If anyone had asked ADASS "what would you do with £2bn?", I think we could safely bet that reimbursing people for the sale of their property to pay for care would not have been high on the list. Whilst many in the care sector understand that individuals facing catastrophic care costs and the loss of life long savings and assets is wrong, it wasn't on any of our campaign lists.
Of course, we were never asked that question, and the government set out to the change the way care is paid for as its priority in the coalition agreement. Therefore this was the question that it asked of the Commission led by Andrew Dilnot. ADASS welcomed the report from the Commission when it launched. We have now worked this through the engagement exercise and beyond, during which our support for this seemingly unlikely priority has deepened not weakened.
This support clearly concerns some, for we have been told that the support of ADASS for this is `a surprise'. Of course, I am in turn surprised at their surprise, but delighted that such attention is paid to what ADASS thinks. So for those who are wondering or worrying abut why we support Dilnot's recommendations as part of the reformed system, here are five key points:
- Care reform is not just about the state funding of social care. Personal spend is growing every year. In some places self funders buy 80 per cent of residential care, spending huge sums of money with absolutely no offer of support, information, advice or care from the state. Dilnot offers an approach that covers all, consistent with our aims of universal approaches to well bein
- You do qualify for state care if your assets are over £23,500. This doesn't mean you are wealthy. It merely means that like three quarters of the population you own a house. Dilnots proposals are about taking away the fear of catastrophic costs that destroy any sense of legacy. 25 per cent of people face care costs greater than £50k.. Dilnot offers freedom from fear, an approach that resonates right back to the very origins of the welfare state, but is placed into a modern context.
- Legislation and policy has long held the aspiration to create systems that prevent need. Last month ADASS revisited the work it did a decade ago on `inverting the triangle of care' to create a system based on prevention, community capacity and wellbeing. While progress has been made, no legal system has ever managed to embed this focus as a core purpose. Dilnot offers a system that could be combined with ways of working to incentivise all who can to prevent costs either for themselves or the state.
- It's this tantalising glimpse of a world we have long argued for that was captured in the vision that came out of the engagement exercise. This is at the heart of ADASS, which as a charity has held this aspiration for a long time as central to our core purpose of advancing the welfare of all.
- The Commission gave great thought to many ways in which the system could be funded. We accept their detailed appraisal of why insurance and other options are sub optimal solutions. Moreover, we heard the same analysis supported by the finance sector during the engagement exercise. ADASS thinks that the advice of finance experts that insurance products can't offer protection to the population has to be taken by us as seriously as we expect our advice on our profession to be taken.
We are persuaded that a capped system offers the most ways in which people can make their financial contribution. We think this includes savings, deferred payments, equity release, pensions and savings products, immediate care needs annuity products and even keeping the cash under the bed. In a world where holding the trust of people will matter, this range of products, and the development of new offers in these areas, seems to us to offer the best chance of getting care cost protection to the greatest percentage of the population.
I could go on, but the tests are clear. This is a debate - our thinking is transparent and if you can make us a better offer that advances from where we see things now, we are up for that! All offers welcome. We are also clear that there are downsides to some of the consequences of Dilnot and reform: no major change comes without some potential adverse impact.
However no system like Dilnot has been tried anywhere, and like any system it won't be perfect. We can't talk ourselves into a failure to design perfection as a basis for no change, when the proposals are such a step forward from where we are now. If the Government no longer wishes to reform on the basis of the recommendations made by Dilnot, it will need to explain why its priority has changed from that it set out in the coalition agreement. ADASS has also been clear that if the decision is made to struggle on with the massively sub optimal current system, then addressing its broken funding system comes back on the table. We think that carries a price tag of up to £25bn just to address state-funded needs. Our support isnt unconditional: we have argued clearly and consistently for reform and resources a new funding framework gives an opportunity to create a different system which in turn will need direct investment, a topic not covered buy Dilnot.
Last summer, ADASS set three outcomes as our ask of reform.
- It must be understandable: a single, simple and modern framework
- The system must be free from fear, particularly about affordability
- Dignity and safeguarding should be guarantees for peace of mind
As the Irish saying goes when lost and looking for somewhere then 'I wouldn't start from here'. I accept that reimbursing care costs to property owners was the most unlikely of starting points, but having been forced to start there we have found the most unlikely destination. The sector's support and vision for a post Dilnot world means that ADASS's view is shared by many. That too is all the more remarkable as the commitment to a radical vision for reform carries consensus. That's not a bad place to be as the government now deliberate on these issues.
And for those that remained surprised, my guess is that this remains a spectator sport. My ask throughout my year as President has been to always remember that we are participants. Three quarters of us will need care, our families increasingly have the experience of care today in our lives. I am not doing this for selfish reasons about grabbing care for me, paid for by someone else. I want to be doing this for realistic reasons. - it's quite likely that it will be me - and you - that needs care in the future.
For my sake - and yours - don't dismiss the offer of reform that is on the table now. To do so would be to set back the reform of care for an indefinite period. I can not support that for others, and I do not want to grow old myself, fearing an unreformed system with uncertainty about how it's paid for.