Getting the balance of social care right

by Paul Scully | May 26, 2017 | News, News, Uncategorized | 2 comments

Given the concerns expressed over the last weekend about social care, it is important to explain the government’s plans properly, cutting through some of the political spin.

The Conservative manifesto includes our commitment to strengthen the social care system with more and sustainable funding to cope with the long-term pressures caused by the fact that we are living in an increasingly ageing society. After all, there will be two million more people over 75 years old in Britain over the next decade alone and a third more people aged 85-plus in 2024 than there were in 2014. Furthermore, the growing number of long-term conditions such as dementia is putting increasing pressure on the social care system. At the moment, elderly people in need of care face high costs and inadequate treatment, as well as the risk of seeing the assets they built up over a lifetime depleted to virtually nothing. I believe the social care system will collapse unless we make some important decisions now about how we fund it.

That is why we have to act. And it is why – to give people security – the government included in their plans, measures to make sure no one should have to sell their family home to pay for their immediate care needs. They have also said that they would protect a minimum of £100,000 of your savings so, however expensive your care, you will be able to pass something on to your family.

Most people don’t have to think about long term care and as a result it is important to understand how the present system operates, for despite the comments by some, care and support services in England have never been free. Right now, most people have to pay something towards their own care and some will already have to pay for all of the costs. The current lower limit, where all their remaining savings will not be used, is when savings fall to £23,250 at that point they will be on a sliding scale means test until their savings reach £14,000. For those in residential care the value of their house is taken into consideration as well.

Whilst local authorities may cover some or all of the cost of care in some circumstances, its help is “means-tested.” Right now whether you are in a Care Home or receiving support in your own home you will be expected to make a financial contribution. Furthermore, property has always been calculated in personal care package, evidenced by the existence of a “12 week disregard.” Worse, the present system can be a lottery, with some local authorities requiring the payment whilst the person needing care is in the home. This has often resulted in people having to sell their homes, causing real anxiety and worry to those who are in need of the care when the system should be supportive. These new proposals will bring an end to the need to sell your home whilst you are alive.

So, this plan would replace and in so doing improve the existing system where people often get poor quality care – and stand to lose almost all their savings and assets, including the family home. This plan addresses the worry people have when they have a loved one with a long-term condition, and they don’t know how they’re going to afford to care for them.

Furthermore, these proposals will be presented in the form of a Green Paper, (a government consultation document) and they provide the beginning of a solution to social care without increasing taxes on younger generations. That consultation will include an absolute limit on the amount people have to pay for their care costs. Importantly everyone will get to comment on what is in the paper and the government will listen carefully to the concerns of all of you before setting the final policy.

But since the manifesto was published, the proposals have been subject to fake claims made by Jeremy Corbyn. It is sad that he has resorted to whipping up fear and scaremongering. That is why I hope Theresa May’s statement, that there will be an upper limit to the amount that people will have to contribute should reassure you that you will not eat into all of your savings and satisfy those who have been worried by some of the scaremongering from the Labour party.

So for the avoidance of doubt, let me reiterate:

• We will make sure there will be an absolute limit on what people will need to pay for their care by capping the amount they will have to pay.
• We will put more money into health and social care.
• We will generate more money for social care by including the home into the test for people getting care in their own home. This is what already happens with people in residential care, and will mean people’s assets are treated equally wherever they are looked after.
• We will protect people from the huge costs that can accumulate from elderly care, by protecting people’s assets up to a minimum of £100,000 from social care costs. This will be done with a capital floor that is four times the current level of protection of assets.
• We will make sure no one has to sell their home within their lifetime to pay for care, by extending deferred payment agreements for people getting care in their own home. This will take the anxiety out of obtaining support.
• We will improve the care people receive by improving co-operation between the NHS and the care system, relieve unnecessary and sometimes unhealthy stays in hospital, and examine how to make best use of specialist housing and new technology approaches that enable people to live independently, with dignity, for longer.
• We will give people the right to request unpaid leave from work to care for a relative for up to a year, because the vast majority of care is provided informally, usually within the family.

