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Shaping the future of care together
The choices around funding
In deciding how to fund care and support, there are some very difficult decisions to make. Stakeholders, experts and members of the public have given their views on these decisions through the engagement process that the Government ran from May to November 2008. The choices focus on who should be responsible for providing care and support and paying for it: people who need care; their families; or everyone in society via the state?
And, assuming that the state will always be responsible for paying for some care and support, there are choices about whether resources should depend on:
- where people live
- when people develop a care and support need, or
- whether they are able to pay.
Hundreds of people gave the Government their views on these difficult questions during the engagement process, and we have used the agreement that emerged to shape our thinking around the funding of the care and support system.
Who should be responsible for paying for care: There was widespread agreement that there should be a significant role for the state, although there was less agreement around what the exact balance of responsibility should be around funding. There was widespread agreement that individuals and their families should also share this responsibility with the state.
Where people live: People told us that they could see the advantages of a system which allows areas to be flexible and respond to local needs. But the majority of people were more concerned that a system which varied a person’s level of care and support because of where they lived was unfair.
When people develop a care and support need: People found it difficult to decide whether people developing care and support needs at different points in their lives should be treated differently. They were split on whether there should be a different approach to younger disabled people because they are usually unable to prepare to meet the costs of their care and support in the same way as people can prepare for their old age. Overall, people’s main concern was that the system should be fair and that everyone should have an equal opportunity to achieve the same outcomes. If this were achieved, it did not matter to them so much whether this was through a single system for everyone. Whether people are able to pay: There was also little consensus about whether a person’s ability to pay for themselves should be taken into consideration when the state is deciding how much support to give to a person. Although people agreed that those who could not afford to pay for themselves had the greatest need for state support, they also felt it was unfair that people who had worked hard and made sensible decisions to save were less eligible for state support.
Funding options
Our care and support needs in life and old age are inherently uncertain. Two in three women and one in two men will develop high care needs during their retirement. But some people will need no care and support at all. The current social care system does very little to help people minimise that uncertainty, with some facing very high costs near the end of their lives and others needing far less care.
The cost of care
The cost of care and support is high. A 65-year-old can expect to need care costing on average £30,000 during their retirement. But there are great differences in people’s needs and the amount that they pay: 20 per cent of people will need care costing less than £1,000 during their retirement – but 20 per cent will need care costing more than £50,000.
Some people who spend years in a care home could face a bill of more than £100,000. And for a couple, the cost of two people’s care can be high. At the moment, we cannot predict who will need high levels of care and support. People told us during the engagement process that they wanted to be clear on how they were going to pay for care and support, if they did need it, and how much it was going to cost them.
We know that as a society we will need more money for care and support. The question which we need to address as a society is where this will come from.
Making the most of current funding
During the engagement process, many people told us that we need to make sure that the taxpayers’ money that is already in the system is being used as well as possible. We have looked at the wide range of funding sources that make up the care and support system, to consider whether they are being used to the best effect.
In developing the new system, we think there is a case for drawing some funding streams together to enable us to deliver the new and better care and support system we want to create. We think we should consider integrating some elements of disability benefits, for example Attendance Allowance, to create a new offer for individuals with care and support needs.
If we did this, the future care and support system would build on the main advantages of the current disability benefits system, providing people with flexibility and an entitlement to have at least some of their care funded wherever they live in England.
Whatever the outcome of the consultation, we want to ensure that people receiving any of the relevant benefits at the time of reform would continue to receive an equivalent level of support and protection under a new and better care and support system.
Bringing more money into care and support
But we know that the money in the system at the moment will not be enough to pay for everyone’s care and support in the future. If we want to meet the needs of all those who require care in the future, then as a society we are going to need to pay more for care and support. The question is where this additional money is going to come from.
We have considered a range of different options, from a system in which everyone pays for themselves to one where everyone contributes to the cost of everyone’s care and support.
Choosing between the systems
In the current system, people who have the highest needs and lowest means get some help through the social care system, and some people get help through disability benefits. But many people, including some with high needs, get no help with paying for care at all. If someone is in a care home and no one is living in their house, they are expected to use their savings and the value of their house to pay for care and accommodation, until they have used up almost all of them.
Because care and support costs can be so high, we think that the Government should provide some support to everyone who has to pay them. We therefore propose that, in the new National Care Service, everyone who qualifies for care and support from the state should get some help with paying for it.
Any new system must therefore be:
- fair
- simple and easy to understand
- affordable
- universal, underpinned by national rights and entitlements, and helping everyone who needs care to pay for it
- personalised to individual needs, and flexible enough to support people to live their lives in the ways they want to.
