The stakes are high to solve the care conundrum

As the population ages, current adult social care arrangements are proving both unaffordable and unfair and, as the government struggles to get public debt under control, the solutions may be unpalatable, warns Andrew Cozens

It looks like it may be quite a long spring this year, for the Department of Health at least. This is the timetable for the much-anticipated green paper on the future funding arrangements for long-term care in England.

Further, what looked like a tricky assignment for the relatively new care services minister, Phil Hope, now looks very tough to pull off. On the one hand a £6bn shortfall looks small beer in the context of the banking collapse – but it represents a huge recurring commitment in a recession. To his credit he has already dampened expectations by promising a very green paper, suggesting options for further public debate and for a future Parliament to consider.

Prior to the financial collapse, his predecessor Ivan Lewis had worked hard to bring this issue to centre stage. A well-judged programme, Putting People First, had kicked off a major overhaul of adult social care based on the principles of greater choice and control, with individual budgets, the more flexible development from direct payments, as its centrepiece. The enthusiasm that generated across the sector created the momentum for tackling the harder nut: developing a sustainable approach to the funding of long-term care, a promise made by the Prime Minister himself, launching the consultation that preceded the green paper.

The stakes are high. There is a unanimous view that the current funding arrangements are unfair and unaffordable as the population ages.

Experts have queued up to predict that only the very poor and those with very high support needs can expect anything from public funds in the next few years as things stand, and even then council tax bills would need to rise substantially just to cope with that diminishing group. Most people would be expected to fund their own care, something the baby boomer generation has already spotted and is very angry about.

All the main political parties accept the need for reform. With subtle variations they echo the Prime Minister’s call for a new settlement, to replace the post-war compromises that led to social care keeping many elements of its Poor Law origins, in stark contrast with the new National Health Service. Two of the main parties are also explicit that care and support cannot be completely free. There will need to be some assessment of need and means and an expectation of co-payment in some form. All of them agree that entitlement should be more simple and explicit and that any assessment of need should be portable across council boundaries.

Within the sector there has been feverish and responsible debate about capitalising on this opportunity in the political spotlight. While many have cherished hopes of a free and transparent system that truly responds to need and promotes independence, most accept the need to be realistic about rebalancing individual, family and state roles. In that context few expect detailed and funded proposals. The likelihood is a set of propositions to test further in debate, based on some core principles.

It would be very surprising if the green paper moved away from the core platform of Putting People First. Councils are now in the process of developing a new approach to planning for support and care based on their wider responsibilities to promote health and social well-being. Together with their local partners they are beginning to address the quality of life for older and disabled people and the contribution of public services and social capital more broadly to things like promoting independence, better health and feeling safe.

More attention is now being paid to national and international evidence about effective services that help get people back on their feet after illnesses or accidents, and better support people with their own management of a long-term health condition.

Councils are also expanding the reach of information, advice and advocacy services to reach all those needing support, irrespective of their means. Similarly, they are required to make sure there are sufficient services in place to respond to the needs of self-funders, as well as those entitled to public support.

The green paper is expected to build on this broad common infrastructure as the basis of a consistent set of entitlements based on need, irrespective of means, co-funded by councils and primary care trusts and broadly similar everywhere. We can expect, too, that councils will be asked to demonstrate they are making the most efficient use of their current funding, and getting good outcomes, as effective commissioners.

Beyond that, some sort of means testing will cut in and this will be the most contentious part of the debate. Policy makers need to come up with interim solutions for those about to enter the system, and prepare the next generation for paying more for their care than their parents have done. Many expect a shift to be proposed from 152 council systems, to a national one, possibly integrated with the benefit system in some way.

Interim solutions are slightly more predictable. We might see tax breaks for care insurance premiums, new equity release products, more use of deferred payments against property and estates, or some variation of the Wanless proposals to match individual contributions with public funds on some basis.

For the next generation, the green paper may seek to trigger a debate about planning ahead for future care needs. An option gaining momentum is the notion of a national care fund that everyone pays into, either in instalments upfront during your working years or with a (probably higher) lump sum at the time of need or from your estate. Your contribution would be capped even if you had costly care and support needs.

This is speculation, of course. What is certain is that this debate will continue in a very different economic and political climate than when it was first floated.

Experts have queued up to predict that only the very poor and those with very high support needs can expect anything from public funds in the next few years

Andrew Cozens is strategic adviser, children, adults and health services for the Improvement and Development Agency for local government