The report sets out a number of far reaching recommendations based on shared responsibilities between the state and individuals (and possibly potentially emerging care insurers), which echo previously recommended partnership models.

Most importantly it makes a clear connection between reforms and resources by recommending an overall increase in resources for social care to the tune of £1.7bn at 2010/11 prices rising to £2.8bn in 2020/21.

There seems to be something for everyone in the report:

People with high lifetime care costs: The report proposes a life time cap of £35,000 for individual responsibility for care costs. Everyone would get free care once they have reached the cap of £35K expenditure.

 Younger disabled people: Those who enter adulthood already with care and support needs will be eligible for free care immediately with no requirement for contribution.

 People on low income and/or with moderates assets/ savings: The £35,000 contribution will be mean-tested. Everyone who currently gets free care under the means-tested system on account of low income will continue to do so.

 People with moderate assets/savings: The asset threshold (including property) to those in residential care will increase from current 23,250 to £100,000, so people below this level will only pay a means-tested part of the £35,000 life-time cap.  However, the report makes a distinction between care costs and general living costs and also proposes a standard contribution towards accommodation and food in residential care of £10,000 per year.

 People receiving Attendance Allowance: Universal benefits such as Attendance Allowance will continue though may be “re-branded”.

 Carers:  Carers will be supported by improved assessment, and the report supports the Law Commissions recommendation on legal rights to services.

 Local authorities: Local authorities will continue to play a central role in ensuring the delivery of care and support services to their local populations. Funding and responsibility for adult social care will continue to rest with local government, and local authorities would continue to assess people presenting with a care need, and assign personal budgets or direct payments. For those eligible under the means-tested system (and, in future, those reaching the cap), local authorities would continue to fund their care packages; for people funding the care themselves, local authorities would assign notional care packages.

The recommendations, if implemented would make it easier for people to plan for care in old age and, possibly encourage the development of financial products that offer insurance against care costs. For some, the reliance on voluntary insurance is controversial though. Professor Ray Jones, in a commentary in The Guardian, notes that the history of insurance is not reassuring and there are many examples of mis-selling of private policies that have left  people stranded at the point of need while generating windfalls for investors.

 The proposals are in the main focused on people with care needs that meet current eligibility thresholds.  It is recommended that eligibility for service entitlement should be standardised across England and a more objective assessment framework developed, but that for the moment at least the national threshold should be set at “substantial”.  The report does not make any specific recommendations about prevention, early intervention or people with moderate or low care needs, though the continuation of universal benefits, including re-branded attendance allowance, is mentioned as a means to support early intervention.

The main question will be whether the governments is ready to accept the additional cost to the public purse. Andrew Lansley has already warned that the cost of the reforms, would need to be weighed against other priorities and that “trade-offs” would have to be made. This might involve going for a cap of £50,000 as opposed to £35,000 on individual care costs, which would reduce the bill for the reforms to £1.3bn.  Lansley has also indicated that the government’s response to Dilnot would not be produced until next spring, in a White Paper, with legislation following “at the earliest opportunity”, a timescale derided by campaigners as “indefensible”. The King’s Fund who has long campaigned for reform are firmly behind the proposals and the necessary additional public expenditure:

“ The budget deficit should not be used as a reason for inaction. This is a long-term issue and questions of affordability go beyond the current economic situation. The additional public expenditure needed to fund these proposals is less than 0.25 per cent of gross domestic product – this should not be too high a price to pay for providing a care system fit for the 21st century.”

https://www.wp.dh.gov.uk/carecommission/files/2011/07/Fairer-Care-Funding-Report.pdf

http://www.adass.org.uk/index.php?option=com_content&view=article&id=742:dilnot-report-social-care-system-well-worth-repair-adass&catid=146:press-releases-2011&Itemid=447

http://www.kingsfund.org.uk/press/press_releases/the_kings_fund_33.html

The data was examined to see whether prior health and social care information could be used to predict the start of ‘intensive social care’ funded by the council. Intensive social care was defined as a move into a care home, the start of ten or more hours of home care per week, or an increase in annualised social care costs of over £5,000 per year.