We have looked at five ways in which the National Care Service could be funded.
I do not think people of 60 should have to pay a lump sum as it is too late in their working life to save it again. If any changes are to be made it should be for future users, we have paid our money in taxes and NI contributions. If the Govn haven't budgeted properly why should we pay. We've been planning all our working life for retirement and now they want to move the goal posts.
Have funding systems that work well in other countries been explored? What ideas came out of that? Surely this is a problem facing many countries with ageing populations and increasing numbers of disabled people through medical advances prolonging and saving lives.
Younger disabled people get a really bad deal financially, especially if they are in a couple and the other person works. The benefit rules mean the working partner has to support the disabled one financially, but the tax rules mean the working partner cannot use the disabled partners tax allowance. This means that the working partner will find it harder to save for their own future care needs, and puts the disabled partner into a situation of financial dependance which puts a strain on relationships. Most couples nowdays keep financial independence even if married so disability benefits for working age should be based on contributions and need, ignoring the partners income. Also the level of disability benefits in no way comes close to a reasonable standard of living for a non-disabled person, never mind cover the extra cost of a disabilty such as extra heating costs (eg young disabled people get no winter fuel allowance, unlike healthy working pensioners). The ESA for disabled people should be based on minimum wage levels as it is supposed to be income replacement for people with a disability and so a 35 hour week at minimum wage of £5.73 ie £200.55 a week should be paid, instead the highest ESA is £95 a week. If disabled people had a higher income they could save towards their own future care needs or pay for top up low level care to help keep them healthy for longer and extend the periods they spend out of the care system. I think the support for young people with disabilities should be looked at seperately - eg where does a young person with dementia get specialist care appropriate to their age rather than being placed with much older people who are often physically frailer and have different needs to young people? Also a young person with dementia is likely to need care for longer than an older person which will also impact on the cost of care. I think you need a different system of funding in this sort of situation.
I do not trust promises that people would no be worse off under changes to the funding system. The ESA has no young persons enhancement unlike ICB so if my husband is 'migrated' to the ESA he will be worse off, but it was promised that no-one would be.
I am worried that care needs which are not 'regular' and predictable, or are even individual choices, which people can fund with DLA(care component) and AA won't be possible if these are bundled with social care. When I worked in home care, I remember visiting an immobile elderly lady and finding one ripped sheet on her bed, so I tried to change it, only to discover she had no others, they had all worn out. Because the council only funded routine care of three half-hours a day, she could not send anyone to the shops to buy her sheets, and drink very little because she could not walk to the commode unaided. This illustrates why some extra money is needed to pay for irregular expenses or care (she had no idea about how to pay for extra care, but the 'irregular' nature of the need is a good example.) Another unmet irregular need I encountered in a care home where, fortunately for the many inmates who longed to buy a paper, there also lived a fit but 'learning disabled' woman whose husband was the one in need of living there but somehow she had ended up there; she would go out with their money and buy their newspapers, to distract them from the interminable days; without her, this need would have gone unmet because it was 'exceptional', not basic care. I give these examples from experience to illustrate why giving the money to recipients to spend as they wish and not bundling it in with 'basic care' and personal care is a good thing that should be protected.
DLA and AA are currently the only non means tested benefits people with disabilities get to help them with all the things that just out right cost more because they are disabled or unable to care for themselves, if a disabled person like myself has a partner who works then the benefit system gives them nothing other than DLA to help them pay their own way in life instead of having to wait weeks and months for the minimal help available from local councils, help that is rarely enough. if you take that funding away from people then they will no longer be able to have any choice in the way they run their life and for someone in their earlier stages of life this idea is terrifying, there are thousands of people out there who have enough trouble with the current system of DLA without having what little they do get taken away from them i think this whole idea is atrocious, as local councils always syphon off funding for sick and disabled people to go elsewhere and not only that but they also utterly focus on sick older people and ignore the disabled younger generations who are also unable to care for themselves but don't have any wish to sit in tea rooms all day long. My disability benifits is the only money i can currently put into my relationship in which my faïence has to not only work 35 hours a week to bring the money home but now has o care for my needs th rest of the time and if that was taken away from me it would also take away the last bit of independence i have.
I have been paying national insurance all my working life, on the understanding that if I became ill and needed care I would receive it. It seems iniquitous to demand more money from me when I am no longer able to earn.
The threat to remove attendance allowance seems to me to be another injustice to people of my generation, now coming up to retirement. We have paid throughout our lives to support other people, but when we need it we are being told either we have to pay for it or we are to be taxed again, on whatever pension we may have, in order to pay pay for our own care when we need it.
