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Shaping the future of care together
National consistency and local flexibility
The Government believes that the care and support system should be fair and universal. This means that it must make sure that everyone who qualifies for care and support can get it, regardless of where they live. This will ensure that people who need care and support are empowered to live their lives the way they want to and able to choose where they want to live and work, in the way that most people take for granted.
But we also need to ensure that the system is flexible enough to respond to local circumstances and to encourage innovative approaches.
Services need to be designed locally, so that they can respond to what people need in a particular area. We need to decide how the new funding system should balance local flexibility and national consistency. Moving to a universal system has important consequences for the way in which care and support works across England. In particular, it has consequences for the way in which money for care and support is raised and spent across England. We have already said that we want a standardised national needs assessment process, and the Government would set the level of need at which someone qualifies for state funding. The Government would also set, nationally, what proportion of someone’s care package would be funded by the state. Beyond this, however, there could be two different approaches to how the system worked, depending on how standardised the system was. The two approaches have different implications for the way in which money is raised and distributed around England.
1. A part-national, part-local system
Under this system, people would know that they were entitled to have their needs met, and a proportion of their care and support package would be paid for by the state, wherever they lived. But local authorities would be responsible for deciding how much an individual should receive to spend overall on care and support, giving them the flexibility to take into account local circumstances.
So a disabled person would know, before they moved somewhere, what level of support they would be entitled to in the new area, but the actual amount of funding that was put into their care could vary from place to place. This would reflect the fact that the costs of care and the requirements of individuals would also be likely to vary across the country.
The advantage of the part-national, part-local system is that local authorities would be able to set the actual amount of funding that someone would receive. This could provide more space and flexibility for local authorities to encourage new kinds of care and support in their area. It would also help them respond to local conditions to deliver real choice and control for individuals. But it would mean that people could still get different amounts of funding in different places, which might be seen as unfair.
2. A fully national system
Under this system, national government would decide how much funding people should get, instead of local authorities. The amount of funding allocated could be consistent across the country, or could vary depending on location to take account of the different costs of care across England.
The advantage of this system is that it would be easy for people to understand and plan for. This will enable people to move around more freely and live the lives they want, wherever they are. People told us that the system seems fairer if everyone gets the same amount of money.
The disadvantage is that the system would decide at national level how much funding someone was going to receive. It could be more difficult for local authorities to tailor the care package that people receive to their wishes and to respond to local circumstances, and it would make the system more rigid.
The consequences of a fully national system
This system would also be likely to mean major changes to the way in which money for care and support is raised and spent in England. At the moment, local authorities can decide to fund social care by using funding from council tax over and above the funding they receive from national government. If national government, rather than local authorities, were deciding how much funding people should get, it would be unfair to ask local authorities to fund this new system from money they raised themselves, as they would have no way of controlling these costs. Under a national system it is likely that all funding for care would need to be raised nationally through national taxation instead of some of it coming through council tax.
The role of local authorities
Under either system, local authorities would play the key role in delivering care and support. They would continue to:
- be the channel for state funding and support
- undertake assessments
- provide information, advocacy and care management for individuals
- provide and commission services, and manage the market of care and support providers
- foster innovation in care and support, using their freedom to decide exactly how services are delivered at a local level.
Consultation question
3. The Government is suggesting three ways in which the National Care Service could be funded in the future:
- Partnership – People will be supported by the Government for around a quarter to a third of the cost of their care and support, or more if they have a low income.
- Insurance – As well as providing a quarter to a third of the cost of people’s care and support, the Government would also make it easier for people to take out insurance to cover their remaining costs.
- Comprehensive – Everyone gets care free when they need it in return for paying a contribution into a state insurance scheme, if they can afford it, whether or not they need care and support.
a) Which of these options do you prefer, and why?
b) Should local government say how much money people get depending on the situation in their area, or should national government decide?
I believe that the government should decide how much money people should be given. My reasoning behind this is because there are still a substantial number of Local Authorities that have illegal social work management funding panels to decide whether or not an individual is eligible for services. Under a fully national system the government would decide the amounts that people can have towards their care or care package. This in turn would then take the control away from managers and place a duty upon them to provide that level of funded care. A good example is Halton Borough Council; they require all their social workers to make an application to a funding panel for access to funds, to commission care packages. I believe that Halton are very good at providing a social care service that tells members of the public that they are ineligible for social service support. If the government where to set national limits then the management structures within council’s such as Halton would therefore be required to fund those packages of care, without using illegal management funding panels to prevent Care Managers commissioning care.
What’s more, I would also like to see a separate comprehensive system that everyone pays into. The current circumstances with the collapse of the world economy and insurance organisations like AIG needing to be bailed out by state intervention clearly shows that the state should provide the safety net for welfare and care and not rely upon private insurance companies that are driven by profit and not values. Moreover, if we are to look at examples of insurance backed health and welfare systems, the model in the United States clearly leave’s some forty million of their citizens, without any insurance cover. This in turn leaves them vulnerable and completely reliant upon a municipal system of health and social care, which clearly does not meet their needs and is not compatible with Human Rights laws and in line with a society that strives for equality for all and not for the few that can afford it.
I think comprehensive but with a defered payment otion ie my contribution to be taken from my estate. To make it fair maybe it should be a flat 25% of anyone requiring care's estate. THat way someone who is leaving £30,000 to thier kids will still be able to leave £22,500 while someone extremely rich will paym more but still leave the bulk of their estate to thier children
How would NCS funding be related to NHS funding? Where would the line be drawn between social care and health care? What would happen to NHS Continuing Care?
