The Appointments Commission had planned to include an article on the remuneration of chairs in the first edition of the ‘Westminster’ bulletin. During discussions on the draft, departmental officials suggested that the article might raise expectations of chairs of national health service organisations about the Secretary of State's discretion when deciding remuneration increases, within the framework of the Public Sector Pay Committee's decisions, which were not correct. The Appointments Commission, who have editorial control, made a decision to replace the article.
The planned article was about chairs' remuneration in general. It did not refer to the remuneration of the chair of the Appointments Commission specifically, and no such reference was removed from Westminster Bulletin.
Remuneration for the chair of the Appointments Commission is in the range of £45,000-50,000 as published in the Appointments Commission's latest annual report and accounts (2008-09). This can be found on their website:
The production cost of the Green Paper “Shaping the Future of Care Together” was £68,451. The cost of obtaining pictures for the publication, which will also be used for The Big Care Debate, was £6,580. These were sourced from the national health service photo library, as well as from private image library banks.
Research commissioned by the Department and carried out by the personal social services research unit (PSSRU) “Analysing the costs and benefits of social care funding arrangements in England: technical report, Julien Forder and José-Luis Fernández, 2009, PSSRU Discussion Paper 2644” looks at the lifetime probability of needing care and the cost of this care. This includes residential home care.
At present, local authorities that choose to can offer individuals to pay for their care through a deferred payments scheme. However, this option is not currently available to all—approximately 30 local authorities do not offer deferred payments to people entering residential care. The Green Paper proposes making the scheme available to all who wish to use it. Further detail on the assumptions made underpinning this proposal can be found in the impact assessment. The detailed design of the system, exactly how it would operate and the precise costs will be finalised once there is consensus about the preferred funding option, since the choice of funding option is likely to influence the cost of the deferred payment scheme.
A summary of the costs and benefits for the comprehensive and partnership funding models are available in the regulatory impact assessment for the Green Paper, “Shaping the Future of Care Together”. This has been placed in the Library, and can be seen at:
A summary of the model from which these costs are derived has been placed in the Library, and can be seen at:
All of the funding options cover the costs of care. The costs of care include services in both domiciliary and residential care.
The Green Paper “Shaping the Future of Care Together” does not make any commitments about the level of state funding for adult social care in the future. This will be a matter for future spending reviews.
The net cost to the state of each of the Green Paper funding options has been estimated for 2014 and 2026. This is given in the regulatory impact assessment (RIA) for the Care and Support Green Paper which is has already been placed in the Library, or can be seen at:
In order to produce these projections of likely cost it was necessary to make a series of assumptions for modelling purposes, including illustrative assumptions around levels of funding. The purpose of these projections is to provide early indicative costs to allow comparison between funding options: they are not intended to be a projection of actual future funding. The actual costs of the different models could alter substantially following decisions about precisely how the funding options are implemented, as well as by future public spending and prioritisation decisions.
The new National Care Service will affect every adult in England, whether people use the system themselves, have family members who need support, or are taxpayers. It is vital that everybody gets involved in the Big Care Debate to have their say on the future direction of the new care and support system.
The Big Care Debate is one of the biggest consultations ever conducted by Government to find out the views of the public. We are reaching out to people in an unprecedented number of ways, through stakeholder events in every region in England, public road shows, leaflets, questionnaires and postcards, a dedicated website, outreach in general practitioner surgeries, universities and other locations and using new digital media including Facebook and Twitter.
The consultation closes on 13 November 2009 and we will be looking closely at all the responses to identify what national consensus has formed around the options in “Shaping the Future of Care Together”, a copy of which is available in the Library.
We do not have an exact estimate of the number of people born with care and support needs who would qualify for free care under the partnership funding option outlined in the Green Paper “Shaping the Future of Care Together”. However, it is likely to be very similar to the number of people born with a disability who receive entirely free care under the present system of care and support.
This is because currently, the majority of individuals who are born with a disability and who are entitled to state support receive their care free of charge because they tend not to have the opportunity to accumulate assets and they tend not to be in employment. This would also be the case under the partnership system.
The personal social services research unit estimates that cost of providing care for people who would qualify for all their care free under the partnership funding option in 2009 would be £9.8 billion.
From the modelling results, the total cost of providing care to those who would qualify for all their care free under the partnership system can be approximated as the sum of the care costs for younger adults, since most will receive it for free, and the cost for the minority of older people who would receive their care entirely for free.
Currently, this would amount to £4.7 billion for younger disabled people (younger physically disabled and people with learning disability) and £5.1 billion for older people, giving a total cost of £9.8 billion.
