Critics slam costings of care at home Bill

11 Feb 10
Government plans to provide free care at home for those most in need have come under renewed fire as the care watchdog published its first survey of services across the country
By David Williams

11 February 2010

Government plans to provide free care at home for those most in need have come under renewed fire as the care watchdog published its first survey of services across the country.

The Care Quality Commission’s inaugural report on The state of health care and adult social care in England, published on February 10, described widespread improvements in standards both in social care and in the NHS.

However, it indicated that pressure on social care services was set to increase, estimating that 1.7 million more adults will need care and support by 2030.

The CQC argued that health and social care services would have to ‘fundamentally change the extent to which they join up services across traditional divides’ as spending is squeezed. But it claimed that £2bn could be saved in reduced hospital admissions if more people were better cared for in the community.

Richard Jones, vice-president of the Association of Directors of Adult Social Services, contrasted the need for increased investment in social care with the likelihood of budget reductions.

‘For every pound you spend on prevention in social care, you save £1.20 in the acute sector. The problem is, there’s no saving for social care – you would have to lever those savings back across the system, but we’re not hearing anything other than “it’s going to be incredibly difficult”,’ he told Public Finance.

‘Whether [£2bn savings are] a big enough gain to offset the type of funding reduction that is likely to be experienced is another matter. I’m not convinced.’

Adass analysis published last month suggested that the government had underestimated the cost of its Personal Care at Home Bill by around 50%.

The Bill, which aims to provide free home care for those with the highest level of need, is currently awaiting its third reading in the Lords.

On the same day as the CQC published its report, an open letter from representatives of 78 councils criticised the Bill as ‘uncosted’. The letter, published in The Times, said the legislation ‘risks adding further strain to an existing system already under considerable financial pressure’.

Among the signatories was Graham Gibbens, Kent County Council’s Cabinet member for adult social care. Speaking to PF after the CQC’s report was released, Gibbens said better joint working between the NHS and councils would not be enough to make the government’s plans affordable.

‘The difference between what we have calculated and what the government are saying is so large, it would take a massive amount of reductions from the NHS… we have looked at the numbers for Kent and they certainly don’t seem to add up.’

He said that providing free personal care to those with the greatest need would require significant council tax increases or cuts to the NHS budget.

Earlier in the week Norman Lamb, the Liberal Democrat spokesman on health, launched a stinging attack on the care at home Bill. Speaking at a February 9 conference hosted by the King’s Fund, he described the policy as ‘a glib, ill-thought-through, back-of-a-fag-packet solution’.

He added: ‘I become more and more horrified by the whole process. It is the most cynical lawmaking, more to do with wrong-footing opponents… rather than any serious attempt to reform a genuinely broken system.’

He argued that the measures would help a ‘relatively limited’ number of people, and could take services away from some by forcing councils to concentrate resources on the most needy.

But at a separate King’s Fund event on February 8, Prime Minister Gordon Brown defended the Bill, which he said represented the first step to establishing a National Care Service.

It set out a national right to care, he said, ‘overcoming local means-tests and charges… giving many thousands the chance to avoid entering residential care against their wishes and at great human and economic cost.’

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