Ruling out asking people of working age to pay for this means people of my generation will essentially have had to pay twice - for the care of others when we were working, and for our own care when we are retired.
Myself and my husband have luckily always worked and payed our taxes and NI surely we have already paid for our future, if the Government have got it wrong why do they carry on throwing money away (winter fuel allowance to people who don't need it, child benefit to children who live abroad etc, fraudulant claims for expences to MPs) need I say more.
Surely in a society of 61 million there is a more simple way of supporting the projected 1.7 million who need care and extra help?
Why has an increase in income tax been ruled out ? People who are employed now must expect to contribute to the care and support they may been later in life.
If the final decision is to require a lump-sum payment on retirement, I think there should be a cut-off point for the payment of say people aged 50 or 55. This could increase year on year until the system is fully established. People approaching retirement now have not had the opportunity to save for this parment towards their care, so should not be penalised. In future, I assume there will be systems to enable people to save over the long term (e.g. private insurance) but now it would be a major drain on what little older people have been able to save for an active retirement.
I think of one good way of getting more money in to care - Getting rid of trident, which is apparently costing £72bn. I dont think any one in Britan will benifit from this spending, however, if its true that one in four people will need care at some point in their lifes, surely thats a more obvious place to spend the money.
As a young person paying the already exhortionate NI/Income tax etc, whilst also trying to support my partner and mother on long term sick, I find it very unfair that people feel the way to help our older generation is to tax the youger generation. I am aware that there will be little state pension when i come to need it in 30 years and so am also trying to sort out my own and my partners future. I have no expectations of the state caring for my mother when she gets to the time she can no longer live alone as feel it is mine and my family's duty to look after her. I have sympathy for people who have paid into the state and agree that they should get what they are due, but I do feel something needs to change!
As a disabled person in my 50's I find DLA provides me with a high degree of independance which I would be concerned to loose if everything is bundled into a national care system. DLA allows me to decide what services, equipment etc. I purchase to help me. Crucially I can decide where and when to spend the money without having to ask social services to consider providing me with something. Any changes, for example the suggestion of large lump sums, should be phased in over several years for those like me who are fast approaching retirement age and would not have time to build up the required capital. The idea of phasing changes is not new as can be seen with the length of time it is taking to introduce the new state pension retirement ages for men and women. I am also a bit concerned that this discussion focuses on a national service for England but then looks at benefits available across the whole of the UK. If AA and DLa are used to support this national service what would happen to people like me who live in Scotland? Would DLA and AA continue outside England or would the benefits simply disappear? I am old enough to have been dependant on services from local councils before the introduction of DLA and I do not want to return to the 'dead man's shoes' attitude to providing services/equipment from limited local authority budgets.
You write
"In developing the new system, we think there is a case for drawing some funding streams together to enable us to deliver the new and better care and support system we want to create. We think we should consider integrating some elements of disability benefits, for example Attendance Allowance, to create a new offer for individuals with care and support needs."
Does this mean "re-allocating" funding such as AA or DLA away from the individual disabled citizen into the hands of LAs ot a National Care Service"?
is it is a heavily retrograde step as it denies the citizen the control of funds which enables them best to decide how to utilise them to offset the effects of their disability. Passing the funds to a third party to allocate as they see fit is a move back to the politics of the work/poor house and should be rejected.
It is interesting that such heavy handedness stands in contrast to the light regulationary touch adopted by successive governments towards the better off in society.
Of course if the government actually tried taxing the bankers disgusting bonuses, or actually getting the tax avoided by the ultra-wealthy, we wouldn't even need to be discussing this as the money would be there.
I also feel AA and DLA should not be bundled into a care package, as they are intended to cover the extra costs of disability and should remain flexible, so people can spend them on whatever they need in order to maintain their independence.
For younger people who do not get the Government’s Heating Allowance, DLA can be used to offset the cost of extra heating, and for older people who do not receive a mobility component, AA can be used to cover the cost of taxis.
In my case, my DLA is used for replacement wheelchair parts (as the cost of my chair was only part-funded by the NHS voucher scheme), replacing clothes worn out by my wheelchair, and my Motability car (amongst other things).
No matter how care services are supplied, disabled people of all ages will still face additional expenses such as these, so should continue to receive AA and DLA.
