When we look to reform the care system in this country, we find ourselves at a quite intolerable starting point. Age UK reported in June of this year that spending on adult and social care had risen by just 0.1% in real terms between 2004 and 2010.
Crucially, our ageing population means that the numbers of people needing care expended significantly during that time. In the same years, between 2004 and 2010, the number of people aged over 65 increased by 7.7% while the number aged 80 and over increased by 11.6%
At the same time that older people's care budgets were rising by just 0.1%, other budgets were rocketing. NHS spending rose by 27%, police spending rose by 20% and on schools the spending increase was 12%.
With next to no real term increase and many more people to care for, it is no wonder that adult and social care budgets are in a state of crisis. Most Councils responded to the challenge by tightening the eligibility criteria for the provision of care at home and by making far more use of private providers.
The situation in my own borough of Dudley exemplifies the problem. We are fortunate with the overall quality of our homes but we, through the Local Authority, are imposing upon their goodwill. The Local Authority pays fees of £380.00 per week per resident yet for the last three years they have had no increase in the rates paid by the state for those patients. The result is that self-funding residents are charged significantly more to make up the lower fees paid by the state.
Turning to care at home the situation is just as bad if not worse. The number of local authorities providing care to people in moderate need fell from 36% in 2004 to 21% in 2010. This must surely be a false economy as the less care provided to those in moderate need the greater the speed with which they will develop more expensive substantial needs.
The home care sector is in a worse situation than residential care because the transfer from public to private provision has worked less well for older people who need care at home. I receive a steady stream of complaints from older people and carers in my constituency about the quality of homecare and very few indeed about the quality of residential care.
The complaints are always the same although the providers may be different, which implies a problem with either the business model or the level of funding, or both. My constituents complain that there is a constant stream of different carers with large variation in standards between them. Carers come at different times, often too late to help the client up in the morning or too early to help them to bed at night. It is too often a patchy, inconsistent and unreliable type of service.
In July, the Dilnot Commission, set up by the Government to examine funding of social care, produced its recommendations. The Commission exposed the means testing of funding for residential care as the biggest cliff face across all of social policy.
At the moment, if you have assets of over £23,250 including the capital tied up in your home, you will receive no state support for residential care. That means that the 68% of householders aged 65 and over who own homes outright without a mortgage will get no support. The result is that people have had to sell their homes to pay for care.
This is why the Dilnot Commission's proposals to set a cap on an individual's contribution to the care they need between £25,000 and £50,000 and to raise the threshold at which they eligible for support to £100,000 are welcome.
Dilnot proposes a single cap to cover the whole country and we have to ask whether a one size fits all approach is fair given the wide variation in house prices across the country. The average house price in my borough of Dudley is £145k whereas the average house price in Greater London is £420k. For families in my constituency the cap on care represents a third of their assets whilst for the family in London little more than 10% of the value of their home.
Unfortunately, we are going to have to ask more of people who have seen the value of their home spiral over the last 25 years. We will have to compromise on our mantra 'people shouldn't have to sell their home to fund their care' - if we cap the amount we will perhaps have to ask people to re-mortgage part of the value of their home in order to contribute more to the overall cost than Dilnot is currently recommending. That would still be a huge improvement on the current situation where so many people have to sell their homes.
The reaction to Dilnot has not been as favourable amongst health and social care managers as it has been among those who campaign on behalf of older people. This is because they fear that they will somehow have to find the money from within cash strapped adult and social care budgets. The danger here is that home care, which I have already described faces huge challenges, will be cut to pay for Dilnot's proposals.
In the current economic situation there is no new public money so we have to find a better way of managing our resources. NHS spending rose hugely under the last Government, more than doubling between 1997 and 2010, and it is one of the few areas protected from cuts.
There are far too many older people in hospitals who would be better managed in the community. NHS funding should be reconfigured in favour of community care. The Government has made a very good start in the health and social care bill by integrating health and social care. It needs to go further and such a policy shift will be Dilnot's enduring legacy.