The Big Care Debate - Part 1
Creating a National Care Service
This section covers chapter 3 of the Green Paper and the first official consultation question asking for opinions on proposed six principles of a National Care Service.
Prime Minister Gordon Brown advises in the Foreword that the establishment of a National Care Service is to address the unfairness of regional disparities and provide greater security for all in their later years. The Government wants a new National Care Service that is fairer, simpler and more affordable for everyone underpinned by national rights and entitlements whilst keeping a service that can respond to individual needs. There are six principles that the Government advises people should expect from a new National Care Service:
- Everyone should be entitled to preventative services
- A nationally applicable assessment that is portable among local authorities
- Joined-up services with only one assessment needed to access services
- Universal access to information and advice
- Personalised care and support
- Everyone will receive some funding towards their care and support costs
This section will ask questions about how these might be achieved.
National assessment & eligibility
There have been criticisms that in the current local system there can be unfair differences in the social care packages received by people with similar needs in different local authorities. The Government seeks to address this by setting national eligibility criteria for support and a nationally set proportion of the calculated costs of care that would be paid. Furthermore, any assessment would be portable i.e. you would not have to be assessed if you moved into a different local authority area.
- Would you like national government or your local authority to decide eligibility criteria?
- Would you like a national assessment that could be taken to any local authority in England?
We would also appreciate your views on the current Carer’s Assessment and whether you think it works, how it can be improved or whether it needs to be replaced. Additionally, we would like your opinions on whether there are any of the six principles that need to be specifically addressed to make a reality for carers and those receiving care.
- What are your views on the carer’s assessment?
- Are there any of the six principles of the proposed National Care Service that need specific attention to make a reality?
A fully national or a part local-national system?
The Government also asks whether it is national or local government that should decide what actual level of support/budget the individual would be entitled to. However, regardless of who decides the money would still go through local authorities.
The government appears to prefer the part national-local system and provides some arguments against a wholly national system (pg. 123):
- A local system of deciding how much individuals get allows local authorities more flexibility to encourage new kinds of care and support in their area.
- It will allow greater response to local conditions i.e. unit costs of care and support are greater in the south of England than in the north due to higher wages and property prices.
We think the first option could still apply in a national system as local authorities would continue to receive funding from national government for social care. On the second point, the national government could still set different budgets for the same needs among different areas to reflect different costs. They effectively do this currently by giving varying grants to local authorities partly because of variance in local costs.
A third government concern of a national system is that the current local system allows local authorities to choose to devote monies raised locally (council tax) to social care, but that in a wholly national system it would be extremely unlikely that local authorities would choose to do this. However, in a Comprehensive system, national Government would meet all social care costs through taxes and personal contributions. Therefore, it would be unnecessary for local authorities to devote locally raised income to social care; whether it was a part national-local or fully national system would not affect this.
The government also advises that it might be more difficult to have a part-national, part-local system with the Insurance system, but does not expand on the reasons why (pg. 123).
One problem for a national system that is not mentioned would be the need to prescribe what a budget should be for certain needs. The current system has drawn criticism because people with similar needs receive different packages of support/budgets due to living in different local authorities. For a national system to eradicate difference, it would need to prescribe an exact package/budget that would be given to people with identical needs, regardless of which local authority they lived in.
The first problem with this would be that given the complexity of needs amongst individuals it would appear impossible to prescribe budgets to every possible combination of needs. Furthermore, there is a difference between having similar needs and identical needs. The Government advises that in a fully national system “everyone who had the same level of need received exactly the same funding” (pg 124), but it is unreasonable to think that there are any two people, let alone whole groups of people, who actually have the exact same level or range of need.
The only way for a national allocation system to work would be for people to be placed in bands or categories that had equivalent allocations into which people would be placed. This would re-introduce inflexibility into a system that is meant to becoming more personal and tailored to individual needs.
- Would you like national government or the local authority to decide what amount of support you need?
Download a printable version of the briefing: Social Care Green Paper Part 1 (173 KB)
