An Outline of the Main Sources of Health and Social Care Funding

Introduction

Finding information about health social care funding can be likened with searching for the source of the Nile: Everyone knows it must exist somewhere. My aim in this article is to explain the principal sources of funding (primarily I address funding for domiciliary care) and provide links that you can follow for more detailed information. Just a word of caution here. I provide links to some of my own articles, which in some cases may contain figures that were accurate at the time. It is always worth bearing in mind that any figures cited may now differ.

Social Services Funding

Funding from social services is means tested. Therefore you may qualify and have to make no contribution; you may qualify and have to make a contribution, or you may not qualify. Prior to any means test being conducted, you will have to have a care needs assessment. This article explains about the care needs assessment. Although it refers specifically to Kent County Council, the principles stated apply wherever you are in England. This article explains about means tests. Again, it refers to Kent County Council but the principles are general.

If you qualify for social services funding you now have a choice. Social services can set up everything for you and that will suit many people. However, you will have been awarded what is called a personal budget. You can take this budget in the form of a direct payment. You can then use this money to purchase your own home care. If you have care from a private provider, you may well have to make a contribution from your own funds. Many people are happy to do this.

With a small number of exceptions, you have a right to a direct payment. A right that is enshrined in law - in the Care Act 2014. You do not have to have your home care through social services. You do not have to have your home care arranged by social services. You do not have to have your home care from a company recommended by social services. You have a right to choose; this right cannot be denied to you.

Social care funding is a controversial topic. You may recall that during the 2017 election the Conservative Party's manifesto proposals for funding social care were met with the most hostile criticism. The proposals were so badly received that is arguable that they contributed significantly to the Conservatives poor showing at the polls. I have been saying since then that history will not judge this government on brexit alone. It will judge it to a large degree on what - if anything - it does about funding social care.

Self Funding

If you do not qualify for social care funding you will have to fund your care yourself. This article offers you some advice about choosing home care. Essentially your choices are: use a private domiciliary care provider; employ you own carers directly; use self-employed carers. Option one is likely to be the most expensive. Options two and three clearly provide you with a financial incentive. There are, though, a few things to bear in mind. 

I go into a little detail about the things to bear in mind in this article. Although this article was written expressly about live-in care, the challenges of employing carers or using self-employed carers are identical whether you are talking about live-in care or other types of domiciliary care. In brief, if you employ a carer, you are an employer and have all the responsibilities that employers have. If you engage a self-employed carer who works exclusively for you, as far as HMRC is concerned you are an employer.

Continuing Health Care Funding

If you are assessed as having primary health need, You may qualify for financial support through NHS Continuing Health Care Funding. The NHS Choices website provides a very unhelpful circular definition of primary health need. Assessments are carried out by a multidisciplinary NHS team. There is no right to an assessment, but if it seems that you might need NHSCHC then the Clinical Commissioning Group (CCG) for your area must carry out an assessment. 

There is no means test for Continuing Health Care funding. As with social care funding there is a mechanism for you to have a personal budget, called a personal health budget. Once again, this is something to which you have a right, with a few exceptions.

Intermediate Care

There are occasions when you might need  little bit of help to maintain or regain your independence, for example, when you are due to be discharged from hospital. In such circumstances, you may qualify for intermediate care. This article explains about intermediate care. There is no means test for intermediate care.

Enablment or Reablement

The approach underpinning reablement is to help you to live your life independently. Reablement workers are not charged with the responsibility of doing things for you; they are responsible for helping you become confident and competent in doing things for yourself. This article gives more details. Again, there is no means test for those who qualify.

If you would like more information about any of the above, follow the links or telephone me at Caremark Thanet on the number below.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Social Care Funding and Political Miscalculation

Health and social care funding is now well and truly a part of the political geography of the UK. As far as England is concerned, it has for years been a blot on the landscape that has undergone several attempts (actual and proposed) to hide it from view. Today, we have now discovered that the blot is built on a fault line and the plates have move. The tremors have been felt in Downing Street: the damage is serious.

During the week beginning 15 May 2917, the Conservatives published their election manifesto. Their plans for social care funding in England proved monumentally - and perhaps - disastrously controversial.  There are very few people who would disagree that something has to be done about social care funding. The question, though: is what should be done?

