Fundamental reset for social care?

Thank you for your detailed explanation (Tue 07-Jul-26 14:07:09) LemonJam.

I was suprised to see ronib's unevidenced claim as I am aware that NHS Continuing Care is so difficult to obtain that many people are turning to solicitors to help. It's difficult because it is a legal process.

LemonJam

Doodledog - yes- as I understand it when a married person goes into care home the house equity is usually protected if their spouse continues to live in that property. LAs apply a mandatory property disregard meaning the home value is ignored.

The patient's savings and most of their pension/s ( retaining a small amount for toiletries etc I think- I am not a SW) will be used towards care fees. Thus the spouse in the home has their pension and must pay all household expenses alone. It can be the case the spouse in the home may find it difficult to maintain the home on one pension and may not wish to continue living there alone.

So- If the house is sold , and the remaining spouse moves out or passes away, the Local Council will then *include the resident's share of the property to use against care home fees*- equity released at time of spouse's death or point of sale on moving out.

Usually females outlive males, and many of the cases I see the husband has died, the wife continued to live in the property and then subsequently became unable to live independently and went into a care home. At that stage the home was her asset alone. Thus now a self funder and sons and daughters set about selling the property to fund the care fees if not found eligible for NHS CHC.

Thanks, LemonJam, that is what I thought. If Cossy's cousin is getting no help with fees, it may be worth appealing on that basis, as she shouldn't be paying them. Her husband will be expected to use his personal money to pay, but the cousin should not be expected to do so.

Individual cases aside, though, it really is time that someone came up with a system that is fair to everyone. As it is, those with money will be ok (although the incredibly high cost of fees will eat through money very quickly) and those with none will be ok, as the LA will pay the bills, but those in the middle - the ones who are likely to have worked and saved - end up having to pay for things that others get free and end up with nothing to leave behind.

I know that some see it as 'fair' that those who 'can afford' to pay should do so, but I see it as unfair that there is a two tier system that charges some and not others - particularly when fees are so high for those who have to pay them. Everyone deserves to be looked after when they are vulnerable, so the solution has to work on that basis.

It might be too late for our generation, but IMO there should be compulsory insurance for everyone*, or a cap on the amount that a couple can be charged. Maybe that should be worked out as a percentage of their estate, so that house price differentials are taken into account, and someone with a cheaper house doesn't end up with nothing.

I quite like the idea of IHT being paid by all, but at a lower rate without a nil band. If we all paid 10% on death, it should bring in as much (or more) than 4% of people paying 40% after a million pound nil rate, and would be (or should be, if it's properly regulated) proportionate. There would have to be ways to stop people opting out, though - it would have to be a compulsory scheme, and things like whether a couple would pay 20% would have to be worked out fairly.

*obvious exemptions for the ill or disabled etc.

nightowl ... exactly so. And that mishmash has been caused by privatisation. Not only is it fragmented but it is hard to monitor properly.

Well, I agree that questions need to be asked, but I question Baroness Casey’s starting point:
‘she argues that social care has never had a foundational "creation moment" like the NHS and is challenging the nation to mandate a fair, universally understood care system.’

Baroness Casey needs to do her homework, social care had a defining creation moment following the Seebohm Report of 1968 which argued for consistent, unified services and led to the Local Authority Social Services Act 1970. This created Social Services Departments headed by Directors of Social Services, all to be swept aside in 2004 with the separation of Children’s and Adult Services following the Victoria Climbie Report

A good starting point might be to look back at the Seebohm Report’s aims of unified departments, community care and accessible support. It seems to me we’ve gone backwards into a complete mishmash of fragmented services and service providers.

Anyone can request a CHC assessment from their local NHS Integrated care Board- approach them for advice and assessment

In general people do not know this - why would they? How would they? They are suddenly presented with a sad family situation and they are told they don't qualify by whoever (DN, GP) and they simply believe them. As you say - it is mega complex and why should the DN be well-versed in it all - they have other important things to do. What they should not do is to make bald statements to patients that they do not qualify.

In any event a lot of patients and their carers simply do not know this funding exists and no-one tells them - in the absence of that awareness how would they know to request an assessment?

The solution is hard to find and whatever it is it will cost a very great deal of money. I have no idea what the solution is but this mess we have at present certainly is not it!

Thank you. Few people realise the complexity of this process.

