BLOG: Relief that decision reached on Dilnot must not gloss over flaws

BASW professional officer Joe Godden assesses the latest incarnation of the Dilnot report.

What our state of health will be in old age, or whether we will become disabled while still relatively young, is impossible to predict. What we do know, regardless of the type of care required, is that anyone with assets will be expected to pay for it. 
Economist Andrew Dilnot presented the report from the Commission on Funding of Care and Support to politicians in July 2011, the main finding of which was that the cost of care for the elderly should be shared between state and individual, with a £35,000 cap on personal liability. 
There are some major drawbacks to how ministers have elected to pursue Mr Dilnot’s solid work, not least that the cap on costs has doubled to £75,000, to be paid by anyone with assets, including their house, worth more than £123,000. Only the poorest will receive free care. Dilnot originally recommended that state help should be available for anyone with less than £100,000 worth of assets.
As if that isn’t already a notably high barrier to accessing state support for the expense of being looked after when dependent on others, those housed in a nursing home can expect further costs – residents will pay an additional fee of up to £12,000 per year for bed and board.
The road to a final decision on the implementation of Dilnot’s recommendations has been a long and rocky one, and relief that a destination has at last been reached should not gloss over the potholes in the government’s proposal.
Under the reforms, people will have an assessment carried out by their local authority will carry out an assessment, and will calculate the cost to the local authority if people are assessed as having eligible care needs. These costs then count towards the cap.
For decades, social workers have faced the conundrum of questions in making assessments and working with users of services, such as when is a bath or a shower a social care bath, or a medical bath; when is assisting someone with medication the role of a domiciliary care worker, or the role of a nurse?
More recently, we have faced the dilemma of whether it should be the health sector that takes financial responsibility for continuing care, or whether social care budgets should take the hit. 
This latest incarnation of the Dilnot recommendations may soften the financial blow for those who own their own houses, or who have significant savings. It is understandable that after working all their lives people want to pass at least some of their estate on to their families. 
What it will not do is bring any more money into the social care system, where it is desperately needed. This funding model will also not bring any more money into the system of preventive services, which has been proven to prevent the need for expensive care packages. 
Oddly enough, however, there is an element of re-distribution in the proposals, with the main funding for what is on offer to come from removing the link between inflation and inheritance tax – in turn ensuring that the threshold at which the latter is paid will fall, securing savings for the state to be ploughed into care provision.
It has been a long-standing joke among social workers that in more affluent parts of the country many people do not ‘own’ their own house; peculiarly, in many instances, their children actually own the parents’ house. With the new measures not being fully introduced until 2017, this leaves a lot of time for households to make similar or more varied attempts to hide their assets. No doubt accountants will move quickly to advise clients about the new eligibility thresholds. 
The actual process of recording and calculating the costs of care over a lifetime is likely to be extremely complex and we need to think about how any claim will be verified. 
Notably among the reforms, people who are disabled before the age of 18 will receive free care, which is clearly a positive. Also, for people who acquire disabilities after becoming an adult, the cap will be lower than for those who do not need help until they are older. 
What seems clear is that the arguments over funding, including the split between health and social care support, will continue as long as we fail to introduce a social insurance scheme for care services along the lines of the funding for the NHS. 
Equally, we will never have an integrated health and social care system until social care is free for those in need and at the point of entry – again, as is the case with the NHS. 
Paying for social care out of general taxation or a ring-fenced tax makes sense; it would be cheaper to administer and would enable the ‘buy in’ of the majority of the population to social care services. 
The vast majority of people like the NHS system and accept that we all contribute to it as a way of pooling risk. BASW would like to challenge the politicians to continue to look for long-term solutions to the funding of social care.

Published : 13th February 2013

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