Robust evidence that specifically examines the cost effectiveness of prevention interventions is limited. This is owing to the long time scales involved—the impact of an intervention may not be felt for many years—and the difficulty of establishing causality. In “Securing Good Care for Older People”, Derek Wanless found that it can be difficult to make quantitative assessments due to the complex nature of prevention. This is because
“even when using a very narrow specific target such as reducing the number of falls in a locality, determining cost-effectiveness is not straightforward...[as] there may be numerous factors at play (for example new transport facilities).”
The Department is funding 29 local authority-led partnerships to take part in Partnership for Older People Projects (POPPs) across England. These partnerships include social care, health and third sector members, and aim to create a sustainable shift in resources and culture, moving away from institutional and hospital-based crisis care towards earlier and better-targeted interventions for older people within community settings. The pilots cover a wide range of activity to meet low to high levels of need. The final evaluation for these projects is expected in autumn 2009.
The relative lack of quantitative evidence should not stop prevention pilots being trialled. There is a great deal of qualitative evidence for the value placed on lower-level services by older people in helping them to maintain their independence. That is why existing and new prevention and early intervention schemes funded by the Government build evaluations into their projects.
HM Treasury’s long-term fiscal projections show that the costs of long term care are set to increase by 17 per cent. by 2027-28, from 1.2 per cent. of gross domestic product in 2007-08 to 1.4 per cent. in 2027-28. These projections are contained in the published “Long-term public finance report”, HM Treasury, March 2008.
The increase in life expectancy for people with Down’s syndrome quoted in the Green Paper “Shaping the Future of Care Together”, Cm 7673, page 38 is based on American research.
The information on the lifetime costs of care for those aged over 65 sited on page 14 of the Green Paper “Shaping the Future of Care Together” is taken from section 5.1.2 Lifetime risks and costs in the Personal Social Services Research Unit (PSSRU) technical report into analysing the costs and benefits of social care funding arrangements in England.
A copy of the report has been placed in the Library, and is available on PSSRU's website at:
The Department is currently working closely with our key partners in the social care sector to develop an action plan for the development of the adult social care workforce of the future.
The Department aims to publish this plan this autumn.
The consultation on the Green Paper will last until 13 November 2009. Once the consultation has been completed, these responses will be used to inform and finalise our proposals. We will then publish a White Paper on care and support in 2010.
Work on many of the areas highlighted in the Green Paper is already underway through the Putting People First programme.
“The Case for Change—Why England needs a new care and support system: Engagement Findings” has already been placed in the Library.
The Care Support Independence engagement process took place between May and November 2008 to give a cross-section of the public and key stakeholders the opportunity to debate the principles that should underpin the future of the care and support system for all adults.
Over the course of the engagement, a total of 1,092 stakeholders and citizens attended 15 deliberative events held across all English regions. A further 97 people were interviewed either individually or in mini-groups. 1,449 separate communications were received through the dedicated website and by letter and email. Inclusivity research with 11 specific groups of citizens engaged in an appropriate and accessible way with people for whom the deliberative events might not be suitable. These included young adults and people with learning disabilities, physical impairments, those living in rural areas, Gypsies and Travellers, ex-offenders and people for whom English was not their first language.
On publication of the Green Paper on 14 July 2009, a wide ranging consultation process was launched to encourage people to give their views on the proposals and join the Big Care Debate. This consultation closes on 13 November 2009.
While re-ablement is, hour for hour, more expensive than home care, many people do not need an ongoing home care package after a few weeks of re-ablement. A re-ablement package would typically pay for itself if a re-ablement user continued not to need ongoing care for around five to seven months, where they would otherwise have required a typical care package.
Using a high estimate that it would cost £1,000 per re-ablement package, we believe it would be possible to offer re-ablement to people leaving hospital who would qualify for care and support from the state for the first time, subject to future funding decisions.
The consultation on the Green Paper will last until 13 November 2009. Once the consultation has been completed, these responses will be used to inform and finalise our proposals, including those on the promotion of telecare and making information available about prevention and early intervention. We will then publish a White Paper on care and support in 2010.
No estimate has been made of the level of personal cost at which paying for costs is fundamentally unfair since this is likely to differ from one individual to another. However, the Government believe that a system which leaves everyone to pay for themselves with no state support—what is called in the Green Paper the “Pay for Yourself” option—would be fundamentally unfair because:
Care would be unaffordable for many people. Many people would not be able to afford the costs of private insurance. For those without insurance, the costs of care can be very high: someone who develops dementia could need 10 years of high-level, skilled care in a residential care home, which could carry a price tag of over£250,000;
This option would have a large negative impact on people on low incomes and with high levels of need, as the group of people who would previously have been eligible for state support and also who are unable to afford the costs of care or insurance themselves; and
Those individuals unable to afford the cost of care would be left without the care they need. This could result in high levels of unmet need in the future, or pressure on friends/families to provide informal care.