For surely the greatest unfairness is if we dump the costs of social care on to our children, for this is the likely alternative. Despite all the scaremongering from Labour, that is what their proposals will do. Labour’s fantasy manifesto with over £10’s of billions of uncosted spending pledges will result in enormous tax increases. First, Jeremy Corbyn plans to drag some 3.9 million more homes, including half of all homes in London, into paying inheritance tax. Jeremy Corbyn has even said he could increase the basic rate of income tax for millions of people from 20 to 25 per cent to fund social care. So Labour will hit those families with heavy taxes, at the very point they might expect to receive the money from their parents.

I believe we save first and foremost so that we are not a burden on our children and so that we can all have a better than basic retirement without the need for our children to have to finance our support. Whatever is left over of our savings and capital, of course should go, if we wish it to our closest relatives

Our welfare reforms are getting more people into work and then ensuring they save through our recently introduced automatic enrolment scheme will make sure there are fewer people in future who fail to save sufficiently for their retirement, reducing the future burden on our children.

Theresa May has shown determination and boldness in tackling this issue head on, I believe she is right to do so, for the alternative is a Corbyn led government which will tax us so much that any thought of passing on savings to one’s children will become a folk memory.

I hope this explains what the government is proposing and reaffirms the fact that a full consultation will take place before any policy is put in place. I also hope that on 8th of June, you will balance this issue alongside the very real damage that a Corbyn led government – shored up by the Scots Nationalists, Plaid Cymru, The Greens and the Lib Dems, (in effect a coalition of chaos), would do to our country.

Whether you voted leave or remain in the referendum, I hope you will agree it is vital our government gets a good deal from the negotiations with the EU. Given that the Prime Minister will sit down with the EU to start those negotiations very soon,only Theresa May’s strong and stable leadership could achieve a good outcome for this great country of ours.

Talking St Helier with Jeremy Hunt

by Paul Scully | May 4, 2017 | News, News, Uncategorized | 3 comments

Over the last 25 years we have had politicians queuing up to ‘Save St Helier’ but precious few coming forward with a realistic plan to do so. I believe that this needs to change which is why I invited Jeremy Hunt, Secretary of State for Health, to come to St Helier Hospital and meet me and the chief executive to discuss how we can secure St Helier’s future. Wouldn’t it be great if at the next general election, the future of healthcare in Sutton had been transformed permanently for the better? The chief executive kindly showed us around the best of St Helier and the worst.

The best included ‘board rounds’, an initiative in the hospital’s acute care centre where a group of doctors considered each patient on the ward in a multi-disciplinary approach, looking at everything together. This has led to mortality rates being at their lowest ever, despite treating ever more patients and recovery being so much better. We saw a new CT scanner adding much more capacity, enough to take in patients from right across South London. We also dropped in on the new restaurant which opened yesterday and which will free up space for a new renal unit.

The conditions of the existing renal unit was less satisfactory. As with everywhere on site, the staff do amazing things in the most challenging of conditions. Beds for dialysis are too closely packed in. The single lift is not big enough for a trolley bed, leading to the incredible situation of the Trust having to spend £10,000 a week on an ambulance shuttle service to take patients from the back of the hospital to the front.

We then went to the boiler room, which contains huge steam-powered boilers from the 1950s. If this is the heart of the hospital, it’s suffering from acute angina. Clearly hugely inefficient in its running, if anything went wrong, the hospital would struggle to stay open for any length of time. Two members of the maintenance staff go around the hospital every day, testing water for legionella and flushing through systems if and when it is found.

The back of the building is largely blocked off by hoarding. Not because of maintenance work but to protect passers-by from crumbling masonry. The trust has to find an estimated £5m of its budget to go to extra maintenance every year simply down to the state of the building. Despite these risks, the staff work so hard to achieve patient outcomes that are among the best in London.

