One of the announcements in yesterday’s budget was that the care cap recommended in the Dilnot report will be introduced in 2016 rather than 2017. It will cap care costs at £72,000 (rather than the £35,000 Dilnot had recommended) and will raise the threshold for the means test on residential care from just over £23,000 to £118,000. Many will welcome this as a step in the right direction. The budget document described it as providing “peace of mind to those who want to plan for their old age and leave savings to their children”.
However, local councils will be under no illusions that this will do anything to resolve the care funding crisis or reverse the ‘graph of doom’. Much of the cost of funding this care falls to councils and the rapidly growing funding gap (£16.5bn a year by 2020 according to the LGA) remains to be addressed. Without a solution, councils will continue to tighten their eligibility criteria, which will typically result in increased pressures on NHS budgets, rather than overall reduced spending.
This is why charities such as Age UK have expressed disappointment in their response to the budget: “Whilst we welcome the earlier implementation of the care costs cap and the higher upper means test threshold from April 2016, this will do nothing to help the 800,000 older people who need help with everyday tasks but receive no formal state support… it has not been enough to halt the downwards spiral in care funding. As a result, 85 per cent of local authorities now provide care only to people with substantial or critical needs.”
The prospect of additional funding being forthcoming is extremely unlikely, as indicated in the recent annual report of the Health Select Committee on Public expenditure on health and care services: “In our view it would be unwise for the NHS to rely on any significant net increase in annual funding in 2015-16 and beyond. Given trends in cost and demand pressures, the only way to sustain or improve present service levels in the NHS will be … focusing on a transformation of care through genuine and sustained service integration.”
But genuine and sustained service integration is a challenging nut to crack, and will not happen quickly. Alongside integration, prevention must also be a focus, although it will not resolve the funding gap on its own. As with children’s services, sustainable solutions for adult social care must include early intervention and prevention rather than focusing solely on crisis. Councils should be making use of strengths rather than deficit based models, focusing on what people can do within their own resources, communities and family support networks, rather than what they can’t. Southwark Circle is one such example, mobilising public, private, voluntary and community resources to prevent social isolation, provide help with practical tasks, and ensure older people continue to actively participate in their communities. If models like this can become self-sustaining, they may provide a significant opportunity to ease some of the pressures on the care system and help improve the quality of later life.