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Caps, opt-ins, opt outs: is England making progress in reforming care funding?
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2012
- Pagination:
- 24p.
- Place of publication:
- London
This discussion paper provides a response to the government's recent progress report on care funding. The government’s report ‘Caring for our future: progress report on funding reform’, July 2012, set out the government's response to the recommendations of the Commission on Funding of Care and Support. In this document, the government accepts as the basis for reform the principle put forward by the Commission of financial protection through capped costs and an extended means test, but reveals that it will not make a decision on the capped cost model until the next Spending Review expected in late 2013. This response paper argues that the government's progress report effectively acknowledges that care funding reform could proceed on a cost-neutral basis for the Treasury, and not interfere with the government's deficit reduction strategy. However, the government fails to set out any of the options for paying for care funding reform and does not seek to use its report to inform a wider debate on this issue. This discussion paper suggests that progress toward care funding reform may occur in several ways: public acceptance of the difficult tax and spending decisions required to make the capped cost model cost-neutral for the Treasury; the implementation of a low-cost capped cost model; or the creation of a voluntary capped cost state-sponsored insurance scheme that becomes mandatory over time.
Gone for good?: prefunded insurance for long-term care
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2011
- Pagination:
- 65p.
- Place of publication:
- London
In the debate on how to fund long-term care in England and Wales, some stakeholders have advocated a central role for financial services, and pre-funded consumer insurance in particular. This report examines this approach by considering: the potential role that pre-funded insurance could take in funding long-term care; and the extent to which the pre-funded long-term care insurance market can help policymakers achieve key strategic policy objectives for social care. It examines the demand and supply-side barriers to the use of pre-funded long-term care insurance, noting the last UK provider exited the market in 2010 citing a lack of demand. No country has achieved an effective market in pre-funded long-term care insurance, with France having the highest rate at 15%. The report argues that even if the UK were in the future to achieve a take-up of 15% this would still result in outcomes that failed to meet many policy objectives for long-term care funding, particularly associated with ‘catastrophic costs’, fiscal pressures and the incidence of means-testing. It concludes by outlining some of the multiple other roles that the financial services industry could take in funding social care, particularly around delivering and servicing a state-sponsored insurance scheme for long-term care, akin to the schemes found in countries such as Singapore and the Netherlands.
Short changed: the Care Bill, top-ups and the emerging crisis in residential care funding
- Authors:
- LLOYD James, INDEPENDENT AGE
- Publisher:
- Independent Age
- Publication year:
- 2013
- Pagination:
- 28
- Place of publication:
- London
In England, more than 350,000 older people live in residential care, of whom 175,000 are ‘self-funders’ who pay for their residential care fees themselves, 143,000 have their residential care fees are paid by their council, and 56,000 ‘top-up’ the local authority funding they receive via so-called ‘third party payments. This report sets out the context for the government reforms to social care by reviewing key aspects of the current residential care market in England, including the growing use of ‘third party’ top-ups. It identifies those aspects of the Care Bill and the government’s ‘capped cost’ reforms to care funding in England that will have significant implications for the operation of ‘top-up’ payments. It explores the consequences of the new category of top-up payments - ‘self-funder top-ups’ - that will emerge following the 2016 reforms to care funding in England, and the rules that should be applied to them. It makes recommendations to policymakers that existing rules on top-ups must be properly applied, and must also be applied to the new category of ‘self-funder top-ups’ from 2016 when the Care Bill reforms are due to take effect. Applying these rules will have budgetary implications for local authorities and care providers, in light of which the Government must review public spending accordingly. (Edited publisher abstract)
Politics and the care conundrum: why does England have a problem funding social care?
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2011
- Pagination:
- 29p.
- Place of publication:
- London
This discussion paper explores the underlying causes of England's long-term care funding problem. It argues that the state, the older population and wider society have sufficient wealth to finance a properly funded social care system. The persistent problem of funding care in England therefore poses what can be termed the ‘care conundrum’. This paper seeks to explain this 'care conundrum', and its root causes in issues of politics and governance. Using ideas and theories drawn from political science, the paper identifies multiple factors that may explain the 'care conundrum'. These factors include: the varied, ‘indefinable’ nature of social care; the illogical, complex ‘mess’ of institutions overseeing social care policy; public ignorance of what social care is and what outcomes represent quality; and the interests of politicians in avoiding unpopular measures. The paper calls for the creation of an Office for Care and Living which would undertake a number of strategic functions, such as public education and data provision, in order to address the failure of democratic accountability alone to ensure a properly funded social care system. It argues that, even in the face of voter disinterest toward social care, the government does have an opportunity to reposition public and political discourse on care funding to create the conditions for sustainable long-term reform.
A national care fund for long-term care: a policy brief
- Author:
- LLOYD James
- Publisher:
- International Longevity Centre UK
- Publication year:
- 2008
- Pagination:
- 9p.
- Place of publication:
- London
The future funding of long-term care for older people is widely recognised as one of the biggest public policy challenges confronting the UK Government. The cost of long-term care is set to increase in coming decades as a result of demographic change, increasing longevity, as well as the widely acknowledged need to spend more on care to raise quality. Proposals for state-funded universal free care have thus far dominated debate, but are becoming increasingly problematic in light of the unprecedented transfers of wealth from younger to older cohorts that have occurred during a period of rising property prices.
A national care fund for long-term care
- Author:
- LLOYD James
- Publisher:
- International Longevity Centre UK
- Publication year:
- 2008
- Pagination:
- 75p.
- Place of publication:
- London
The future funding of long-term care for older people is widely recognised as one of the biggest public policy challenges confronting the UK Government. The cost of long-term care is set to increase in coming decades as a result of demographic change, increasing longevity, as well as the widely acknowledged need to spend more on care to raise quality. Proposals for state-funded universal free care have thus far dominated debate, but are becoming increasingly problematic in light of the unprecedented transfers of wealth from younger to older cohorts that have occurred during a period of rising property prices.
Right care, right price: a discussion paper exploring the way in which the price of care is determined and its implications for social care policy
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2013
- Pagination:
- 36
- Place of publication:
- London
This discussion paper explores issues about the way in which the price of care is determined in local care markets, including local authority monopsony power (that is, the local authority is the only "buyer"). It examines the relationship between price and quality, and identifies how the way in which the price of care is determined affects the broader objectives of social care policy, for example that the public does not understand the price of care or know what local authorities pay for care. The report argues that to correct these problems, the government should:ensure financial sustainability among care providers coherent with investment and quality; strengthen the link between prices and quality across the market; improve the public’s knowledge of the price of care in their area; improve ‘consumer knowledge’ among families paying for care; and improve public understanding of local authority commissioning of care and the prices paid. (Edited publisher abstract)
Toward a new co-production of care
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2010
- Pagination:
- 55p.
- Place of publication:
- London
The Commission on the Funding of Care and Support has been instructed by the Government to make recommendations by July 2011 on how to fund older people's long-term care. Any new settlement on long-term care funding will inevitably also affect the balance of formal and informal care across the population. This discussion paper explores these dilemmas with reference to current informal care policy, the long-term care funding system and the effective offer to carers that results, particularly around the unpredictability and variability of support to carers. It examines how, building on the current system, a new offer for carers could be developed that is communicable, guaranteed and personalised. Given the continued difficulty in engaging the public in thinking about the potential risk of needing care, the report argues that attaching an improved offer for carers to a new settlement on care funding, effectively inviting households to insure against the burdens that can be associated with high levels of informal care provision, may be the best way of unlocking general support for reform.