1. The Impact of Health & Social
Care Changes on the
Jewish Community
2. •Dilnot Report
(Andrew Dilnot CBE. Chair, Commission on
Funding of Care and Support)
•Government Plans
•Personalisation
•Challenges and Effects
•What can we do?
3. 3
Conclusions and recommendations of the Commission on Funding of Care and Support
The number of older people is increasing
0%
20%
40%
60%
80%
100%
65-69 70-74 75-79 80-84 85+
Growth in the number of older people in England 2010-2030
4. 4
Conclusions and recommendations of the Commission on Funding of Care and Support
Flexible societies are good at adapting
Proportion of UK population aged 65 and over
0%
5%
10%
15%
20%
25%
1901 1921 1939 1961 1981 2001 2021
5. 5
Conclusions and recommendations of the Commission on Funding of Care and Support
Social care is one element of state support
Public spending on older people in England 2010/11
Social security
benefits
Social care
NHS
£0bn
£50bn
£100bn
£150bn
6. 6
Conclusions and recommendations of the Commission on Funding of Care and Support
Funding has not kept up with demand
Expenditure and demand: older people’s social care (2009/10 prices)
Expenditure
Demand
£6.0bn
£6.5bn
£7.0bn
£7.5bn
£8.0bn
2005/06 2006/07 2007/08 2008/09 2009/10
7. 7
Conclusions and recommendations of the Commission on Funding of Care and Support
Some people can lose most of their assets
Maximum possible asset depletion for people in residential care (150k cost)
5% 25% Median 75% 95%
0%
20%
40%
60%
80%
100%
£0k £50k £100k £150k £200k £250k £300k £350k £400k £450k £500k
Assets on going into care
Maximum
possible
asset
depletion
Percentiles
of housing
wealth
8. 8
Conclusions and recommendations of the Commission on Funding of Care and Support
A cap offers significant asset protection
Maximum possible asset depletion for people with £150k residential care costs
5% 25% Median 75% 95%
0%
20%
40%
60%
80%
100%
£0k £50k £100k £150k £200k £250k £300k £350k £400k £450k £500k
Assets on going into care
Maximum
possible
asset
depletion
Percentiles
of housing
wealth
Current system
£35k cap
9. Dilnot recommended a cap of what older
people could pay in their lifetime for social
care and support of £35,000.
In April 2017 the government will introduce a
cap of £75,000 for personal care and ‘basic
nursing’. This does not cover accommodation
and food costs (known as ‘hotel costs’).
‘Hotel costs’ will be limited to £12,000 a year
for everyone.
10. 10
Conclusions and recommendations of the Commission on Funding of Care and Support
But we also need to reform the means test
The effect of extending the means test on the amount of support people receive
Current
system
0%
20%
40%
60%
80%
100%
£0k £25k £50k £75k £100k £125k
11. 11
Conclusions and recommendations of the Commission on Funding of Care and Support
But we also need to reform the means test
The effect of extending the means test on the amount of support people receive
Reformed system
Current
system
0%
20%
40%
60%
80%
100%
£0k £25k £50k £75k £100k £125k
12. 12
Conclusions and recommendations of the Commission on Funding of Care and Support
Extending the means test helps the poorest
Maximum possible asset depletion for people with £150k residential care costs
5% 25% Median 75% 95%
0%
20%
40%
60%
80%
100%
£0k £50k £100k £150k £200k £250k £300k £350k £400k £450k £500k
Assets on going into care
Maximum
possible
asset
depletion
Percentiles
of housing
wealth
£35k cap with extended means test
Current system
13. In April 2017 the means tested threshold for
people entering residential/nursing home
care will be raised from £23,250 to £123,000.
As before, this financial assessment will
consider both income and assets. If a person
has less that £14,250 in capital and savings,
these are disregarded and the Local Authority
will meet the full costs of care.
14. What is personalisation?
“Personalisation” is about making
services fit around the individual;
enabling people to make
decisions, maximising their life
opportunities and giving them
choice and control, in the way
care and support is delivered
16. What is driving the changes?
• social work values (individual self-determination)
• government policy
– Public service reform
– ‘Putting People First’ protocol
– Carers Strategy
– Big Society
• community care reforms in early 1990s
• experience of direct payments
• public sector funding
• changing demographics
• best value and outcome focused work
17. What is driving the changes?
• People’s aspirations
• the demand for choice
• the demand for control
• greater understanding of the power of the
consumer
• demand for flexible services
• responsive & tailored services, not “off the peg”
• changing needs
• impact of technology
19. Current Model
Zoe – needs social care
Contacts Initial Assessment Team / Hospital team
Receives Social Work Assessment
Prescribed services from limited menu e.g. 20 hours homecare,
3 sessions at day care, and 5 weeks respite
21. Terminology
What is a Direct
payment?