Agree Casdon

The solution will be very expensive- likely to involve tax or NI payments if some ilk- not a vote catcher in short term…

I think that would be the worst case scenario myself Iam64. Community health services are already the Cinderella in the NHS, and the NHS is such a monolith already that handing a totally new care service over would result in worse services to clients.

Luckygirl3

It is indeed shocking. There have been a number of occasions when I have had to tell people that the information they have received from district nurses is wrong.

But it is such a political hot potato that no-one will deal with it. Theresa May gently chipped away at the edges once and found herself with a bloody nose.

District nurses can get it wrong- they are not immersed in the complexity of ChC assessments and neither are GPs.

Anyone can request a CHC assessment from their local NHS Integrated care Board- approach them for advice and assessment

If you don’t agree with ICB DST NHS CHC assessment at local appeal request Independent review through NHS England.

There has long been the concern that if the social care funding was to be handed to the nhs to administer, it would be swallowed up by Health

The country needs to decide what can be afforded and what we are willing to spend on the care of those in need. Whatever that is it needs to be administered in such a way that this fight between health and social services is eliminated. It is expensive, time wasting and leads to bed blocking.
There are firms of solicitors raking it in as they exploit this fault line.

It is indeed shocking. There have been a number of occasions when I have had to tell people that the information they have received from district nurses is wrong.

But it is such a political hot potato that no-one will deal with it. Theresa May gently chipped away at the edges once and found herself with a bloody nose.

Luckygirl, a friend aged 79 caring for his wife was told by district nurses he would not qualify for support in her care. She was immobile, blind, diabetic and demented. She needed care 24 /7
Mr I had managed services for adults, he helped our friend complete the necessary forms. He qualified for carers four times a day.
It was shocking

I’ve been to two CHC meeting for my daughter. Both lasted almost the whole day and both times funding was refused from health

I would not care so much but the NHS caused her disability in the first place

People forget social care funds other people outside of ‘elderly cate’

The problem is that those making assessments on the ground for CHC simply get it wrong a lot of the time. I have sat through meetings or talked to people where completely wrong information is given:
- people are wrongly told that they need not do the quick assessment because they would not qualify anyway.
- your relative is not terminally ill so does not qualify
- you have to be in a nursing home to qualify
- it is a mental health problem so you do not qualify
- you are receiving care at home so you do not qualify ......

And so it goes on. District nurses are the worst culprits in my experience!

But ..... it is a complicated specialised area so why should they understand the complex details? ... they have got nursing tasks to get on with and are madly busy.

I refused to fill in the forms for SSD care as this is means tested and I knew my OH qualified for CHC. I insisted that a decision should be made as to whose financial responsibility it was before going ahead to organise care.

He was turned down twice .... each time on the basis of forms completed by people who did not know the rules. He then received the funding on appeal ... the appeal panel agreed it instantly as they could see he qualified. They were very kind and vrry apologetic.

But .... did I need all that hassle or the energy-sapping battles at that sad and difficult moment in our lives?

And ... if I had not known the system and been articulate and persistent the outcome would have been different ... this is not what it should depend on.

However, as I said upthread ... if this informal and unfair weeding out of potential legitimate recipients on the basis of wrong information were not happening then the NHS would go under because it would cost too much.

What we have is funding given to those with the confidence, education and knowledge to fight their corner at the expense of everyone else. It is fundamentally morally wrong.

In order to change this unfair system I suspect the NHS Act would need amending .... but good luck to any government doing that!

Until we sort out this false dichotomy between nursing and social care this mess will go on. Patients do not need to be caught in this crossfire ... they just need proper professional help at a cost that they (and the country) can afford.

It truly is a can of worms and every government has ducked it so far ....

Doodledog - yes- as I understand it when a married person goes into care home the house equity is usually protected if their spouse continues to live in that property. LAs apply a mandatory property disregard meaning the home value is ignored.

The patient's savings and most of their pension/s ( retaining a small amount for toiletries etc I think- I am not a SW) will be used towards care fees. Thus the spouse in the home has their pension and must pay all household expenses alone. It can be the case the spouse in the home may find it difficult to maintain the home on one pension and may not wish to continue living there alone.

So- If the house is sold , and the remaining spouse moves out or passes away, the Local Council will then *include the resident's share of the property to use against care home fees*- equity released at time of spouse's death or point of sale on moving out.

