Personal care gets political, by the King’s Fund

Posted in: PF blog

6:31 pm, 30 September 2009 | kingsfund

If  ‘there is no such thing as a free lunch’, as economists remind us, the same can’t be said for personal care if the prime minister’s pledge at the Labour Party conference is to be taken at face value.

After all, only in July the government’s green paper ruled out free care because it would require higher taxes and place an unfair burden on the working population (a Royal Commission having reached the same conclusion almost ten years earlier). Instead, views were sought on three other options, including insurance schemes and co-payment. A ‘big care debate’ was launched, and there is still eight weeks to go before the public consultation ends.

So the prime minister’s announcement that ‘for those with the highest needs we will now offer in their own homes free personal care’ was not so much a rabbit pulled unexpectedly out of the hat but a species that we thought was to become extinct.

It will receive a warm welcome in many quarters – the distinction between free NHS care and means-tested social care continues to offend public perceptions of what is fair.  But it is an expensive commitment – £670m. It will not in itself generate any additional care to meet the unmet needs of those falling outside the system; but will financially relieve those who pay towards the care they are already receiving.  This might not be the best place to begin fundamental reform of care funding.

Some of the money will come from councils’ savings – yet more efficiencies, one presumes – and creates the danger of inadvertently incentivising councils to steer people towards residential care, where the cost will fall on the individual, when most people prefer to stay at home. Most people expect, wrongly, that care will be free anyway. And the Scottish experience has taught us that the devil is in the detail. Just how is ‘personal care’ defined in practice, how are the ‘highest needs’ demarcated and by whom?

Any steps to tackle a chronically under-resourced care system will be welcomed. Let’s hope that this particular proposal will be viewed as part of a wider package of  measures in the promised white paper. That way the rhetoric of the prime minister’s announcement will be matched by the reality of a better social care system.

Richard Humphries is a senior fellow at the King’s Fund

http://www.kingsfund.org.uk/

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