The shortcomings of the government’s proposals for a cap of £75,000 (or £72,000 as is now being suggested) on individual liabilities for long-term care funding have been much discussed. Some of the practical implications of how the cap would operate need also to be explored.
If the system is introduced, many more people will have contact with their local authority than is currently the case. At present people who have sufficient assets that they expect to be self-funding have little or no incentive to contact the local council for any help, and may be deterred from doing so. Indeed, the experience of self-funders who do approach the council is too often negative.
In future, however, there would arguably be good reasons to approach the council for assessment, monitoring and checking in order that self-funders ensure their “care cap” tariff metre starts running and their contributions are recorded. This will necessitate major transformation of the way assessment operates in councils; certainly there has been growing recognition of the importance of the “universal offer” of information and advice that should be available to all, and that financial means testing should not precede needs assessment, but local practice remains highly variable.
Establishing contact with self-funders would need to be more than an administrative process. Rather, it provides an opportunity for appropriate information and advice to be given (including independent financial advice) to empower people and their families to make better informed choices about care options. The requirements to monitor and review people’s needs, and the cost of meeting their needs whether or not the local authority is responsible for those costs, and to keep a tally of contributions towards the cap in an individual care account, will have considerable impact on local authority assessment services, and most significantly will necessitate a massive cultural shift away from a model that is still largely concerned with gatekeeping access to publicly funded support.
The report of the joint committee on the draft care and support bill points out that the increase in people being assessed for a personal budget or notional care account “is likely to lead to an increase in disputes and legal challenges”, and accordingly recommends establishing a care and support tribunal to provide independent review decisions.
In addition to the direct demands on assessment services, additional numbers of people approaching their council are also likely to increase other pressures on adult social care departments and social workers. Sarah Pickup, president of Adass, told the committee in January that this brings new opportunities, but not without cost:
“… when people come to us to trigger the metre we may identify that they would benefit from enablement services, preventative services, falls prevention, telecare or telehealth. Those may be people who have not thought about accessing that. The implementation of the commission’s proposals, alongside the bill and our need to work with self-funders more, will increase the requirement for enablement, preventative, telecare and telehealth-type services. Those have a cost and the cost will increase.”
For some people, prevention will avoid or delay the need for care and support, and while some of that will be achieved through targeted intervention, other benefits will be associated with enabling access to a wide community infrastructure of universal and mainstream services.
As Pickup also described to the joint committee, such an approach to “prevent, inform and advise” can be crucial in helping tackle isolation, enable people to get shopping or to access transport, before there is any need for formal care and support services.
It may not be the aspect of the capped costs proposal that is attracting most scrutiny, but the possible consequences that arise from the necessity of seeking assessment in order to trigger the care meter could prove to be of great benefit to thousands of people who otherwise have little knowledge of where to turn for help and information (including where to get independent financial information and advice). Ensuring that councils are able to respond to this enhanced role builds on best practice already in evidence, but for many councils the cultural transformation required will be profound, will necessitate new practice guidance, and will take considerable time to deliver.