Is social care a postcode lottery because of Localism?

  • Full Facts look in to how you're cared for in your old age in certain parts of England depends on which side of the street you live on, due to localising services.

     Many people are shocked to discover that social care is not free at the point of use - unlike the NHS. The Health Service will pick up the bill if you're elderly and in need of hospital treatment; but if you're too frail to get out of bed in the morning or you can't cook for yourself any more, then you'll probably have to pay for any help you require.

    That is unless the local authority assesses your needs as being severe enough that you're entitled to social care (although even then you'll need to qualify via a means-test to receive assistance). 83% of local authorities in England only provide care for those with "substantial" or "critical" needs.

    A local authority is free to choose how much money it will allocate to social care, as long as it meets the needs of those it has assessed. This means that where you live - your town, your street, even your house number - will decide what support you're likely to receive. 

    In setting a standard limit on how much it will pay for an individual's care, a local authority ought to account for various costs - including the number of local people in need of care, the price of living in the area and the wage-levels of care workers in the region. In certain cases, the local authority is obliged to pay extra for a person's care - for example, if it needs to place someone in residential care and the only care home with vacancies charges a fee that's more than its standard rate.

    In some areas there are big differences in how much money neighbouring councils will spend.

    We might expect care costs to be broadly similar across a particular region. But because the government doesn't have a policy on what constitutes a "fair price", it's up to each council to make a judgement call. This is the localism agenda in action - a council decides its own spending priorities.

    In recent years, many local authorities have raided their social care funds: money that in a time of surplus would have been spent on social care has now been allocated to resurfacing roads or keeping the doors of the local library open. 

    A local authority that funds a high fee for residential care will not necessarily pay more towards every type of care; there's still no consistency in how much a local authority will spend.

    Certain local authorities - West Sussex, for example - spend more money across the board, whether it's residential care, home care or day care; others will prioritise spending on certain types of care - Suffolk, for instance, is one of the lowest spending local authorities for day care, but spends more than the average on home care.

    In his 2011 report into the future of social care funding, the economist Andrew Dilnot argued that the current system amounts to a "postcode lottery".

    It's more problematic to draw conclusions about how the standard of care differs from area to area. Just because a local authority is spending less on social care doesn't mean that the care it provides is of poorer quality.

    Some authorities will offer an excellent standard of care to local residents who are in need - and these may not be the councils with the largest social care budgets.

    However, in certain places the standard rate for residential care is so low that we might reasonably ask how it's possible to ensure decent care. We might expect these local authorities to be heavily reliant on so-called "third-party top-ups", when someone's relative or a charity is asked to pay extra for an improved quality of care. In the coming months, Full Fact will be investigating how this hidden economy operates.

    Since the publication of the Dilnot report the government has committed itself to tackling the inequality that's built into the current framework, although it hasn't yet explained how it will do this.

    Source: Full Fact




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