Whilst it was possible to construct stable models to predict the start of intensive social care, the models were relatively insensitive: that is, they only detected a small proportion of the people across the population who did start intensive social care. More accurate predictions were achieved when the definition of intensive social care was broadened to include annualised social care costs of above £3000 or above £1000. Significant predictor variables included age (in particular 85+), gender (female), prior social care us, emergency encounters with health services.

Interestingly, models built from social care data alone performed roughly as well as those that contained health and social care data. Nevertheless, certain health variables were significantly predictive of future social care costs.

The study concludes that whilst the predictive accuracy of the models is comparable to some of the models used by the NHS to predict hospital admissions, it is less clear how they might be used in practice. There is a need to pilot and evaluate the tools in a range of sites to see how the models might fit into everyday working practice.

The study also highlighted the long standing issue of promoting and facilitating better data linkages between health and social care data, to benefit not just predictive modelling but also more broadly commissioning of integrated health and social care.

http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=758

Planning4care 2.1 launched in January 2011, providing a range of powerful future planning scenarios, the latest demographic projections and social care data from the National Adult Social Care Intelligence System (NASCIS), and an  easy-to-use web interface.

For more information, see the articles on this Planning4care Blog, register for a demonstration of the Planning4care tool, contact the Planning4care team, download an information pack, or look around the Planning4care website.

As part of supporting high quality JSNA processes, Department of Health JSNA Development Programme has launched a new JSNA theme in LG Improvement and Development (LGID)  Healthy Communities  Community of Practice (CoP).

The CoP will host the latest resources and tools from the DH JSNA Development Programme and promote peer-to-peer exchange, learning and discussion. Learning activity will include commentary and discussion starters from key opinion leaders, and discussion fora threads on key issues in the JSNA process. These include: data access and analysis; linkage with commissioners; and models for engagement of third sector and community partners.

To join the community of practice:

• Go to http://www.communities.idea.gov.uk and under ‘Register and become a member today’, select ‘Register’ and complete the registration form
• Search for ‘healthy communities’ to locate the CoP and request to join
• Go to JSNA themed area on page 2 of the Forum section.

 The white paper sets out an agenda for greater local influence over health matters which includes:

- giving  local authorities the lead role on public health
- the appointment of Directors of Public Health ,  who will lead local  developments. DPHs will be employed by local government but jointly appointed by local authorities and the secretary of state.

- providing for ring-fenced LA budgets to enable them to discharge their public health responsibilities
- making stronger incentives available for GP’s to become involved in public health issues.

 -creating a new national service in the DH – Public Health England – to provide advice and expertise to local organisations 

The core elements of the new system are included in the Health and Social Care Bill (introduced to parliament 19/1/2011) and subject to Parliament’s approval. The Bill also provides for the establishment of local health and wellbeing boards and for the national patient-voice body: HealthWatch England.

The White Paper signals a significantly enhanced role for local government in Public Health which could mark a radical shift in the way the public health agenda is developed and delivered. However, Council leaders have criticised it for centralising control, despite it purporting to empower councils. The Local Government Association warned that the White Paper represented a “swing to central control” of public health through the creation of Public Health England. The ADASS has been more positive but has also called for more clarity over how much of the estimated £4bn annual public health budget would be retained by Public Health England and how much devolved to councils.

The White paper is under consultation until 8^th of March. Specific consultation questions are on:  the role of GP’s in public health; how to extend and improve public health evidence (3 questions); and the regulation of public health professionals. Responses can be made online http://consultations.dh.gov.uk/healthy-people/healthy-people/consultation/intro/view

 http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm

http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm

For details of the data and methodology underlying the Planning4care methodology and analysis, see the Planning4care website, help and FAQ pages. For an introduction to the system, please register for a demonstration or contact us.

At the Planning4care session, our instant poll of delegates identified tightening of resources (perhaps unsurprisingly) as the major barrier to investing in preventative care, but also a lack of evidence/ intelligence to make the business case was highlighted as a real issue. The session explored

• Gaps affecting joint planning of preventative care, and emerging evidence of the impact of different types of preventative services
• How Planning4care can model the potential effects of prevention on costs and services at a local level (including powerful future planning scenarios)
• Present work in progress with local partners on modelling impact of specific local interventions.

We’ve now put the presentation from the session up on the Planning4care blog.

If you would like to find out more about how Planning4care can help commissioners and providers improve service planning and delivery, contact us on 01273 201 316 or info@planning4care.org.uk, register for the Planning4care tool, download an information pack, or have a look at the Planning4care website.