I simply cannot comprehend this debate; so many different governmental staff/politicians have said so many different things - which just muddies the water; maybe that is the idea. People with disabilities deserve the right to decide how to spend their DLA which is awarded them on their individual circumstances and at this stage there should be no risk to anyone over 55 losing any DLA, legislation should include be a period of consolidation and protection for current claimants. Needs of the elderly are different and many are a result of frailty - whether physical or mental, so don't confuse the two issues. Much of the "care" cost could be covered by taxing bonuses, pay-offs, savings in the changes in MP and MEP etc expenses, and reverting to a higher rate of tax for high earners (say over £75000 pa); child benefit should only be paid to those with a lower income (under £20000 grand a year for one child and pro rate) and dropping the birth bonus also to these children.
Local Authorities cannot be trusted to ensure current claimants will receive a similar service, even through the direct payments scheme. I want to make some building alterations to my home so it will remain suitable for my needs; one borugh council dept will accept DLA as evidence of disability; another not - they want an Occupational Therapist's confirmation of my disability/mobility problems; yet the Bc doesn't emply any - they are the responsibility of the County Council. Exemptions from building and planning fees is my right, as is applying for a disabled facilities grant - yet this mysterious OT I have been asking to call for 4 months simply does not materialise.
Everyone should share responsibility of the cost through income tax and perhaps a small lump sum when retiring - up to £10000.
Being single with no family to look out for me, I am terrified of the future; particularly if in residential care as my parents were for 4 years - and it was a constant battle to keep good care high on the agnda - because staff were untrained, and not earning enought o cover their own training costs; some were kind - others not so.
Assuming that people pay £20,000 if they can afford it.
Who will judge whether they actually receive any care for that money?
And what if they are judged "not eligable"?
And what if they refuse to pay? Will they then not receive care and support and be allowed to die?
Increase National Insurance. It is an insurance plan created to provide medical care, and financial support should your situation require it.
(Just in case you had forgotten.)
Alternatively refund all NI contributions and allow people to purchase their own insurance policies.
If the National Insurance Policy is bankrupt, then surely it is due to financial mis-administration and those found guilty should be penalised.
Not the people who have paid their premiums.
Quick to assist the banks, less quick to investigate the mismanagement of a National Insurance Policy.
Similarly the mis-managed pension funds.
Stop expecting the poorest members of society to pay for your lack of financial planning.
why is it that as soon as you reach 65 you are not as disabled as before 65. the reason is plain we are not fit for purpose ie living. i myself cannot cope now, without the help i get i don;t know what i will do. it is no use saying they will put the money in the hands of social services what a joke they can't manage now. my wife asked for a weelchair 7months ago, she was referral with a doctor and seen by a nurse who filled in a form to get the weelchair. after 2 months it had not arrived so see rang the hospital to find out what was wrong, she was told that the nurse had not filled out the form correctly so they canceled the weelchair so my wife applied again a nurse arrived filled out the form once again my wife rang again to be told that tha chair had arrived but they sent it back because the measurements where wrong so she is still waiting. his money they are taking away from us is just to fill in a black hole the MP'S have caused by there greed and the bankers greed.
surely this treatment is against our human rights, i am going to take this to the human rights body but i need help to do this, i have there address but i need help to ask them.
I do think that those who plead that they have paid taxes and NI all their lives (and I am in this category) and then reason that therefore they are entitled to expect all the care needed, should be more realistic. We 'oldies' are benefitting from far greater life expectancy that could ever have been predicted and thus the finacial liability for care is far greater than could have been taken into account when our taxes etc were set.
The situation has changed, and so must oyur expectations.
If care funding is given to the councils social services, we will be back with having no choice of when and what care we get. I have MS and my carers are my employees ( direct payment system and DLA) , they have been with me for years and with out them I could not funtion and my quality of life would suffer. if my carers were supplied by the council i would have no control of who came or when or what they do. I would not be able to ask them to take me to the theatre or maybe clean out a messy cupboard or massage my legs. i have night care and I could not sleep if different poeple were coming each night and care supplied social services (home helps ) can not gauantee that the same poeple will sent, my team will arrange cover between themselves to make sure I'm never without care. Very often I am not able to communicate to my carers what wants doing, but they know my routine if someone else was sent they would not know what to do and that would cause me more stress trying to instruct them. Oh please don't take even more of my independance away!
Quote> We think we should consider integrating some elements of disability benefits, for example Attendance Allowance, to create a new offer for individuals with care and support needs.
What is the new offer? and how can the councils do it for the same money. They can't even sweep up my street properly.
Recently my District Council was taken over by the "Cornwall Council" against the will of 82% of the people, and now costs more to run (the council tax has risen).
Now it looks like these changes are to be done against the will of the people.
Quote> Whatever the outcome of the consultation, we want to ensure that people receiving any of the relevant benefits at the time of reform would continue to receive an equivalent level of support and protection.
Not if you put it in the hands of the local councils.
I it aint broke, don't fix it !!!!!