very misleading. It only applies to the personal care element and is subject to both eligibility criteria and the prevailing local authority rate. The cap will not cover accommodation, food and general living expenses, or above the rate paid for by the local authority. This can be as low as £276 a week with the average cost of a care home with nursing in the South East  being around £800 a week. So in reality the cap is nearer £200,000.MB900423551

Change in financial threshold

The current financial threshold of £23,250 will increase to £123,00. As the value of the average UK house is higher than this it will make little difference to many older people needing care and most homeowners will still have to sell their homes to pay for care fees. The plans will be paid for mainly by taxpayers in the South East by raising inheritance tax thresholds.

An underfunded care system

The stringent rules around care home fees are only one aspect of our grossly underfunded care system, and not the worst. The decision by most local authorities not to fund people who are in desperate need, but not technically ‘critical’ is an even worse problem.

Will insurance be the answer?

The insurance industry will be planning ways to cover that first £75,000 of costs. With the exorbitant mark-ups for which the industry is known, these products will be unaffordable for many. Experience has also shown that the market for insurance products to fund elderly care has hitherto been very small, largely because most people believe that social care, like the NHS, is free at the point of demand and therefore fail to plan for them.

Self funders

While I am pleased that at last a decision is made to place a cap on care fees for older people, which is particularly important for the 41 per cent of elderly people in the care system who are “self-funders” because they have over £23,250 in assets including property, many are not very wealthy, yet I believe they are among the most overlooked and underserved in the care system.

They are people like you and me who have worked hard all our life for a pension that will make us ineligible for most welfare benefits, yet have savings that will not last long when paying care fees at the rate of over £2,000 a month.

 

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under  £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and  negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

The Francis Report and Older People in Hospital

My initial reaction to the Francis report into the failure of Mid Staffordshire hospital to provide safe, dignified and compassionate care leading to the deaths of hundreds of vulnerable older people is one of great sadness. I am also astonished that the people responsible are not being investigated for consideration of corporate manslaughter. bigstock-Sad-Elderly-Man-Sitting-With-A-6067493-1

Whenever front line staff are accused of a transgression affecting patient care they are quite rightly subjected to disciplinary investigation. Why on earth should this be any different for the people ultimately responsible for patient care at that hospital?

Poor practice in hospitals

The Francis report is the most recent in a long line of reports highlighting failures in patient care and I suspect it won’t be the last. 11 other hospitals are already being investigated for unexpectedly high death rates. I fear poor standards of care for older people on hospital wards is endemic, although I acknowledge there are pockets of good practice too.

Only the other week one of my elderly clients was discharged from our local hospital to a care home in a thin hospital gown with nothing on her feet on a freezing cold day. I alerted the Safeguarding Team which worryingly the manager had not done before I arrived. She told me bad discharges were the norm and despite raising it with hospital staff nothing seemed to change.Frequently I also find discharges delayed because my elderly clients are dehydrated (something which costs the NHS dearly as time in hospital is increased)

Recommendations made by Francis

I believe that if the recommendations made by Francis are to stand any chance of success there needs to be a robust action plan WHICH IS IMPLEMENTED AND MONITORED. So often good ideas and recommendations made after expensive enquiries and by so called Tsars who have been brought in to change things are unheeded by the Government and never translated into practice.

I believe the success of turning things around will ultimately involve breaking with tradition and involving patients, relatives and front line staff in finding successful solutions.

Government Reform of Social Care Care. Part Two: Food for Thought

Having finished my rant about the Government’s lack of backbone to adequately fund social care, here are some of the important points that were raised in the Social Care White Paper and Draft Care and Support Bill.

From 2015 the government will introduce national standards on access to care services.  At the moment each council can set its own criteria, creating a so called postal lottery. National standards will help people to understand what they are entitled to.

New rules will be introduced to make it easier for older people to move around the country, to live for example, nearer to their relatives. Currently they have to undergo new assessments, which results in some losing out. This will give people the flexibility to make the most appropriate choices about where they and their families live.

The Government will offer state loans for care costs and residential fees can be taken from a person’s estate after death. Interest will be charged but the level of interest and whether this will be capped is not known. However this offers  nothing new and local authorities already offer deferred payment schemes without interest. 

