If not Dilnot, What?

On 29 May, Lord Lipsey hosted an event in the House of Lords, exploring the potentially contentious issue of “If not Dilnot, what?”. Whilst most speakers accepted that at this stage, Dilnot is probably “the only show in town”, the event considered how the Dilnot recommendations may need to be adapted to meet a changing political reality.
There was a recognition that Dilnot’s proposals were fairer than the current system in that for example, prudence is penalised less than under the current system. But also acceptance that the recommendations add layers of complexity to an already complex system. And the solutions are ‘expensive’.

Speaking at the seminar, Professor Julian Forder of PSSRU highlighted the current unmet need which will need to be funded on top of the cost of the Dilnot recommendations. He argued that the funding gap going forward under the current system would be £3.8bn. Under Dilnot the gap would be £7.3 bn (2025 costs). Even with assumptions of compression of morbidity, the costs are very high.

Most speakers, at the event, supported by Partnership, felt that taxpayer funded care was not going to happen. They felt that there isn’t the money or appetite for free care for all. And the public seems unwilling to pay higher taxes.

The event explored a number of potential adaptations to the Dilnot recommendations:
1: Whether there are adjustments that could reduce the cost e.g. changing the level of the cap
2: Whether there are clever ways financing that wouldn’t involve extra tax e.g. an inheritance based tax or redistributing funds from Attendance Allowance.
3: Whether there are things that can be done to mitigate some of the distributional challenges, e.g. Cap a low percentage of the wealth of very rich people.
4: Whether there was potential to review possible supplements e.g. the potential of Equity release/pensions to fund some care.

Les Mayhew explored the role (and potential) of pensions and other financial products in paying for long term care. His analysis included immediate needs annuities; top up insurance; disability linked annuities (like a pension annuity but higher rates if become disabled/need care); and long term care bonds.

But there was an acceptance by many speakers that the insurance market had failed so far. Steve Groves CEO of Partnership highlighted that there were only two providers of immediate needs annuity. 40% of care recipients are self funders yet only 4% take some form of insurance (costing the state £4bn). He argued, however, that there was no alternative to the state picking up the so called ‘catastrophic’ care costs.

During the discussion, a huge number of additional options (“Dilnot on a diet”) were explored including
* Raising the upper capital limit
* Setting a higher cap
* Changing the capital rules
* Restricting access to the very frail and those most at need
* Making integrated care work
* Clarifying the boundary between health and care
* Investing in prevention

Introducing the event Lord Lipsey noted that the Government had “gone relatively quiet” on the issue of care funding, although pointed out that this may not necessarily be a bad sign. “We can’t even find out from the press what is going on”, he said.
We can expect a draft Care and Support Bill, based on the Law Commission report, alongside a progress report on funding. The All Party talks continue. The issue of long term care funding has probably gone up to the quad of Cameron, Alexander, Clegg and Osborne, but their focus has probably been elsewhere over recent months. Lord Lipsey argued that either nothing is happening and the issue is being kicked into the long grass, or the decision has been made to incorporate this issue into the spending review.

Sadly, as one speaker commented at the end of the event, care funding still not an issue hitting MPs post bags. Whilst the event highlighted some very interesting options, what is clear is that for the Government to be motivated to act on funding, there is a need for further political pressure from older people and their carers. The “granny tax” debate has highlighted the power of this group. We need to find a way of focussing their energies on the need for a sustainable funding solution to the care crisis.

David Sinclair

NB. Counsel and Care are currently running a sweepstake on when the Government will launch its Care White Paper. http://www.independentage.org/social-care-white-paper-sweepstake.aspx What do you think?

Open Age and New Philanthropy Capital

Open Age, the Charity I Chair, recently (7th June) organised a meeting to celebrate featuring as a case study in the recent New Philanthropy Capital report on the voluntary sector. The report led to Open Age being invited to speak on the Today programme.

The Mayor of Kensington and Chelsea hosted Open Age in his parlour.

I was given the opportunity to speak at the launch and made a few points

Context

• We have an ageing Society and are seeing significant growth in the number of oldest-old
• The Jubilee celebrations highlighted but one example of active ageing. But we know that not everyone is so fortunate and man suffer from significant heath and care challenges in old age.
• On the one hand the boroughs where Open Age Work are relatively wealthy. But there are huge wealth and health disparities. Open Age works with some of the most isolated people within the borough(s).
• There is a lot of evidence about "use it or lose it". We need to keep our mind and body active. Open Age is focussed on promoting and supporting active ageing.

Linking to the findings of the NPC report, I highlighted challenges ahead for Open Age.

