People ‘should get free personal care’ to eat, wash and visit toilet

People who need help with essentials of daily living like eating, washing and going to the toilet should receive free personal assistance, says a report demanding massive new investment in social care.

Some 1.4million people had an unmet care need in 2018, and the number of elderly and working age adults requiring help is increasing rapidly, while public funding is not only failing to keep pace but has declined, it says.

The bold plan demands an immediate extra £8billion a year in funding to restore care quality and access to 2010 standards, and the launch of universal free personal care by 2025 at a cost of £7billion.

The bulk of funding should come from general taxation, but £1billion could be raised by making people over state pension age carry on paying National Insurance contributions on any earnings, says the report.

Titled ‘Social care funding: Time to end a national scandal’, and published by the House of Lords’ economic affairs committee, the report arrives ahead of the Government’s long-postponed plans for social care.

The Government should issue ‘clear and plausible proposals’ in a white paper – meaning a policy statement – rather than issue a green paper – a consultation document – to avoid further delay, according to the Lords’ committee.

‘After decades of reviews and failed reforms, it is not clear how another green paper is going to make progress on addressing the challenges in social care funding,’ it comments.

‘With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues. Government action, rather than further consultation, is required.’

Health Secretary Matt Hancock raised the possibility of closer integration between health and social care services in a speech to the Local Government Association Annual Conference today. 

But the lack of Government proposals has led a former Tory MP, Damien Green, the Association of British Insurers, and now the House of Lords, to float their own ideas to overhaul the social care system.

Green said everyone should receive basic care in old age, but fork out individually for extras like a bigger room and better food in a care home. The ABI proposed tax breaks, a new Isa, and more opportunities for people to tap the value of their homes to help them pay for social care. 

Meanwhile, The Lords’ committee plan involves the introduction of free personal care, which means ‘essential help with basic activities of daily living, such as washing and bathing, dressing, continence, mobility and help with eating and drinking’ for people with substantial and critical levels of need.

This would not cover assistance with housework, laundry or shopping, or accommodation and living costs.

‘The Government should retain a means test for accommodation costs. To avoid catastrophic accommodation costs, the Government should also explore a cap.’ the report says.

It goes on: ‘Free personal care is fair, better aligned with NHS entitlement than the current system and easier to implement than alternative proposals.

‘It may be more expensive than some alternatives, but it could reduce demand for residential care and health care in the long-run by encouraging users to seek domiciliary [home] care early.’

When it comes to funding, the Lords’ committee proposes using general taxation and making people above state pension age continue to pay National Insurance on earnings – the latter to reflect the fact that older generations are more likely to benefit from social care in the short term.

The Lords stress that social care funding should not be reliant on revenue raised by local councils, which they say has little connection to local demand for social care, and leads to a ‘postcode lottery in standards of provision’.

They voiced concern about Government plans to make local authorities more self-reliant, saying: ‘Demand for social care is often greatest in areas where business is least buoyant.’

The Lords’ committee proposes instead that funding should be provided as a Government grant, ‘distributed directly to local authorities according to an appropriate national funding formula which takes into account differences between local authorities in demand for care and ability to raise funds from local taxation’.

It adds: ‘Funding social care should be approached in the same way as any other funding pressure. We recommend that social care is funded largely from general taxation.’

The report also makes the following points.

– Greater pressure has fallen on family and friends to provide unpaid care, as fewer people have been able to access local authority funding, and this may not be sustainable.

– The increasing disparity between prices for social care paid by people funding themselves and those paid for by local authorities is ‘unfair to both sides and therefore unsustainable’.

‘The effect is to drive care homes to market to self-funders, and so reduce the availability of places for individuals funded by local authorities.’

– Increasing funding for social care will allow for investment in the care workforce, and for higher pay which is required to allow social care providers to compete with other local employers.

‘The care workforce needs a career structure which better reflects the skills required to be a good care worker and the social importance of the sector.’

– The committee is sceptical about the contribution that private insurance can make towards funding social care.

‘No country relies primarily on private insurance to fund adult social care costs. In the current system, establishing a market for long term social care insurance in England would be difficult, even with a cap on lifetime social care costs or accommodation costs or an auto-enrolment scheme,’ it says.

‘Private insurance cannot provide the amount of funding required by the social care system, not least because roughly half of public social care funding is currently spent on people who are working-age.’

Barbara Keeley MP, Shadow Cabinet Minister for Social Care, said: ‘This report is yet another sign that social care services are at breaking point.”

‘The Government’s relentless and savage cuts to council budgets have caused a crisis with £7.7billion taken out of social care funding since 2010, cuts that even Jeremy Hunt now accepts were wrong and went too far. Boris Johnson must now do so too.

‘Social care has been neglected by this Government for too long. Both leadership contenders must match Labour’s commitment to invest an extra £8 billion in social care across a Parliament. That’s how we’ll build a sound funding solution for the longer term.’

What do financial experts say? 

Rob Yuille, head of long-term savings policy at the ABI, said: ‘The House of Lords economic affairs committee has made some sensible and well-thought through recommendations this morning.

‘We urge the Government to consider the interaction between the state and private provision, whilst ensuring that any new or reformed system is very clear, increases awareness and minimises confusion by clearly setting out what each care user is responsible for funding themselves.’

Rachael Griffin, tax and financial planning expert at Quilter, said: ‘The Government’s social care green paper is now badly overdue and today’s scathing remarks from the House of Lords illustrates the price we are paying for procrastination. 

‘Many people assume that long-term social care, like health care, is free at the point of need. That is not the case, with social care devolved to local authorities who offer various levels of cover.

‘Under the existing system, individuals must meet the cost of their own care, with no ceiling on the level of cost they may incur. The only protection to prevent care costs claiming all someone’s assets is a floor of around £25,000, which varies across the UK.  

‘We must have clarity on this issue as a matter of absolute urgency. There are a number of options on the table but without certainty about which will be adopted, people cannot plan and good quality insurance products to cover the cost of care will not flourish.’