I'm surprised that the Government is considering absorbing AA (and possibly DLA) benefit payments into funding this system. In Scotland care is wholly funded, and customers can continue to claim/ receive these NATIONAL benefits, subject to the normal rules. I agree that those with means should contribute towards their care, but this should apply NATIONALLY. The contribution should not be to the detriment of the partner/ spouse under any circumstances. Anything else is unfair. As to what is left to the children - this should not be an issue. Where the children themselves provide care, then there is no demand on the taxpayer and they should be supported/ compensated for saving the taxpayer money in care costs. If the children choose not to provide care then they should not expect to receive the parent's estate. The taxpayer would require a like-for-like return (where possible) for their investment in the parent's care, and this is simple economics. In terms of benefit payments - DLA/ AA can give people the flexibility to reward those who care for them, whether they are friends, family, neighbours. Apportioning the equivalent to Social Services removes this privilege completely; although funding would probably remain focussed on those regarded as being in the greatest need, the denial of access to these benefits would undoubtedly have an adverse impact on countless others who have some capital or savings but try to live within their means and who find it increasingly difficult to cope due to ill health, age, or disability. If care can be funded in Scotland, why can't it be funded in England also?
I believe that if the system is to change then a national standard should apply.
Under the present system local authority care and conditions vary so widely that attempting to access care for yourself or a family member is like navigating a minefield blindfold, even people employed to help, have to report back to a funding panel.
Having dealt with three different social work departments in three different areas, but in the same part of the country, all I can say is please set out the terms clearly and consistantly, with no loopholes or it will fail the people it's supposed to help.
Partnership – People will be supported by the Government for around a quarter to a third of the cost of their care and support, or more if they have a low income. This proposal leaves a burden on the person needing care and looks to be a means tested method for the poor, I am also pretty sure unless the person is wealthy the care costs would soon make the person needing care very poor.
Insurance – As well as providing a quarter to a third of the cost of people’s care and support, the Government would also make it easier for people to take out insurance to cover their remaining costs. This proposal cannot work if the insurance is taken out late in life, insurers already turn their backs on people for health grounds, this proposal will again make the poor poorer as insurance firms increase premiums.
Comprehensive – Everyone gets care free when they need it in return for paying a contribution into a state insurance scheme, if they can afford it, whether or not they need care and support. This will work only if the insurance scheme if worked as National Insurance was supposed to be used in the first place. An increase in national insurance contribution to provide back up for those needing care could work, only if the funds are kept for the purpose and not diverted as has been the case with NI. A state increase of NI will be seen as a tax as NI has been misused since its introduction. Re asserting NI for Healthcare will be needed.
local authorities are hopeless in providing care by their nature they have admin staff taking up chunks of funds, they also refuse care to many and limit in order to minimise use of funding. The local authorities needs to be taken out of the loop. A system run via the NHS as a home based national care and support system funded through NI would be better. Bringing in a national insurance scheme that lives upto its name should have been the case since 1949. The emphasis needs to be free care funded via NI paid over years, and emphasise care at home first, not a system that leaves a person in debt. Where a person can no longer look after themselves and has no carer then free state run care homes should be in place, these homes could have been provided via NI and still could be. There is no need to force a working person into poverty to do this, either whilst at work or after retirement. State care homes hould not go to private contractors they should instead be run by national government with NHS standards and should be like social housing. Those who prefer private homes could then chose.
Don't we already have a state insurance scheme - National Insurance - that we all pay into one way or another?
The question here seems to be not how much care people should get - but how much money should be put into it. Until the different systems all agree on how to assess care needs, there is little point in discussing paying for them.
National system but reflecting different pay rates in different local authorities so people who live in expensive areas still get the same hours of support to someone in a cheaper area. Funded by national taxation increase. I dont trust local decision makers to ration support services. You only have to look at how Care in the Community and Supporting People have always been underfunded and rationed to see it doesnt work on a local level. Good care and support is not cheap and vulnerable people least able to fight for their rights are an easy target for cuts at a local level.
Pease please please remove as much responsibility as possible from local authorities. In many other areas this clearly hasn't worked as there are huge differences in the levels of care and services provided depending on the ideology of the local incumbents. Support for the elderly and disabled must be to a national standard. Not everyone has an angel like Yvonne Hossack to fight local bureaucracy.
Having worked with people who fall into this category and once being in it myself. I find it hard to understand that there is no clear national guidline for this. Saddened to think that if this was left down to a local authority many of us are going to suffer this tax burden and at retirement age find ourselves in poverty. Let alone kave anyhting to will to our children The economic downturn in the economy and the various miniters banging on about this is no cure. They need to face reality and get down to grass roots level and talk to people who this is going to affect. To many green papers and not enough inout from the people whi know what it is like to be in this position
This scheme is diabolical. The PUBLIC money that the government gave the banks which is funding fat cat bonuses could pay for a lot of this. Not to mention all the expenses the politicians have fiddled over the years.
3(a) - please see answer to "Funding Options" above.
3(b) Local Authorities ate better placed to decide on funding in their area
The principle of fair and universal care must be backed up by equal and universal funding - No postcode lottery
Some basic benefits should still be paid nationally. For example invalid care allowance: people with moderate learning disabilities will then know this vital funding is safe. They deped on this for help with care and mobility to live their lives fully and make their own contribution to society. We all know that when funding is given to local authorities it becomes at risk from changes in eligibility criteria. If given by local authorities MLD people will lose funding.