In recognition of the pressures on the social care system the government has allocated an additional £2bn by 2014/15 to support the delivery of social care.

The additional money comes in two parts. Half of the extra money will come from an increase in Department of Health funding for councils. The money is in addition to existing DH grants for social care which will rise in line with inflation to £1.4bn by 2014/15. All this money will be rolled in to councils’ general grant, which is not ring-fenced.

The rest of the extra money for adult care will come from the NHS. This £1bn includes up to £300m per annum for re-ablement to help avoid demand upon social care, while the remainder will be used to support other social care services. The money will be allocated to primary care trusts – and new GP consortia 2013 – to spend on social care measures that benefit the NHS. There is no indication as yet as to how NHS commissioners will be held to account for spending this money.

In a Dear Colleague letter David Behan, Director General for Social Care writes that “with an ambitious programme of efficiency”, there is enough funding available both to protect people’s access to services and deliver new approaches to improve quality and outcomes”, though ”tough choices” will still need to be made. Care services minister Paul Burstow has told councils that they have no excuse to cut adult social care and that  the extra money would provide councils with “the wherewithal to meet the demographic pressures”.

In addition to this funding there will be two new grants issued from the Department of Health over the SR period reflecting a forthcoming transfer of responsibility for services from the NHS to local authorities: Learning Disabilities and Health Reform grant (an un ring-fenced, specific grant worth around £1.3bn from 2011/12) and the Public Health grant (which will be introduced from 2013/14).

Social care leaders broadly welcomed the funding announced yesterday but warned that it is unlikely to help councils manage the cuts or cope with demographic pressures. ADASS had calculated, in their submission to the Spending Review that there would be a £5.7 billion shortfall in adult social care funding. In view of the overall cut in funding for councils, local authorities will now face extremely difficult choices about which services they can keep on running. ADASS has cautioned that with the extra finance not being ring-fenced “some very tough local decisions about the share of the overall budget going to adult social care are going to have to be made”.

The challenges for local adult social care departments are enormous. They must not only ensure the critical intelligence to support decision-makers, commissioners and providers, but also make a crystal clear case for the need to safeguard social care resources.

In reviewing capacity, local partners need to ask two key questions: Have we got the critical local intelligence we need to make an effective case for people who depend on publicly funded services and budgets for their care and support?  And how can we develop intelligence to support a business case for upstream investment in preventive services that may bring potential savings in the future?

http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_120684

http://www.adass.org.uk/index.php?option=com_content&view=article&id=653:funds-for-adult-social-care-funding-gap-still-there-to-be-bridged&catid=127:press-releases-2010&Itemid=419

http://www.lga.gov.uk/lga/core/page.do?pageId=14454811

The Planning4care team are running a master class at the Healthy Communities 2010 conference, on how local partners can develop and use evidence on population need and the impact of preventative care to make more informed decisions about future commissioning and resource allocation. The master class will:

• Explore gaps affecting joint planning and outline emerging evidence of impact of different types of preventative services
• Model potential effects of prevention on costs and services at a local level (including powerful future planning scenarios)
• Present work in progress with local partners on modelling impact of specific local interventions

Details of the conference:

• Date: Thursday 7th October, 2010
• Location: Church House Conference Centre, Westminster, London
• Website and booking: www.healthy-communities.co.uk

We hope you can join us there! If you are coming to the conference, and would like to arrange a demonstration of Planning4care for your local area, please contact the Planning4care team on 01273 201 316, or email info@planning4care.org.uk.

The tools and methodology have been piloted with six Planning4care users – Essex, Derbyshire, North East Lincolnshire, Rochdale, North Tyneside and Bolton – and provide:

• credible evidence on needs and costs for planning and commissioning MH and LD services
• locally sensitive baselines and projections of demand for services by MH and LD groups
• modelled cost and service implications based on adjustable scenarios of demand and service patterns
• outputs that translate directly into quantifiable service requirements
• tools designed for easy access by users,  that are practically robust and require a manageable amount of data input.

Please contact us if you are interested  in finding out more on how Planning4care can help Mental Health and Learning Disability service commissioners and providers in your area, sign-up for demonstration access to the tool and data at www.planning4care.org.uk/register/, or download the information pack for more information.