People will be given access to personal budgets (money given to the person in lieu of services) by 2013 and have a legal right to them by 2015. The government will also invite expressions of interest to pilot direct payments in residential care in the summer of 2012. I was involved in Personal Budget pilots and feel strongly that until alternatives to direct payments are offered universally to older people who are unable to manage direct payments, nothing much will change. Council managed budgets will continue to deceive government statistics into thinking Local authorities have more older people with a personal budget than they actually have.

There will no longer be a requirement for carers to provide regular and substantial care, so any carer with needs could be assessed. The  Government also plans to extend the right to a carers assessment and provide an entitlement to services for the first time. A national minimum eligibility threshold for support for carers will be set  . However the amount of money needed to fund this new entitlement will be dependent on what money is available in the system and we will have another case of ‘robbing Peter to pay Paul’

Local authority can charge for services that they are not under a duty to provide. For example, people who are not eligible for the local authorities help. For these services, local authorities may also charge ‘arrangement’ costs. Up until now, it has only been the services that have been charged for, not the ‘management’ or ‘arrangement’ charge.

The government will be strengthening support within communities. They will introduce a duty on local authorities to commission and provide preventative services and fund or encourage a number of projects to encourage supportive networks of volunteers within communities, including Time Banking which is very good news.

The social care needs of people facing end of life are recognised with a commitment to abolish means testing for people on the end of life care register.  Most people would prefer to die at home but currently less than a quarter are able to do so. We simply cannot afford, in human or cost terms, to continue to allow people to die in hospital against their wishes.

Only time will tell if political will can be turned into reality. If I sound cynical it is because I have found over many years, that the devil is in the detail and the implementation of policies. As people come to terms with an ageing population and the reality of a care system stretched to breaking point, I have faith that ‘the people’ will decide. Let politicians from all parties heed my warning.

 

The Shame of Government to Adequately Fund Care Reform

After enjoying a career in Social Services and the NHS, I was naturally interested in the publication of the Government’s plans this week to reform social care. Furthermore, my passion for changing the way we care for senior citizens in England fuelled my frenzied activity between live web coverage, watching the TV and listening to the radio on the day it was published. With experience of helping my elderly parents manage their direct payments, more recently caring for my terminally ill father and my elderly clients and their relatives in mind, I found myself vacillating between excitement and outrage.

Firstly let me explain what all the fuss is about. The government has set out its proposals for the reform of social care in a White Paper. This has been published alongside a draft Care and Support Bill which will become the main plank of social care legislation, effectively replacing many statutes from the last 16 years. A progress report on funding reform was also published.

I plan to discuss these milestone documents in two parts. Firstly focusing on funding, then on the most relevant points for older people and their families in the second part.

I was thrilled to learn that the government made a commitment to the principle of capping costs, but sadly that’s where the good news ends because no radical decisions have been taken on funding at all. It has to wait for the next spending review in two years time when the government wants to look at cheaper options to the £35,000 level suggested by the economist, Andrew Dilnot last year.

For the sake of clarity, Andrew Dilnot CBE, was asked by the Government to chair an independent body, the Commission on Funding of Care and Support, with a remit for reviewing the funding system for care and support in England. It built on an extensive body of work already undertaken in this area and carried out new analysis before providing advice and recommendations on how to reform the system in July last year. The point I am making here is that over a year ago, independent experts, selected by the government, have already undertaken extensive work to recommend a way forward. So why is the government procrastinating now? 

According to Dilnot’s commission, the contribution any individual makes to their care, not including general living costs, should be capped at £35,000 and the level of assets at which people living in residential care should have to pay the full costs should rise to £100,000. This simply makes the cost to the individual a bit less daunting. It would mean nobody would have to spend more than 30% of their assets paying for their care.

According to Dilnot the figures that the government themselves published, show the cost would be significantly less than one x one-thousandth of total public spending over the three years covered by the comprehensive spending review.

Dilnot claims that the average person pays £10,000 tax a year. To implement the recommendations he made last year, which received wide support, would require a mere increase of 10 pence per person in taxation. Can we really not afford 10p to improve the situation for when we too, become old? Why is social care one of the few areas that we don’t fund through general taxation, like education and the NHS?

