The Impact of Health & Social Care Changes on the Jewish Community

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Dilnot Report

(Andrew Dilnot CBE. Chair, Commission on Funding of Care and Support)

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Government Plans

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Personalisation

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Challenges and Effects

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What can we do?

Conclusions and recommendations of the Commission on Funding of Care and Support

The number of older people is increasing

Growth in the number of older people in England 2010-2030

100% 80% 60% 40% 20% 0% 65-69 70-74 75-79 80-84 85+ 3

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

25% 20% 15% 10% 5% 0% 1901 1921 1939 1961 1981 2001 2021 4

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

£150bn

Social care NHS

£100bn £50bn £0bn

Social security benefits

5

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)

£8.0bn

Demand

£7.5bn

Expenditure

£7.0bn

£6.5bn

£6.0bn

2005/06 2006/07 2007/08 2008/09 2009/10 6

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)

100%

5% 25% Median 75% 95% Percentiles of housing wealth

80% 60% 40% 20% 0% £0k £50k £100k £150k £200k £250k £300k

Assets on going into care

£350k £400k £450k £500k 7

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

100%

5% 25% Median 75% 95% Percentiles of housing wealth

80% 60% Current system 40% 20% £35k cap 0% £0k £50k £100k £150k £200k £250k £300k

Assets on going into care

£350k £400k £450k £500k 8

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.

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

100% 80% 60% 40% 20% 0% £0k

Current system

£25k £50k £75k £100k

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

100% 80% 60% 40% 20% 0% £0k

Current system

£25k £50k

Reformed system

£75k £100k

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

100%

5% 25% Median 75% 95% Percentiles of housing wealth

80% 60% Current system 40% 20% £35k cap with extended means test 0% £0k £50k £100k £150k £200k £250k £300k

Assets on going into care

£350k £400k £450k £500k 12

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.

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

Social Care – a changing system

What

is driving the changes?

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social work values (individual self-determination) government policy

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Public service reform

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‘Putting People First’ protocol

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Carers Strategy Big Society

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community care reforms in early 1990s

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experience of direct payments

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public sector funding

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changing demographics

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best value and outcome focused work

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

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

Terminology

What is a Direct payment?

• 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

What is an individual

• • •

budget?

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 )

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.

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.

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

The Challenges

• Currently there are 2,880 people living in Salford who have dementia • Salford is the 15 th area in England most deprived local authority • 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)

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

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)

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.

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.

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.

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.