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Health Services: Older People

Volume 506: debated on Monday 22 February 2010

To ask the Secretary of State for Health (1) how many elderly people resident in Cumbria are in receipt of elderly care; and what the projected figure is of the number of people requiring elderly care in each year up to 2020; (317685)

(2) what steps his Department is taking to ensure that elderly people living in poverty have access to an equal standard of elderly care; and if he will make a statement;

(3) what assessment his Department has made of the effect of care charges on users of elderly care services (a) in England, (b) in Cumbria and (c) amongst elderly people living in poverty.

The number of people receiving social services, funded either partially or in full by Councils with Adult Social Services Responsibilities (CASSRs) in England is collected and published by the NHS Information Centre for health and social care from the Referrals, Assessments and Packages of Care return.

Provisional data for the period 1 April 2008 to 31 March 2009 show that 13,500 adults aged 65 and over in Cumbria were in receipt of CASSR-funded services. Information on the numbers of people who fund their own care services is not collected centrally.

The Department has not made projections of the number of older people who will require social services care in Cumbria in each year up until 2020. It has commissioned the Personal Social Services Research Unit (PSSRU) at the London School of Economics to make national projections of future demand for social care and associated expenditure. The PSSRU has projected an increase in numbers of older service users in England from approximately 880,000 in 2010 to approximately 1,050,000 in 2020; Forder and Fernandez, 2009, PSSRU discussion paper 2644, table 26—available on the PSSRU website at:

The Fair Access to Care Services (FACS) framework was introduced in 2003 to address inconsistencies across the country about who gets support, in order to provide a fairer and more transparent system for the allocation of social care services.

At the heart of the FACS guidance is the principle that councils should operate just one eligibility decision for all adults seeking social care support. FACS introduced four bands of eligibility based on people’s needs—Critical, Substantial, Moderate and Low. Once eligibility for social care has been established using these four bands, the council may then means test the individual and apply the local charging regime.

The Department has been working with stakeholders to revise the FACS guidance in the context of “Putting People First”, in order to support councils to implement eligibility criteria for social care as fairly and consistently as possible. The Department carried out a consultation on the revised FACS guidance simultaneously with the publication of the Fairer Contributions guidance, in July 2009. The FACS guidance is integral to the assessment of a person’s need for social care, while the Fairer Contributions guidance is employed, where appropriate, once that assessment has been made. The revised FACS guidance will be published shortly.

The regulations under the Personal Care at Home Bill, introduced to Parliament on 25 November 2009, would offer free personal care at home for 280,000 people with the highest care needs. An additional £130 million will provide 130,000 people with an active programme of reablement to ensure they regain their independence. This will build on the most innovative practices already adopted by many local authorities and primary care trusts. We have already begun engaging with local authority stakeholders to discuss the workings of the scheme, and councils are invited to respond to the consultation document, “Personal Care at Home: a consultation on proposals for regulations and guidance”. The consultation document is available in the Library.

In April 2009, my right hon. Friend, the then Secretary of State for Health (Alan Johnson) asked Sir Ian Carruthers OBE, chief executive of NHS South West, and Jan Ormondroyd, chief executive of Bristol City Council, to undertake a review of age discrimination and age equality in the health and social care sector. They were asked to consider what health and social care organisations should do to ensure that people are not discriminated against by services because of their age. The review was set up to help health and social care organisations meet the ban on age discrimination and the new public sector equality duty in the Equality Bill.

The consultation, “Age Equality in Health and Social Care”, is now live and includes the Government’s response on the recommendations in the review that are not directly tied to the legislation.

The consultation is concerned with action to be taken in England. However, the Equality Bill applies throughout Great Britain. The Scottish Executive and the Welsh Assembly Government are considering separately what action to take to prepare the NHS and social care in Scotland and Wales for implementation of the Equality Bill. There will also be a further consultation on a draft Legislative Order led by the Government Equalities office later in 2010.

It is for councils to decide whether or not to set charges for non-residential social services. The legal basis is that charges generally should be ‘reasonable’, as set out in the Health and Social Services and Social Security Adjudications (HASSASSA) Act 1983. Should councils decide to charge for these services, this must be in accordance with statutory guidance issued by the Department, “Fairer Charging Policies for Home Care and other non-residential Social Services”.

For service users in receipt of personal budgets, the Department’s Fairer Contributions guidance provides councils with a model for calculating how much a person should contribute to their personal budget. It has been produced as a companion to the existing Fairer Charging guidance.

Charging for residential care services is governed by regulations, which prescribe a national means test and a statutory system of charging, which councils must follow. Councils assess a person’s ability to pay residential care charges according to the National Assistance (Assessment of Resources) Regulations 1992 and statutory guidance, the “Charging for Residential Accommodation Guide”. Copies of all regulations and guidance are available in the Library.

No assessments have been made by the Department of the effects of care charges on users of social care services for older people in England, in Cumbria, or among older people living in poverty. However, all charging systems include safeguards to protect the least well-off from charges. Anyone with less than £23,000 in savings is entitled to apply for local authority assistance with the cost of their care.