Lets not consider how quickly ministers can find money for other things if it seems electorally prudent. This is about the future shape of our society. It isn’t a transitory decision, a momentary crisis. It is a decision that will affect us all in one way or another. If politicians think that a better deal for older people is unaffordable then let’s have that debate. At least that means doing something rather than burying their heads in the sand.

In my opinion the White Paper isn’t worth the paper it’s printed on and MPs of all parties should rise in revolt. I for one will be behind them and would urge you to do the same.

NHS and Social Care Reforms- The Health and Social Care Act 2012

Healthcare in England is in the midst of major reform and there have been many discussions, U-turns and revisions of the government’s contraversial Health and Social Care Bill which has divided opinion amongst the medical profession, politicians and the public. A newly amended Health and Social Care Bill has emerged, representing the biggest shake-up of the NHS since it was created. After a year in parliament, more scrutiny than any bill in living memory, and more than 1,000 amendments in the House of Commons and House of Lords, MPs approved final changes to the legislation on 20th March 2012. On 27th March 2012 the  Health and Social Care Bill gained Royal Assent to become the Health and Social Care Act (2012) .

The core principles of the Act mean that doctors and nurses will be able to tailor services for their patients, more choice will be given to patients over how they are treated, and bureaucracy in the NHS will be reduced. So what are the main legislative changes?

Summary of the Act

  • Primary Care Trusts and strategic health authorities will be abolished as part of a radical structural reorganisation, with new health and wellbeing boards being established to improve integration between NHS and local authority services.
  • Establishes an independent NHS Commissioning Board to allocate resources and provide commissioning guidance.
  •  Commissioning Groups will take over commissioning from primary care trusts and will work with the new NHS Commissioning Board in doing so
  • A new regulator, Monitor, will be established to regulate providers of NHS services in the interests of patients and anticompetitive behaviour.
  • The voice of patients will be strengthened through the setting up of a new national body, HealthWatch, and local HealthWatch organisations
  • Strengthens the role of the Care Quality Commission.
  • A new body, Public Health England, will lead on public health at a national level and local authorities will do so at a local level.

Key amendments 

  • New duties to promote integrated care have been placed on key bodies including the NHS Commissioning board, Monitor and clinical commissioning groups.
  • The original deadline for establishing Clinical Commissioning Groups by April 2013 has been relaxed.
  • Several changes have been made to increase clinical involvement in commissioning, with clinical commissioning group governance arrangements also strengthened and a requirement added to them to publish a members’ register of interests.

Most of the detail of how the Health and Social Care Act will work in practice is still to be addressed through secondary legislation and guidance and questions remain around much of the detailed operation of the bill so it’s a question of watch this space!

Looking at this Act,  and all the controversy that surrounds it, we would do well to remember that GPs initially opposed the introduction of the NHS in 1948. Opposition to change is part of the NHS’s history. My experience of introducing personal social and healthcare budgets reinforced how strongly health and social care professionals resist change, even when the current system is clearly not working and people’s quality of life can be improved.

How the Health and Social Care Act will work in practice is still to be addressed through secondary implementation and guidance. The Act does not have an immediate impact on patients and the way it is implemented will be critical. As with most things, the devil will be in the detail!

I for one am getting bored with all the rhetoric about privatisation via the back door, processes and structures and want us to get back to talking about how the quality of people’s lives and healthcare experience can be improved and personalised.

Let’s stop bleating about the NHS being free at the point of delivery. Isn’t there a prescription charge so many of us pay towards medication? And what about NHS dental care? Many of us contribute towards these costs too. There always has and always will be a two tier system. People who have the means can already choose private healthcare. No it isn’t fair, but we are not a communist society. We would be better spending our energy on how we can share out the diminishing cake as fairly as possible, so at least basic care for older people is adequately funded.

Nye Bevan could never have envisaged the extent of the progress made since the NHS was formed and had he known, would certainly have done things differently. His vision of the NHS in the last millennium could never have been fit for purpose in 21st Century Britain.

I will be watching with interest to see how implementation of the Health and Social Care Act will affect us and share my findings with you so watch this space!