The Impact of Health & Social
Care Changes on the
Jewish Community
•Dilnot Report
(Andrew Dilnot CBE. Chair, Commission on
Funding of Care and Support)
•Government Plans
•Personalisation
•Challenges and Effects
•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
2009/106
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%
Maximum possible asset depletion
100%
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
5%
25%
Median
75%
95%
Maximum possible asset depletion
100%
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%
Current
system
20%
0%
£0k
£25k
£50k
£75k
£100k
£125k
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
100%
80%
60%
Reformed system
40%
Current
system
20%
0%
£0k
£25k
£50k
£75k
£100k
£125k
11
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%
Maximum possible asset depletion
100%
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?
• 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
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?
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)
Terminology
What is self directed
support?
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
What is self directed
assessment?
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 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)
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.