Care: Older People

Baroness Greengross Excerpts

Thursday 7th September 2017 Grand Committee

[Baroness Greengross (CB)]

My Lords, I thank the noble Lord, Lord Lipsey, very much because this is a very important issue. I think I have been involved in it for longer than anybody else. I have tried to get the issues around social care, care homes and how to pay for care right. This is a persistent, complex and very difficult subject, and we have to do something about it. If we started again, I think we would have a unified system but, let us face it, the majority of people who have to go into care homes are very old and have some form of cognitive dysfunction or dementia. They are shuffled between healthcare and social care. We are once again talking about how these people are going to be funded. It is very important that eventually we get this right. All these terribly frail people cannot go on waiting year after year while David and I meet regularly at events. Those events are not perhaps as important as being here, but they are occasions where people try to deal with this subject.

It is very hard to know what the prevalence of deferred payment agreements is because the data collection is now mandatory but the 2015-16 data collection was voluntary. Data collected by Care England, Age UK and NHS Digital found that out of 55 local authorities in England, just 1,300 DPAs were written in 2015-16, the first financial year in which the mandatory scheme was in force.

If we assume that this sample is representative of the 152 local authorities offering adult social services in this country, these data suggest that only 3,600 DPAs were issued in 2015-16. That is less than a third of the Government’s original estimate and lower than the figure in 2012. Meanwhile, Reform suggests that a higher figure of about 6,000 DPAs were issued in 2015-16 compared with the Government’s projection of 12,300. But whatever figure we use, the uptake and availability of deferred payment agreements has been very much lower than expected.

Reform concluded that tighter than expected eligibility is the principal reason why the Government overstated the number of people who would take up a DPA. These outcomes are despite councils having a statutory duty to offer DPAs under the Care Act. However, there is no government target for the number of DPAs issued by local authorities. To redress this imbalance, Reform argues for the DPA means-test threshold to be increased from £23,250 to £100,000, which would raise the percentage of self-funders who are eligible for support from 45% to 62.6%. One major challenge, however, is the lack of public awareness. Different councils develop different approaches and the pause in the Care Act is also something to be contended with.

All this has led to a huge amount of confusion. First, people do not understand the difference—they never have—between healthcare and social care. I have spent years saying that somebody who has a terminal disease, such as one of 100 different types of dementia, needs only social care, according to the rules, whereas somebody with a chronic illness such as back pain is given health service care. It is all very odd, really.

There is huge confusion in people’s minds, particularly about deferred payments. Neither is it transparent to the people who provide care or to people admitted to homes under a DPA, who would otherwise have been self-funders paying the home directly. DPAs also work by placing some people under a council contract, at council fee rates, and the home does not know their true status, which might mean that they have enough money to pay for it. So, as much as I deplore the fact that we have different criteria for healthcare and social care—as we always have had—it works both ways. Some people who really have enough money are not paying, because we know that councils pay very much less, which is one reason why so many care homes are going out of business.

So the use of DPAs is not transparent to the provider and, as an example of the rather covert nature of this landscape in which DPAs operate, the Department of Health recently completed an internal review of them in order to inform policy making, but it has chosen not to make the findings public. Perhaps the Minister can say why. It would be useful to know. There has not been a detailed analysis of the deferred payments scheme since 2013, when an impact assessment was published alongside the Care Act. At the time, the analysis suggested a highly patchy take-up of the scheme. There was a lot of regional variation, ranging from 1% to 40%. A new analysis to see how much take-up has changed is very much overdue, in my humble opinion.

Expectations from citizens, however, have risen. We know that they experience social care and healthcare as a continuum. The current financial challenges make the delivery of such expectations completely untenable. Taxpayers really are not getting value for money, so I endorse Care England’s view that, for DPAs to become a constructive part of a secure funding environment, a long-term vision with strong central leadership is required to take duplication and unnecessary administrative burdens out of the system. At the national level, much more clarity is needed about the partnership between the state and the individual in terms of funding. Locally, commissioners and providers need to agree the suitability of an individual’s care package, rather than this being seen as part of an arbitrary standard price.

DPAs are only part of the solution to funding social care fees, and the promised consultation on funding is a key opportunity to think about what sort of society we want to live in. Therefore, key questions on this issue are: when will the consultation be published and what form will it take, and in the meantime what short-term provision will the Government be recommending to tackle the current levels of unmet need? I hope that the noble Lord will be able to answer at least some of those points.