The current government is actively pursuing an agenda of localism, encouraging more responsibility for local councils. In the Health Bill we see a greater role for local authorities and local patient groups to influence health care commissioning and provision. Whilst on many levels it makes sense for budgets to be decided locally according to local needs, will we really like the results of this agenda?
Recent investigations by the consumer group Which? have shown wide differences in local charges for domiciliary care provision, with some local authorities providing free home care (Derbyshire, Newham and Tower Hamlets) whilst others charge around £20 per hour (Surrey £21.66, Cheshire East £19.80, Poole £19.70). Currently, councils are free to set home-care charges as they see fit, within the Fairer Charging Guidelines issued by the DH in 2003. The main stipulations of these guidelines are that a means test should be carried out when total assets (not including the home) are below £23,250 (2010-11) and that an individual’s net income should not be reduced below a certain level (currently £165.75 per week). However, these leaves a wide degree of flexibility, and as has been pointed, means that nearby boroughs, such as Tower Hamlets and Lambeth have vastly different charging policies for care.
In designing future policies, we need to decide whether we want the benefits of localism, empowering local people and allowing for more efficient local planning, or whether we want standardised delivery of services across the country, with the additional clarity of provision and charges that this hopefully entails.
This is one of the issues which will need to be considered by the Dilnot Commission on the Funding of Care and Support. There has been a wide recognition that the current situation with respect to social care funding is convoluted and confusing to the public. However any new funding scheme will need to consider carefully the balance of achieving uniformity of provision and funding against the scope for allowing local decision making.