Operational guidance to implement a lifetime cap on care costs -  consultation

This is quite staggering and also simultaneously terrifying - sets out what the government are expecting local authorities to put in place by October 2023 in relation to their proposed new cap on social care charging. Also got a ridiculously short time frame to respond.

The government is seeking views on the statutory guidance which sets out how a cap on care costs would operate in practice.

This consultation closes at 11:45pm on 1 April 2022

Operational guidance to implement a lifetime cap on care costs

I mean, just to take on random example, see this screed on transparency, which is probably one of the most opaque and dense pieces of text it’s been my misfortune to happen to come across.

Transparency
2.20 It is possible that self-funders approaching the local authority to register for the cap will have limited awareness of what will and won’t count towards the cap and/or of the types of care and support required to meet their eligible needs and what these would cost. Therefore, it will be important that the local authority provides clear information and advice to enable the person to understand how their IPB has been calculated and on what basis. This will give people confidence that the IPB allocation is correct and therefore sufficient to meet their care and support needs, helping to minimise the likelihood of complaints. In particular, the local authority should ensure that the person understands from the outset that their IPB must reflect what the cost would be to the local authority of meeting their eligible needs, which may be different to the rate the person has been quoted, is paying, or expecting to pay. In particular, the local authority should also communicate clearly to the person that the monetary values contained in an IPB are reflective of what the local authority deems to be sufficient for meeting a person’s needs following the needs assessment and eligibility determination. (See chapter 6 in the CASS guidance on Assessments and eligibility for more information on needs assessments.) The person should also be made aware that they are able to challenge their IPB through the local authority’s internal complaints system if they believe that the amount would not be sufficient for the local authority to meet their eligible needs. The local authority should also provide information and advice to help the person to understand that their accrued costs will be backdated to the date they requested an assessment (or October 2023 if the assessment was requested prior to that date) and that any costs incurred prior to that date will not count towards the cap. The local authority should also make clear that, of the costs incurred prior to the assessment, only those deemed as meeting eligible needs as set out in the IPB will count towards the cap. (See the section ‘How people start metering towards the cap’ in the chapter ‘Cap on care costs’ of this document.)

If that’s what the section on Transparency looks like I’d hate to see the section about Opaqueness.

The transparency doesn’t appear to extend to the impact on disability benefits. The changes to social care charging are complex, so complex in fact that it’s not very easy to spot that care home residents who pay their own fees won’t keep their Attendance Allowance as is the case under the current system.

DHSC published some examples showing the impact of the reforms but then revised their case studies (https://www.gov.uk/government/publications/build-back-better-our-plan-for-health-and-social-care/adult-social-care-charging-reform-further-details#case-studies) that illustrated the impact of the reforms.  One in particular was changed in a way which a more cynical observer than I am might think isn’t entirely honest.

In the first version, which a colleague managed to copy (in early January) before it was replaced in the Google cache, it ran as follows:

Case study – Yusuf
Yusuf is in his late 70s. He has lived on his own since his wife died from cancer 10 years ago. When she died, he downsized from their family home in Hastings to a smaller property worth £180,000. As a result, he has £70,000 in savings. Yusuf develops dementia, can no longer cope at home and needs to move into residential care. His underlying health is good and he ultimately spends 8 years living at the residential home. Yusuf’s care home costs £700 per week.

Under the current system, Yusuf would spend about £293,000 on his care from his assets and his income, and as a result only have £72,000 left in assets.

Under the new system, Yusuf hits the £86,000 cap after 3 years and 4 months. He no longer needs to contribute for his personal care from either his assets or his income. Beyond this, he will only have to contribute towards daily living costs. He is now left with £173,000, almost 70 per cent of his original assets.

Over his whole care journey, Yusuf spends £123,000 less than under the current system.
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The revised version published on 28/02/22 updated some figures, and “simplified” the example – giving an explanation of what was changed. The incoherence of the explanation about why the case studies have been updated might possibly reflect a guilty conscience about removing Attendance Allowance from the “before”, or current situation, calculation:

Case studies

These case studies have been updated to reflect likely inflationary changes in the rate of MIG or PEA after reform is implemented from October 2023. The MIG or PEA figures remain the same in the current system. In addition, the case studies were simplified to remove Attendance Allowance, and now reflect DLCs at the forecast level they will be in October 2023.

Case study: Yusuf
Yusuf is in his late 70s. He has lived on his own since his wife died from cancer 10 years ago. When she died, he downsized from their family home in Hastings to a smaller property worth £180,000. As a result, he has £70,000 in savings. Yusuf develops dementia, can no longer cope at home and needs to move into residential care. His underlying health is good and he ultimately spends 8 years living at the residential home. Yusuf’s care home costs £700 per week.

Under the current system, Yusuf would spend about £293,000 on his care from his assets and his income, and as a result only have £35,000 left in assets. This does not factor in any additional income he may receive from state benefits, such as Attendance Allowance, which he may be entitled to.

Under the new system, Yusuf hits the £86,000 cap after 3 years and 5 months. He no longer needs to contribute for his personal care from either his assets or his income. Beyond this, he will only have to contribute towards daily living costs. He is now left with £152,000, or 61% of his original assets.

Over his whole care journey, Yusuf spends £118,000 less than under the current system.
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Because very few people understand social care charges, I don’t imagine anyone much will notice that by removing AA from the current funding example they have managed to keep the benefit of the reforms within £5K of the figure they first announced by hiding (in plain view, but only to those who understand) the fact that in the current system Yusuf would receive AA (as opposed to may receive it), and in the future system he wouldn’t.

Basically, in the earlier example where Yusuf had AA, he was left with £72k in assets under the current system but after the case study was “simplified” he has £35k left in assets under the current system. 

Just trying to bring some transparency…

Thanks Keith, that’s a really useful piece of information to have.

I’ve got a ’ under development’ calculator which compares, over a 10 year period, the current and proposed schemes for idividuals.  Domiciliary and residential.  If anyone would like to play with t then please message me.