There are a number of points of interest to note.
First, at a stroke, just before the Parliamentary recess there was a simple announcement that most of the important Dilnot changes in the Act would not be implemented for the foreseeable future. Apparently, this is in response to local authority lobbying that the costs were simply unaffordable.
Whilst this was headlined as a retraction of the “cap” on individual personal care costs, the change goes much further than that. Effectively, for care homes, the Act is now a single source restatement of the law, helpful in itself, rather than a piece of major social care reform.
The “cap” on costs payable for personal care in an individual’s lifetime has been postponed. The “cap” mooted at £72k would in fact have cost little, because, with the exclusion of accommodation, food and activities, it is estimated that an individual would have had to be in care for more than 6 years before any individual benefit was achieved but:-
• The increase in capital availability from £23k to in excess of £100k has also been postponed. This would have brought into non-contributing care many more people and would have ring fenced an inheritance fund. This is the item that would have cost so much more for LASSDS. Further Government would have had to fund but would local authorities have been forward to ring-fence? We shall never know.
• The introduction of national eligibility criteria for care has also been postponed. LASSDS will remain entitled to set their own criteria, no doubt heavily driven by financial budgets and not drawn into a national scheme. All of this amounts to “ALL CHANGE BUT NO CHANGE AT ALL.”
Human Rights
The conversion of care homes and care at home agencies to public authorities when providing care and accommodation is re-enacted in section 73 so that service users are entitled to the benefit of Humans Rights protection to the extent that that has any real practical implication.
However, as before, the provision does not apply to residents/care users who are funded by any source other than a local authority .i.e. self-funders, those funded by voluntary organisations, and, the NHS are excluded.
It has never been clear as to the real impact of this provision as the extent of CQC’s regulation under the Health and Social Care Act clearly provides for a backdrop of regulatory expectations, which, when combined with local authority commissioning contracts, provide a much more comprehensive and effect protection than the rather generic approach of the Human Rights Act.
Mental Health Aftercare
Persons discharged from secure mental health services who require “aftercare” may not be charged for all or part of that service irrespective of means. That is to change.
Aftercare means a service to meet needs related to a mental disorder and reducing the risk of deterioration and a return to hospital [this appears to limit local authority exposure].
The liable local authority will be the authority where the person is permanently settled (ordinary residence) prior to hospital admission. Ordinary residence disputes will be settled as with other such disputes. In particular, this means that care should be seamless and the residence dispute should not obstruct care delivery.
Choice of preferred accommodation must be honoured.
In England there may be regulations to permit charging to the person concerned, all or part of any additional costs .i.e. the cost in the preferred accommodation which is more than the price which the local authority would expect to usually pay .i.e. this is provision for a dent in the principle that after care services are free to the user, but, only to the extent that the cost of such services is inflated as a result of service user choice.
All in all, the changes present rely much on local authority supporting and not addressing the issue that the public purse should meet a greater proportion of care costs for all.