Usually females outlive males, and many of the cases I see the husband has died, the wife continued to live in the property and then subsequently became unable to live independently and went into a care home. At that stage the home was her asset alone. Thus now a self funder and sons and daughters set about selling the property to fund the care fees if not found eligible for NHS CHC.

ronib

Thanks LemonJam this is very helpful information. But I respectfully disagree that property owners with houses worth over £1million should be given free continuing NHS care. The country can’t afford it. It needs to be means tested.

A property valued at over £1 million in the South East is often just an ordinary family home, whereas the same amount could buy a mansion in parts of the North East. Penalising pensioners because of where they happen to live is unfair and ignores the huge regional differences in house values.

Cossy

winterwhite

The term social care is meaningless when you think about it. It is all 'health'.

The great injustice in older adult care is that sufferers from diseases of the body (e.g cancers, heart, kidney and lung problems) receive free NHS care, whereas sufferers from diseases of the brain (dementias and I believe Parkinsons) do not.

At the moment it is impossible to predict who might develop dementia (that may change) making insurance policies actuarially difficult).

It was the Thatcher government that prohibited local authorities from running care homes because it was thought that gave them a monopoly of provision. The current for-profit system is the result.

The same thing happens in mental health services. Grossly underfunded compared to, say, cancer care.

I believe an additional tax is required to cover all aspects of health care. And the NHS must become more efficient. But reform must not start with tinkering round the edges which annoys everyone and gets nowhere.

Yes!

My dear cousin has a DH who had early onset dementia and a very healthy body.

He’s now in residential care and she doesn’t get a penny from the state to help her with fees, because he doesn’t specifically traditional nursing care.

My understanding (which may well be wrong) is that social care is free if there is a surviving spouse. If the care resident has savings in their own name they will be used, as will pensions, but even then, I thought that if the spouse would be disadvantaged by the resident's pension being spent on fees that could be disregarded. Joint savings are assumed to belong to both partners equally (ie on a 50/50 basis), so only half will be used in an assessment.

Either way, as I understand it, if the surviving spouse lives in a jointly owned house it won't be sold, and there won't be a debt payable when the client dies. It is when the surviving spouse needs care that the house is taken into account.

Is that not the case?

I wonder if the financial cost of keeping lifelong complex care cases in the community will figure in the consultation Lemonjam? Keeping one person in their own home on a CHC package can cost many hundreds of thousands of pounds a year, much more than it would cost for them in a care home, when the same amount could be used to provide social care for many.

Could be even more £.

Luckygirl3

ronib

NHS continuing healthcare is assessed by the Nuffield Trust at a cost of £6.5 billion a year.

And if everone who was entitled to it but has not got it through misinformation were to get it, that bill would be exponentially higher!

And that is the cost of the few that receive it.

If those that have social care needs received NHS CHC the bill would be astronomical. £2k fees a week not exceptional- say approx £100k per year.

I cover a UK region. We audit conversion rates of appeals at IRP stage. We know how many are many accepted and how turned down for NHS CHC funding, albeit not applicants appeal if found not eligible.

Possibly multiply that £6.5 billion a year figure 10 to 20 fold? Thats a lot for the NHS or alternatively local authorities to fund and the elderly population is increasing exponentially.

Further, important to highlight, following 13 years or so of Conservative austerity the health of UK late middle age and elderly population demographic has declined.

The elephant in the room is the cost and staffing needs for adequately providing social care, never mind improving provision, I think. It’s a bottomless pit in terms of need, and the reliance on families to provide care is partly because of the lack of people wanting care as a career, rather than purely about funding.

It's the management of the personal care budgets that can enter crisis. When the families are incapable of managing the relatives budget then in theory the Court of Protection steps in.

You can imagine the crisis situations this produces, when the very best outcomes take 4 to 6 months but that depends on SW's being available to move things forward. And locally (a friend of mine involved, she can't cope anymore with her very very ill MH wise daughter) people don't get a long term SW appointed, they are "Task Oriented"and pick up problems when they reach crisis not knowing the people.

Labour will be blamed, for sure, for actually daring to try and do what successive governments have dodged - sort out the care system.

BJ's promises in 2019, and no, no attempts post Covid.

Gran22boys

I don’t know what the answer is. But it seems so wrong that people at the end of life, and often their children who are not young themselves, should have this worry.

Children ie under 18, always get free care.

When assessed as end of life, ie Palliative care stage- NHS care is deemed necessary and funded.

It is complex I agree- I spend a good proportion of my time listening to families and explaining. Legal firms representing families in such funding appeals don't always explain in my experience- they want their fees after all. Some firms are better and fairer than others.....