Finally we had a chance to talk to Jeremy Hunt about creating a vision for the future. The NHS cannot start a public debate during the election ‘purdah’ period but I can. The views here are mine, I don’t speak for the trust, nor the government and I am open to change my mind through meaningful discussion with residents. To my mind there are three options for a new hospital. St Helier, Epsom or the Sutton Hospital site co-located with the Royal Marsden. If we went for the latter, the Marsden would benefit from extra intensive care and acute facilities to support its work. The vast majority of services at both Epsom and St Helier would remain where they are but the trust could remove some duplication thus releasing more money to spend on front-line treatment. To be clear, I do not want St Helier to close, neither does anyone in the trust. The reported one-for-one replacement with a super-hospital in Belmont is a non-starter. The key thing is to get residents involved and focus on care, outcomes for patients and the best locations for services here in Sutton, rather than just buildings. Each site should be able to retain their full urgent care centre with the A&E placed in the best location on clinical grounds, but we should remove the matter as a party political matter, instead discussing this in a pragmatic way that brings everyone behind a solution that we can secure from the NHS and the Treasury.

Once we have agreed on how we configure services over the three sites, we need to look at the difficult issue of funding. Building a new hospital now will cost in the region of £300m. Delaying this for five years will increase the cost to £400m, purely through the effect of construction inflation. One way of securing this funding is to work across London to realise the value of NHS-owned land that is surplus to requirements. It is estimated that there are a small number of trusts in London with around £1bn worth of surplus land. However, the challenge is to release this and then to see that money shared across other trusts, when they will want to keep it for themselves. Another possibility is prudential borrowing via Sutton Council or through pension funds. Sutton Council has borrowed money to buy Oxfam’s head office in Oxford and an office block in Wallington. When I was on the pensions committee for the council, we used to review Sutton Council’s pension investment in a number of shopping centres across the country. I can see no reason why this investment could not be better used to invest in our infrastructure. Either way, pension fund managers are on the lookout for low-risk, long-term investments like hospitals. As a loan, ownership would remain with the NHS, not in private hands. The challenge in this case is how to account for the debt which would sit on the government’s books at a time when they are trying to get to a point that they can reduce debt, not increase it.

If we can secure alternative funding for the largest part of investment, we would then need to secure funding for ensuring that the existing buildings are up to the job for the next 20 years. I have talked about £75m for this as an estimate. However, this figure is bound to increase as time moves on and the buildings continue to degrade. The trust has secured £12m, the biggest investment into the building at St Helier for years, to refurbish B and C blocks. They won’t look that different to the eye but that money will allow the windows at the back to be replaced and to firm up more of the crumbling structure. They have bid for £10m of energy efficiency grant funding to sort out the boiler but more will be required.

St Helier needs the brightest and the best to continue the great work there. As long as some politicians talk down the future prospects of the hospital, staff may be put off going there, instead looking to other hospitals like St George’s. Well, St Helier is not closing and the training and systems there work incredibly well, giving great opportunities to staff. It is therefore sad to see the continuing tales of woe from politicians with a campaign to fight, dragging down morale. It would be easier for me to take the default position of joining others in making supportive noises without any clue of what to do next. But I am a local resident first; one who wants to help to shape a solution. Whilst others petition, I have been trying to engage with decision makers to get answers. They won’t necessarily listen to political sloganeering but they just might to a reasoned, well-evidenced solution that is affordable, practical and deliverable.

Jeremy Hunt said after the meeting: “St Helier has made huge strides in recent years and I was delighted to hear more on my visit about progress and plans for the future. There is no question that St Helier hospital is here to stay, but we do need a plan for improving the facilities and the services on which local people rely. So it was great to see how Theresa May’s local Conservative candidates are working with the local NHS leadership to deliver a vision for St Helier.” I am pleased that he took the time to come, to listen carefully and really take on our thoughts as to how best to keep St Helier performing at its best for Sutton residents.