Government legislation is major step forward for social care but funding gap will still remain

The Government’s plan to introduce a new cap on the amount any individual pays, and a higher upper means-testing threshold for social care support will help to create a fairer funding system.

However, the funding that will support the new cap and means test threshold will not fully bridge the growing gap between funding and demand for social care.

This is the view of experts at the Nuffield Trust in a briefing it has issued to Peers ahead of the Second Reading of the Government’s Care Bill (due to take place in the House of Lords on 21 May 2013).

The briefing welcomes moves toward financial eligibility for help with social care, and the implementation of a system of provider ratings based on an independent review that the Government commissioned the Nuffield Trust to undertake earlier this year.

Ultimately, the real prize is not finding a single summary rating for hospitals at large, but rather rating individual wards, departments and clinical services within hospitals as this is more likely to be of value to patients
Nuffield Trust Chief Executive Dr Jennifer Dixon CBE

However, it warns that peers must closely examine whether future levels of funding for social care will be enough to meet the Bill’s goals, and to ensure that vulnerable people do not go without help which could prevent their conditions worsening.

The briefing also calls for parliamentarians to look at whether NHS regulators are ready to take on their crucial new roles in rating providers for quality, and intervening in failing hospitals and care homes.

It concludes that:

• The introduction of a cap and raised means-testing threshold are a milestone in a process of reforming social care funding which has stalled too often in the past. However, the severe funding pressures facing the social care system, coupled with the poor coordination between health and social care providers, are likely to cause increasing harm before 2016.

• This funding gap is causing councils to raise the level of social care need at which they start offering financial help to individuals, leaving out people whose needs may be serious but are not classed as ‘substantial’. It is not clear that the current system where 94 per cent of money spent on over-65s goes to welfare and the NHS, rather than social care, is the best way to help older people and to keep pressure off the health service.

• Although the briefing welcomes reforms to standardise eligibility for help funding social care, we are concerned that the eligibility threshold – which will be set in secondary legislation – will continue to exclude some people in significant need of help. This might undermine the Bill’s provision for local authorities to help people before their conditions worsen and they need more extensive care.

• The framework for the introduction of ratings for health and social care providers broadly reflects the recommendations of a recent Nuffield Trust review, which was commissioned by the Government. The Trust supports its general principles.

• It is important that the Care Quality Commission (CQC) should be allowed time to develop a system of ratings with the public and professionals so that the ratings can have their full confidence. We welcome the intent by the Government to give CQC space to develop this independently, but believe this should include the timetable for development.

• Peers need to look closely at whether the CQC, which until now only looked at the quality of care, has the expertise to carry out its new duties overseeing the finances of large and specialist social care providers.

• It needs to be determined whether a single national set of quality standards broad enough to be used by many different bodies can contain enough detail to be useful.

Nuffield Trust Chief Executive Dr Jennifer Dixon CBE said:

"There are many important steps forward in this legislation. The reforms to social care funding will give peace of mind to many people facing the costs of funding their own care, especially as catastrophic costs fall disproportionately on an unlucky minority who need help for several years.

"However, we must remember that this will only apply to people whose needs are deemed severe enough to be eligible for help. Councils are tightening their thresholds as a result of austerity, and research shows that many people who need help dressing, bathing, and carrying out everyday activities are not getting support of any kind.

"This may result in avoidable deterioration and faster need for more costly and intrusive care funded by councils or the NHS.

"I am glad that the Government have taken account of our recommendations in implementing a ratings system for health and social care providers. It is important now that the Chief Inspector of Hospitals and Chief Inspector of Social Care are given time and space to develop robust systems which the public and professionals can trust.

"Peers should ask for reassurance that the system will reflect how complicated large hospitals with many wards are, and the limitations that exist in the data available.

"Ultimately, the real prize is not finding a single summary rating for hospitals at large, but rather rating individual wards, departments and clinical services within hospitals as this is more likely to be of value to patients. This more granular rating must be developed with the public and professionals.

"These reforms pave the way for Monitor to take a short-term role in regulating quality when hospitals are failing. Meanwhile CQC will have a role in assessing the finances of large care home chains.

"There should be a debate about how to prepare them to work together and individually on these new and different responsibilities, which will be central to the new system of provider failure."