Social care needs more money; but where is that money to come from. The options are few. First, money can be taken from another area of public spending. That's not going to go down too well with the people in the departments affected.

Second, money can be raised from the public. The thorny point here is who should pay. At the moment, if you require social care you get no financial help if you have savings above £23, 500. Below this figure, you receive some financial help. If more money is to be raised, should it fall upon everyone to contribute even though not everyone will need social care during their lifetime. Alternatively, should those who need social care be required to pay for it.

At this election, the big division between the parties on the question of social care funding saw the Liberal Democrats and Labour in favour of distributing the burden more widely, and the Conservatives placing the burden on those who need social care. With the Tory proposals, if you required domiciliary care, your home would form part of your savings for means test purpose; whereas at the moment it is excluded. I should submit, that the Tory manifesto proposal for funding social care was electorally catastrophic for them. Teresa May's claim a few days later that there would be a cap on the social care fees you would have to pay - a cap not mentioned in the manifesto - just made things worse.

Labour called the Tory proposals a dementia tax. The grey vote was alienated. At the 2015 election, 47% of people aged 65 and over and 46% of property owners voted Tory.  I may be wide of the mark here, but I would not be surprised if the children of property owning parents voted to keep their inheritance. On Monday May 15 2016, a poll of polls but the Tories 17 percentage points ahead of Labour. Today, with the election results all but in, the Conservatives are the largest party in Parliament but have lost their majority.

With a hung Parliament, it is questionable whether social care is going to be high on any coalition government's agenda. On the other hand, perhaps there now exists an opportunity deal with the issue of social care funding: it is not going away, that is certain.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Funding Social Care in England: What the Main Political Parties Propose: UPDATE

At the time of writing this article, political parties have published their manifestos and are actively campaigning throughout the country for our votes. Predictably, there is little agreement amongst the parties on most things. There is one point, however, upon which all parties agree, and with which few people in the country would take issue: that point of agreement is that our social care system needs reforming. There is no agreement, though, about how this reform will be funded. This article very briefly looks at what the main parties propose for funding social care in England.

The week just gone, week beginning Monday 15 May 2017, saw the Conservatives publish their manifesto. The proposals contained in that manifesto for funding social care have received quite an amount of media attention. At the moment, financial help with social care fees is provided to people with savings less than £23,250. With regard to domiciliary care, the equity in your home is not taken into account (it is for residential care fees).

The Conservative's proposal is that help with social care fees will no be available for people with savings up to £100, 000. However, the equity in your home will be included in the calculation for qualifying for help with both residential and domiciliary care fees. You will not have to sell your property during your lifetime nor whilst a surviving partner is living in your home. You will, though, have to take some form of loan to pay for your care fees until your savings drop below £100,000.

The thing that occurs to me is that the long term consequence of this may be to discourage home ownership and saving and in a generation or two's time we will be back to a social care funding crisis. To prevent this occurring there may need to be penalties incurred by those who dispose of assets in their lifetime and/or some kind of social care tax or insurance. Which brings me to the Liberal Democrat's proposals.

The proposals from the Liberal Democrats include an immediate one penny rise in the basic, higher and additional rates of income tax. This will raise, it is claimed, £6 billion that will be used to fund the NHS and social care. At some future point, this one penny increase will be replaced by a health and care tax, which may involve a reform of our national insurance system. Eventually, the aim is for one health and social care budget.

Labour's proposals include developing a National Care Service for England. Social care will receive an extra £8 billion during the first Parliament of a Labour government, with an additional £1 billion in the first year. The National Health Service and the new National Care Service will require £3 billion extra in the "first years". A limit will be placed on an individual's lifetime contribution to care fees. To pay for these proposals the Labour manifesto suggests options including wealth taxes, employer contributions and/or a social care levy.

The inescapable fact is that the money to fund social care has to come from somewhere. To give more money to social care either some other area of Government spending receives less, or more money is raised. And the ways of raising more money are fairly limited.

Update

As you are undoubtedly aware, Teresa May announced last week (week beginning 22 May 2017) that, should the government be re-elected, there would be a cap on the amount that you are expected to pay for your social care; notwithstanding that this commitment was not present in the Conservatives' manifesto.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.