A bold blueprint for the future of elderly care?

5 Mar 09

Proponents of ‘social insurance’ believe it is an answer to the huge policy challenge of caring for elderly people. But there is a fear that the recession might put an end to such radical initiatives.

More than 150 compact redbrick bungalows are clustered around quiet drives edged with neat grass verges and pretty flowerbeds. It could be any well-kept housing estate. What marks this community out as different is that it represents a model of social insurance in action.

The Hartrigg Oakes project, on the outskirts of York, is run by the Joseph Rowntree Housing Trust. Residents, who are all retirees, purchase their bungalow at the market rate and on top of that pay a monthly community fee, which covers not only the general maintenance of the buildings and grounds but, significantly, their care costs.

It is the first scheme in the UK to be based on an actuarial model, so that the amount a person pays each month is based on their age when they enter the community. Risk is pooled, so the fee is payable whether care is needed or not and does not increase along with care need. Contributions paid by fitter, younger residents go to fund the care of their infirm neighbours.

Once residents become too frail to live independently they can move into the community’s care home, located at the centre of the estate.

The ten-year-old scheme has proved to be very popular. ‘I find it gives me a wonderful sense of security,’ says 76-year-old resident Sarah Cleverley, who has lived at Hartrigg Oakes since 2006. ‘They might call it God’s waiting room, but it’s the best waiting room in the world and we can have a lot of fun while we’re waiting.’

Indeed, as well as care services, the community provides a full range of entertainments and amenities, including a gym, restaurant, woodworking shop and DVD library.

Hartrigg Oakes was established as an experiment, Cleverley explains. The fact that people who are affluent enough to pursue other housing and care options in their old age are choosing to live there shows the experiment has been a success, she says.

Social insurance is an idea that has struggled to gain much mainstream support in the past. But maybe its time has come – at least in social care where there has never been universal welfare state provision.

It is certainly beginning to attract support in significant quarters. John Dixon, president of the Association of Directors of Adult Social Services, has given personal backing to such a scheme.

And just last week, the New Local Government Network think-tank, led by former Labour minister Chris Leslie, came out in support of social insurance. Leslie, a committed localist, acknowledges that there needs to be some kind of national settlement on social care.

‘No matter which way we looked at it, it was not possible to sustainably gain the uplift in investment required to move to a really radical level of [improved] care without some kind of national fund,’ he tells Public Finance.

A social insurance model, requiring low levels of compulsory payment for all, was the most pragmatic option, he adds.

The NLGN envisages a ‘completely refashioned’ role for councils as commissioners of services and facilities. ‘We thought it was worth floating that model and placing it in front of the minister at a time when he’s considering options for the green paper,’ says Leslie.

All eyes are still fixed on the long-awaited green paper to provide some answers to what the government has now acknowledged is an enormous policy challenge. The demographic realities are stark and well-documented. By 2020, the number of people aged 80 and above will have quadrupled, while those aged 85-plus – and thus more vulnerable to dementia – will have trebled.

But the timetable for the green paper’s publication continues to slip. Hopes that it would appear early in 2009 are fast disappearing and current promises of a ‘spring’ publication date are being interpreted to mean ‘more like mid-summer’.

There is also a wider and more immediate question over the extent to which these large public service reforms can compete for ministerial attention and resources while the recession rages.

‘We felt we needed to bang the drum for change and hoped the government would be sufficiently radical and far-sighted about it… The government has sent some signals that it’s willing to think big,’ Leslie says.

Sue Collins, principal policy and public affairs manager at the Joseph Rowntree Foundation, agrees there is a danger that the recession will obliterate debate. She adds, however: ‘I think there are now sufficient numbers of stakeholders saying [the government] can’t move away from this and are acutely aware we need to be working… to ensure this doesn’t slide off the agenda.’

The Joseph Rowntree Foundation this week lobbied the government for urgent change that would immediately put the social care system on a fairer footing without recourse to legislation.

But Collins is keen to stress that none of this negates the need for fundamental reform.

‘In the longer run, you can’t move away from a more radical solution and we would still be very keen on co-payments, a partnership model, being introduced,’ she says.

The starting point must be clarity from the government over just what it is prepared to fund, she adds. ‘People [have] said to us over and over again, “if we were clear about what the state offer is then we’d be much more likely to think about contributing ourselves”.’

The foundation’s own consultation work has shown that the idea of a flexible state offer – which an individual could use as they wish, maybe to purchase a stake in a community like Hartrigg Oakes – was incredibly popular.

Care services minister Phil Hope is giving little away. The green paper is in a ‘cocoon stage’, he told an NLGN conference last week. The six-month consultation period concluded late last year and ministers and officials are still picking over the feedback. Hope said a collective understanding of what social care should be was beginning to emerge.

‘You get this understanding of social care, not as a menu of services, not as a binary relationship between the state and the individual – but a shared endeavour, a collective agreement, understood, entered into and fulfilled by everyone,’ Hope said.

‘That’s what we’re looking to build: a new deal for care and a wider shift in attitudes across society.’

This talk of shared endeavours and collective agreements might be music to the ears of social insurance advocates.

It’s not clear whether there is room in this vision for something as bold as social insurance, but the government will have to show its hand before too long.

  • Vivienne Russell

    Vivienne Russell is managing editor of Public Finance magazine and publicfinance.co.uk

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