Andrew Dilnot’s plans have since been considered, altered, then rejected by the government.
Lord Warner did not mince his words when speaking to the National Children and Adult Services conference last week. “You are the saviours of the NHS, which is something politicians care about,” he told the audience of social care providers.
Warner, a former Labour health minister, had a simple calculation to back up his argument: elderly patients are usually cared for better and more cheaply through social care services than in acute healthcare. He told the conference that too many 80 year-olds are in hospitals costing £3,000 a week, rather than medically supervised nursing homes costing £1,000 a week. Making the politically popular health service more efficient would be a better argument for changes to adult social care than “we’ve been treated unfairly, give us the money,” he said.
The specific changes Warner advocates as a member of Andrew Dilnot’s commission into adult social care would involve the introduction a lifetime cap on charges in England of about £35,000, along with means tested support for anyone with assets of less than £100,000, compared with a cut-off of £23,250 at present.
The plans, which were published in July and are now the subject of a government consultation, would stop those requiring expensive social care from having to sell almost all their assets. The commission’s calculations say that older people requiring extensive services would have to sell at most about a quarter of what they own, and the estimated annual cost to the state would be £1.7bn, when fully introduced.
Dilnot himself presented his plans to the conference with the aid of a graph showing an ever-steepening curve of social care’s lifetime costs. He pointed out that such a curve, with a relatively low average but ruinously high costs for the least fortunate, is not unusual: it also applies to healthcare, car accidents and damage to houses. The difference is that the first is covered by the NHS, and the second and third by insurance. “It’s just wrong that people can’t pool risk,” he said of social care costs. “It’s the only area of our lives where people can’t pool risk.”
He said that no country in the world has a fully private insurance system for social care, meaning that the government will have to take “the tail end risk”. The plan would remove a great deal of the fear among elderly people that a stretch in an expensive care home could wipe out most of their wealth. It could also reduce their use of more expensive and less appropriate NHS capacity.
The problem, as delegates pointed out in their questions, is that the extra costs of social care would fall on hard pressed local authorities, while the savings would accrue to the relatively well funded NHS. “Health and wellbeing boards ought to be cuddling up to clinical commissioning groups in a very big way,” responded Warner.
He said that health secretary Andrew Lansley and his colleagues are hoping for a new bill to enact the Dilnot proposals, but that this is not needed: an amendment supported by Warner to the health and social care bill currently in the House of Lords could lay the ground for a series of parliamentary regulations that would achieve much the same thing. While such an amendment is unlikely to make its way into law, Warner indicated that his aim is to get the government to say how it plans to solve the problems of social care costs for individuals, something it listed in the coalition agreement. “I think it’s time for the government to stand up and be counted on some of these issues,” he said.
If it happens – and Dilnot and his fellow commissioners are campaigning hard – would increased use of social care really help the NHS as much as Warner suggests? The Department of Health’s own figures say that in 2009-10 the English public sector spent about £50bn, roughly half the NHS England budget, on older people, compared with £8bn on social care. This suggests that an expansion of social care could make substantial savings, if it displaces more expensive healthcare.
Pilot projects carried out under the last government suggest that improved social care services could save significant amounts of NHS money, while producing better outcomes for the elderly. Another session at the conference heard Professor Les Mayhew of Cass Business School discussing the Popps project in the London borough of Brent, which helped elderly people who had not quite qualified for social care with a range of support services. His assessment of the project, which took place in the late 2000s, found that participants spent 14 to 29 fewer bed days in hospital in that year and three to eight fewer visits to accident and emergency. “The savings were accruing to the NHS, but the costs were accruing to the local authority. If repeated nationally, it would save over £2bn a year,” he said.
But do councils want to help save health service money? Local authority leaders at least seem keen to work more closely with the NHS, particularly through the new health and wellbeing boards.
David Rogers, leader of the opposition for East Sussex county council and the only councillor who served on the NHS Future Future group earlier this year, told the conference that he was looking forward to the boards, that public health will be returned “to its rightful place in local government, after being exiled in the NHS for four decades”. Keith Mitchell, leader of Oxfordshire county council, suggested that the cost of the Dilnot reforms could be returned to local authorities through localisation of business rate receipts.
Warner’s claim for adult social care is strongly pitched, and its expansion could well help the health service meet its efficiency targets. However, the next move is the government’s, in deciding whether and how to reform social care – and whether it is willing to pay for Dilnot’s recommendations.
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