Presentation to rep council 7 july 2013

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  • 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.
  • Presentation to rep council 7 july 2013

    1. 1. The Impact of Health & Social  Care Changes on the  Jewish Community
    2. 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. 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. 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. 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. 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. 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 Maximumpossibleassetdepletion Percentiles of housing wealth
    8. 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 Asse ts o n g o ing into care Maximumpossibleassetdepletion Percentiles of housing wealth Current system £35k cap
    9. 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. 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. 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. 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 Asse ts o n g o ing into care Maximumpossibleassetdepletion Percentiles of housing wealth £35k cap with extended means test Current system
    13. 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. 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
    15. 15. Social Care – a changing system
    16. 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. 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
    18. 18. 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
    19. 19. 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)
    20. 20. 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.
    21. 21. 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.
    22. 22. 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
    23. 23. 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)
    24. 24. 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
    25. 25. 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)
    26. 26. 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.
    27. 27. 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.
    28. 28. 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.
    29. 29. 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.

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