What is an individual
budget?
• a means-tested cash
payment made in the place
of regular social service
provision to an individual
who has been assessed as
needing support
• following a financial
assessment, those eligible
can choose to take a direct
payment and arrange for
their own support instead
• applies only to social care
services
• sets an overall
budget for a range of
services
• can be taken as cash
or services or
mixture of both
• combines resources
from different funding
streams
(sometimes referred
to as a personal
budget)
22. Terminology
What is self directed
support?
What is self directed
assessment?
Finding out what is
important to people with
social care needs and their
families, and helping them
to plan how to use the
available money to achieve
these aims.
Keeping a focus on
outcomes and ensuring that
people have choice and
control over their support
arrangements
A simplified assessment led,
as far as possible, by the
person in partnership with the
professional
Focuses on the outcomes that
they and their family want to
achieve in meeting their
eligible needs.
Looks at the situation as a
whole and takes account of the
situation and needs of family
members and others who
provide informal support.
23. Example 1
Ms W, in her 30s, lives alone, has mental health
problems.
Outcome to support her in therapeutic activities of her
choice in order to maintain her well being, reduce
social isolation.
Direct payment to purchase a place on art and
photography courses. Also funded materials needed
to participate in and complete courses, e.g. binding
portfolios, framing pieces of work to portray in
exhibitions.
One off direct payment to purchase a computer which
she uses to communicate and navigate the internet to
source ideas and information with her peers in order
to maintain social contact for her courses.
24. Example 2
Mr G in his early 60s and lives with his wife who is his
carer. Significant health problems including angina,
high blood pressure, osteo-arthritis. Uses a
wheelchair. Isolated at home due to disability.
Outcomes to maintain personal hygiene, restart work
as a DJ in his local pub and relieve carer stress.
Money used to employ carer with direct payment to
assist with personal care and be taken to and from the
local pub once a week. Additionally has respite care.
Personal budget: £120/week
25. The Challenges
• Currently there are 2,880 people living in Salford
who have dementia
• Salford is the 15th most deprived local authority
area in England
• The number of people aged 85+ living in Bury is
predicted to increase by 39% by 2021
• The Jewish community has a much larger
percentage of older people than other
communities. 40% of the Jewish community is
over 60 which is twice that of the national
average (2001 census)
26. How will it affect service providers?
• The end of block contracts and large service
level agreements
• Services need to be commissionable on a private
individual basis
• Services needs to be flexible
• In tune with customer needs and expectations
• Competitively priced
• Diverse
• Changes traditional relationship - no longer
charity and beneficiary but provider and
customer
27. How will it affect service providers?
• New areas of service delivery
• Wider competition
• Potentially increased costs (complexity, out of
hours)
• The can pay won’t pay culture
• Dilnot report www.kingsfund.tv/annualconference
• Lifestyle choices
• Role of the social worker
• Eligibility criteria
• Risks (financial, litigious, H&S, HR)
28. We need to understand
• the major changes taking place to care and
health services that affect the Jewish
community.
• the personalisation agenda, meaning that
individuals in need get their own budget to
spend, where as previously this money went
to organisations to deliver services.
29. We need to recognise
• that a number of new Clinical
Commissioning Groups (CCGs) seem to
be focused on value for money and will
seek the cheapest option, regardless of
promoting Jewish providers for end of life
care.
• that there is evidence to suggest that
CCGs may signpost people to non-Jewish
care homes based on cheaper price.
30. We need to educate
• the Jewish community to use and value
their communal assets whether they be
residential homes, day services,
domiciliary care, housing providers.
• that if people chose to use non-Jewish
providers then the Jewish ones will get
more expensive as their revenue reduces
until they cannot afford to run anymore.
31. We can resolve
• to work with Manchester’s Jewish care
organisations to run an information
campaign for the community and promote
the use of Jewish care provision
• to invite those who have been told that a
relative cannot have end of life care in a
Jewish home to complain to the Council
and to support individuals to pursue their
complaints, wherever possible.
