Personal Care at Home Bill

I have spoken to Kent County Council's Cabinet on Monday 1st February re the significant issues relating to the Personal Care at Home Bill. The press release that was issued follows and I hope you find it of interest.


Personal Care at Home

Graham Gibbens, Kent County Council Cabinet member for Kent Adult Social Services, spoke at the Cabinet meeting on Kent County Council’s response to the government’s Personal Care at Home proposals.

“In an ideal world, we would wish to give free personal care at home to as many elderly people as possible. However, it is simply not affordable, particularly since we are in the throes of a debt crisis and the reality is that this could only be paid for through cuts to the NHS and higher council taxes.

“We are pleased that Adult Social Care has come out of the shadows and been accorded the increase importance and high public profile that is has long deserved. To this end, we eagerly await the Care and Support White Paper, which we hope will place Adult Social Care on more sustainable foundations and make sure that the health and wellbeing of the people of Kent is safeguarded for as long as possible.

“One particular concern we must raise is the issue of the affordability of the government’s proposals. It appears to be unaffordable. Having given careful consideration to the details in the consultation document and accompanying impact assessment, we have grave misgivings and have reached the conclusion that the proposals have not been sufficiently costed and assessed.”

ADLs are Activities of Daily Living. Working out how many of these activities require help is a way of identifying levels of need.

Mr Gibbens quoted the Impact Assessment for the Personal Care at Home Bill, published on 6 January 2010:

“We know very little about the disability of those younger adults who do not already receive free personal care, so all of the estimated costs of extended free care to this group have been included in the 4+ADL figures. These costs are themselves uncertain...

“Particularly alarming is the fact that Department of Health has worked out its costs on the basis of an average of 6.54 hours a week for those in need of this level of care. Independent research from the Personal Social Services Research Unit suggests that the target hours of personal care for an individual needing help with four activities of daily livings (4+ADL) is 15.6 hours per week, and for an individual needing help with five ADLs, the figure is 18.7 hours per week.

“This evidence, combined with our experience in providing care and support in Kent, suggests that 6.54 hours would be woefully inadequate to meet the requirement of those with the highest level of need.

“We have carried out our own analysis of what implementing the proposals would cost. It is hard to provide a clear estimate for the likely cost of this policy. There are some very significant areas of uncertainty that I want to highlight:
· the extent to which current self-funders qualify for this financial support,
· the extent to which current service users on Critical also need significant help with four or more ADLs,
· the extent to which people currently in residential care will seek to discharge themselves to benefit from this policy.

“Other financial risks, which cannot be assessed but which could further increase costs, are:
· people believe that they should be eligible for this support when they are not, refusing to pay for their support, thereby increasing levels of debt,
· individuals who are eligible for this support not seeing the need to apply for Continuing Healthcare status (and indeed PCTs being reluctant to assess for this) thereby increasing the numbers and costs of people who Kent County Council will be supporting,
· informal carers will step back from some or all of the care they currently provide, on the basis that this is now a free service.

“The proposed legislation goes on with the assumption that, of the estimated £670million national cost, £250million (or 37%) will be found by efficiencies in local authorities. In Kent (as in many other local authorities) the efficiency savings arising from enablement and other preventative services have already been factored in to our medium term plan – all part of how we are envisaging how we pay for challenges that will come with increases in older people numbers. It is also considered that the assumption that local authorities will pay for a part of a new policy is in direct contravention to the government’s own New Burdens Doctrine, which states that new government requirements should be fully funded. As I read it, this proposal is in conflict with this government’s own policy.

“Taking all of these factors together, the current estimate of the costs of this policy for Kent is £9m-£22m – depending on how you view the uncertainties and imponderables involved. This is over and above the assumed level of grant from government and includes the unfunded level of efficiencies.

“I have been glad to see a report this weekend from the Association of Directors of Adult Social Services that raises their concerns about this proposal.

“Finally, I come back to where I started. In an ideal world, we would like to offer free care at home; at the present time it is simply not affordable. If the government wanted to do it properly, there would at least be a pilot that allowed us to see how this would work in practice before it is implemented across the country.

“In my opinion, this has been pushed through with limited debate in the House of Commons and it would be a shame for it to appear as though it has been pushed through merely for electoral gain.”

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