Challenges
Relationship with the Statutory Sector: We benefit from a great relationship and are much more fortunate than many others in the voluntary sector in terms of funding. It is vital that the productive relationship we have with the statutory sector continue.
Funding Crises. The Economic crises, cuts in Central Government funding, Trusts with less money and a very competitive fundraising make for a challenging environment. There is less money to support our preventative work. Recent research in a London borough suggested that not impossible that in 20 years almost all of local authority funding would need to go on social care. This highlights the importance of investing in preventative health.
Risk The NPC report found that 90% of the voluntary sector are facing a riskier future. It is notable that for the last two years our trustees meetings have been dominated by issues around risk and fundraising. It is very difficult to fund core costs (Open Age have very small core team - finance, director). And it is also difficult to get the full costs recovered.
Volunteers Another key finding of NPC report was that charities were using more volunteers. Open Age always been a volunteer led organisation. We rely on volunteers to manage our reception and volunteers on the trustee board. We will always use volunteers. But it is important to note that there is a cost to volunteering. Volunteering isn't free. If we didn't support volunteers and treat them well, they would walk out on us.
Cuts The NPC report highlighted how the sector is having to make cuts/redundancies. Let me be frank. There is no guarantee that Open Age wont have to cut services this year. The organisation does not have huge reserves. NPC highlighted that 6 in 10 charities will need to dip into reserves. We may do but they wont keep us going for long. Open Age is well managed and delivering a huge amount. But it is vital that we work with statutory funders and others to try and ensure that services are not cut.


Open Age is however in a good place to meet the challenges.

• It has a fantastic staff team and great support from funders (including statutory sector)
• It attracts a lot of respect from opinion formers and decision makers.
• It runs some great projects
• It benefits from significant user involvement
• It is willing (indeed keen) to partner with others.

I finished by setting out three things we need to do to meet the challenges
FIND A BETTER WAY OF INVESTING IN PREVENTATIVE SERVICES: Investing in preventative services will save money in the long run. If we lose services like Open Age there is a risk that 5-10 years down the track you will see the cost in terms of additional social care costs. Lets find a way of working together to deliver new models, building on localism and big society. We want to work with local authorities and other commissioners.
LETS FIND WAYS OF SUPPORTING STAFF AND KEY VOLUNTEERS: We expect to work hard. And believe me, the staff and volunteers do. But the last three years have seen extraordinary pressure on the team. Our Board is forced to talk about funding at every meeting. But the bit we most enjoy is where a member of staff comes and talks through the services they provide and some of the case studies.
HELP US HELP YOU: We welcome feedback. We want to deliver for older people across London. Started off by saying we have great relationship with funders. Let's find ways of not just maintaining this but by developing it further.


The Open Age Website is available at: http://www.openage.org.uk/

Housing, demographic change and the National Planning Policy Framework

In 2007, ILC-UK published “Sustainable Planning for Housing in an Ageing Population” (1). It pointed out that older households will represent half of all household growth to 2026, that one third of households were headed by somebody aged over 60, and that the 80 plus population would grow by one million from 2008 to 2025. It made a strong case for planning future housing supply based on demographic change.

Yet planning has become a very real barrier to creating the sort of housing our society needs. We cannot blame planning alone for the lack of affordable or appropriate new housing. But it has played its part.

There is already a major shortage of well-designed housing across all tenures and housing types to meet the demographic challenge ahead. The growth in the older population will accentuate the problem and the shortages will get worse. That is, unless the planning system, current or future, systematically addresses the significant growth in older households.

Yet fears that the English countryside will be tarmacked over has led to recent campaigns by the National Trust and some national newspapers against the Government’s new National Planning Policy Framework (NPPF).

The Government’s recognition that planning was becoming a barrier to economic development led them to propose a new NPPF which reduces the 1300 pages of current planning regulation to just 52. But despite being a relatively short paper, officials have managed to incorporate some very positive policies in terms of demographic change. The NPPF talks for example, of planning to promote healthy communities and the need to create a good quality built environment which will support health and wellbeing. Most importantly in the context of demographic change, it talks of the importance of meeting the needs of present and future generations. And it flags the role for inclusive design.

The most controversial part of the NPPF is the presumption in favour of sustainable development. Yet this is a proposal which makes sense. For too long, planners have been tasked with finding reasons to oppose developments rather than actually planning for a changing world. Planning is an extremely important profession. Yet it is one which has become too focused on tick boxes and finding reasons to oppose.

Of course, green space is important, not least to wellbeing. But the framework does maintain the need to comply with local plans. Localism will ensure communities still have significant planning power. The Presumption only comes into effect when a Local Plan is not in place. Where a Local Plan has been prepared, development must accord with its policies or be refused. This is empowering for local democracy.

The NPPF is a positive development. It is also the only game in town. The current system is a complicated and convoluted one to work with. It contributes to housing supply not meeting demand. If we fail to produce adequate aspirational retirement housing for older people, we will not free up stock of existing housing for future generations.

Of course the NPPF could be developed further and it could actually be stronger on demographic change and the links between health and housing. But Government must resist any changes which could damage the ability of our communities to meet the demographic challenge ahead.

1) http://www.ilcuk.org.uk/record.jsp?ID=25&type=publication

In September ILC-UK published “Establishing the Extra in Extra-Care” which set out the role for extra care housing in the context of demographic change. It highlighted how good quality specialist retirement housing is important for the health and wellbeing of the older population. http://www.ilcuk.org.uk/record.jsp?type=publication&ID=100

Yorkshire Post

Yorkshire Post have published a piece I've written on younger people and pensions.

http://www.yorkshirepost.co.uk/opinion/David-Sinclair-Young-free-and.5599866.jp