Hinweis der Redaktion
There is no doubt that we need to spend more on social care and support. This is for two reasons: because the system we have currently is inadequate and because of the significant increase in demand, particularly among older people. This chart shows that over the next 20 years, the number of older people age 65 to 69 will grow by 40%. The number of people age 80-84 will grow by 70%. The number of people age 85 and over (the group that is the most likely to have care and support needs) will double in size. This is great – we are living longer than our predecessors.
That we’re living longer is nothing new. In 1901 there were 61,000 people aged 85 and over in the UK, and now there are nearly 1,500,000. It’s true that in the future the numbers will grow more quickly than in the past, however that is not the end of the world. We shouldn’t be frightened about this, as societies and economies are very flexible and very good at adapting. We can cope with these changes perfectly well, as long as we face up to them and make the right decisions. More resources will be needed: more public money, more private money and sustainable support from carers.
This chart shows the public spending on older people in England: £82 billion a year goes on social security benefits £50 billion a year in health services Only £8 billion on social care Need to look at social care spend on older people as a whole. Only 6% is spent on social care. If we had a blank sheet of paper, we wouldn’t start from here. When we add the budget spent on working age adults, the total is £14 billion a year. The social care slice is a very small slice compared to the much larger health and social security chunks. Interactions between social care and health spending are significant. If we get social care right, we are much more likely to do well in health.
So what’s wrong with the current system? There is evidence from King’s Fund and others that there is a lot of unmet need. The dark line in the chart shows the level of spending on social care since 2005. The other line shows how demand has increased. So unmet need that existed in 2005 will have become worse. Clearly the system has been under-funded in the past. It has failed to keep pace with demographic change, especially for older people services but also for working-age. We believe that over time there have been more people not receiving all the care and support they need and the pressure on carers has been increasing. The system for funding social care harks back to the Poor Law - it is not fit for the 21st century.
This is the proportion of your assets that would be lost under the current system. With high care costs of £150,000, the worst scenario is for people just below the median. They lose 86% of their assets. With care costs of around £100,000, the worst affected people lose 81%. With costs of around £75,000, the worst affected people are those at the bottom 10% of wealth distribution. This is not an issue about middle classes. These are ordinary people with low levels of income and wealth. Their lives are made difficult because of this system.
The light area of the chart shows how much people can end up spending under the current system, with care costs of £150K. The brown area shows the maximum costs they would face, if a cap is put into place. People who were losing 86% of their assets, with a cap would only lose around 20%. The 25th centile that were losing 85% of their assets, would now lose around 27%. There is still a group that is losing significant amount of wealth. So as well as dealing with the cap, we need to deal with the means-test.
The light area of the chart shows how much people can end up spending under the current system, with care costs of £150K. The brown area shows the maximum costs they would face, if a cap is put into place. People who were losing 86% of their assets, with a cap would only lose around 20%. The 25th centile that were losing 85% of their assets, would now lose around 27%. There is still a group that is losing significant amount of wealth. So as well as dealing with the cap, we need to deal with the means-test.
If your assets are less than £14,000, the state would cover the whole cost of your residential care. If you have more than £23,251, you get no support. As you can see, there is a cliff edge that we need to get rid of. We know that not everyone will be able to afford to make their personal contribution, and those currently just outside the eligibility for means tested help are not adequately protected.
To address this, we recommended that means-tested support should continue for those of lower means, and the asset threshold for those in residential care beyond which no means tested help is given should increase from £23,250 to £100,000. Taken together, the cap and the increase in the threshold for state support in residential care, would mean that those with lower incomes and wealth receive greater protection.
The red area shows the impact of raising the threshold to £100,000. These two parts of our proposals (the cap and the increased means-test threshold) work together to ensure that the maximum anyone could lose is less than 30% of your assets, no matter how high their needs might be. They work together to help those at the bottom of wealth distribution.
The light area of the chart shows how much people can end up spending under the current system, with care costs of £150K. The brown area shows the maximum costs they would face, if a cap is put into place. People who were losing 86% of their assets, with a cap would only lose around 20%. The 25th centile that were losing 85% of their assets, would now lose around 27%. There is still a group that is losing significant amount of wealth. So as well as dealing with the cap, we need to deal with the means-test.