Paying for care in Wales – A Consultation (respond by 31 July 2015)

 In Elderly/Vulnerable Client

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Paying for Care in WalesOn Friday, 8 May 2015 the Welsh Government finally published their proposals as to how to reform the system of paying for care in Wales.

Surprisingly, most of the recommendations of the Dilnot Commission on reform of charging for care services have been rejected. This seems particularly strange, given that Wales still has a Labour administration – one might have expected the new rules for Wales to be at least as generous as the new rules for England. Instead, the key points recommended by Dilnot have been rejected, with seemingly only Universal Deferred Payment Arrangements being adopted. Doubtless, Cardiff’s politicians would point out that Dilnot was only meant for England, and that Wales is somehow different.

The consultation document, draft regulations and draft Code of Practice can be found here:

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http://gov.wales/consultations/healthsocialcare/part5/?status=open&lang=en

The consultation runs until 31st July. These are some of the key points:

  • This framework will be largely based on existing arrangements and initially contain no material change over current Welsh Government policy in relation to charging for social care and support.
  • Rejection of Dilnot style cap (to be introduced in England next year).
  • No change of Upper Means Test Threshold (remains £24,000, whereas in England it is increasing to £118,000 for homeowners and £27,000 for others).
  • No Lower Means Test Threshold/Tariff income (as per current Wales system but unlike old and new England systems).
  • Local authorities must ensure there is information and advice available, in a suitable format, in relation to their charging policies (in particular for those with a sensory impairment, learning disability or for whom English is not their first language), to ensure that individuals, or their representatives, are able to understand why they are being charged and how any charge is calculated. Local authorities should also make the person or their representative aware of the availability of independent financial information and advice. (I like this one, but would have preferred the use of the word ‘specialist’ in front of independent financial advice, to highlight the existence of SOLLA etc!).
  • The various documents contradict as to whether or not Local authorities will be given universal discretion whether or not to charge a person for care and support that is being provided who has the financial means to pay such a charge.
  • In the main consultation document it says “Part 5 provides local authorities with the discretion to charge a person for care and support that is being provided (or support that is being provided to a carer) who has the financial means to pay such a charge.” and in the Executive Summary it says “It will clarify such charging powers to become a universal discretion to charge for care and support, whether it is non-residential care and support provided in the community or residential care provided in a care home.”
  • Elsewhere,  however, to apparently contradict with the above, on Page 5 of the charging regulations it says: “‘capital limit’ means the maximum amount of capital, assessed in accordance with the Financial Assessment Regulations, which a chargeable person may have, above which that person will be required, in accordance with regulation 11, to meet the standard charge in full’. In a further contradiction, in the Code of Practice document is says “Only in care homes, where the financial assessment identifies that a person’s resources exceed the capital limit, is a local authority precluded from paying towards the costs of care of that individual.”.
  • So, it may be discretionary and it may not! Introducing discretion for Local Authorities to charge or not would be a scary prospect, particularly in Wales, where there are 22 Local Authorities, many of which are tiny, and means that the policy of a particular Local Authority will have to be ascertained/ considered when advising a client. We could see one client in Merthyr being charged for care, and a client with identical financial assets in Caerphilly having it all paid for. Perhaps it was a typo…
  • Sections 50-53 of Part 4 provide a similar discretion to set a contribution or reimbursement for direct payments, where care and support needs are being met through the provision of these.
  • A person who is suffering from any form of Creutzfeldt-Jakob disease cannot be charged; usual s.117 Mental Health Act aftercare exemption continues to apply also.
  • A local authority cannot set a charge, contribution or reimbursement that is more than the cost of the care and support being provided or arranged and has to be assured that the person upon whom these are levied has the financial means to meet them
  • Section 57 of Part 4 also provides that where a person is in residential care, the local authority can arrange accommodation that costs more than it would normally provide if a person is willing to pay the difference in cost. However, as with the old system, the caree seems to be precluded from self top ups in most circumstances.
  • The new framework will introduce one set of financial assessment and charging arrangements [FOR RESI CARE AND DOM CARE] rather than the differing arrangements for residential and non-residential care and support which presently exist;
  • For domiciliary care, the value of main residence to be excluded from means test calculation.
  • Each person required to pay a charge receives a written statement detailing the charge and its calculation [ALREADY APPLIES TO DOM CARE BUT RIGHT TO BE EXTENDED TO RESI CARE SELF FUNDERS]
  • Introduce mandatory deferred payments in residential care [AS DOES THE CARE ACT 2014 IN ENGLAND] to enable those whose property may need to be sold to pay for this to delay the sale until a more appropriate time for them; they also provide the ability of the local authority to charge a low level of interest– defined in the documents as Market Gilt Rates (as published in the Budget documents) + 0.15% p.a., the same formula as used now in England.
  • The same get-out clauses for Local Authorities seem to apply as per the new England system, notably that someone with more than the capital limit in non-property wealth can be turned down.
  • Also, Local Authorities will it seems be permitted to decline to defer some payments if the caree’s weekly income exceeds the Pension Credit Guarantee Credit level, £151.20 in 2015/16. In practice, then, a Local Authority will only be required to offer deferred payments up to £151.20 pw. At least, that’s what the Deferred Payment Regulations say, although the COP says “In principle, a person should be able to defer the entirety of their care costs; subject to any contribution the local authority is allowed to require from the person’s income.”, so this seems to contradict itself, too.
  • Change current legislation from “a person who requires residential accommodation to meet their care and support needs may express a preference for particular accommodation” to “where a local authority is responsible for placing a person into such accommodation, that person must be able to exercise choice over this accommodation”
  • Maintain the current CRAG rules as to for which current individuals, or forms of care and support, a charge cannot be made, e.g. undertaking a financial assessment or six weeks free home care following a period in hospital;
  • The draft regulations and code of practice under Part 5 will maintain the present weekly maximum charge and “buffer” for non-residential care and support [THIS IS £60 PER WEEK CAP FROM APRIL 2015 HOWEVER, AGAIN, LOCAL AUTHORITIES ARE GIVEN THE RIGHT TO HAVE A LOWER CAP FIGURE]
  • Personal Expenses Allowance to be renamed as Minimum Income Amount and initially set at £25.50 per week.
  • As per the current rules, the surrender value of life insurance policies (including investment bonds) will be disregarded. The new COP also explicitly disregards the surrender value of annuities (presumably in anticipation of the possible new annuity resale market).
  • The rules for how to assess pension funds for the purposes of charging are:
    • If a person has removed the funds and placed them in another product or savings account, they should be treated according to the rules for that product;
    • If a person is only drawing a minimal income, then a local authority can apply notional income rather than drawn income, according to the maximum income that could be drawn under an annuity product. If applying maximum notional income, the actual income should be disregarded to avoid double counting;
    • If a person is drawing down an income that is higher than the maximum available under an annuity product, the actual income that is being drawn down should be taken into account.
    • Notional income should also be applied where a person who has reached retirement age and has a personal pension plan but has not purchased an annuity or arranged to draw down the equivalent maximum annuity income that would be available from the plan.

Extracts have been taken from the consultation “Implementation of the Social Services and Well-being (Wales) Act 2014 – Consultation on the code of practice in relation to part 10 (Complaints, Representations and Advocacy Services) of the Act”  is © Crown Copyright 2015 and replicated here under the Open Government Licence on the National Archive.

 

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