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Funding Welsh Care
Money is tight in Wales as it is in the rest of the UK, and so is the urgency of finding a sustainable funding formula for social care. Whilst England has just allowed its local authorities to raise care funding from levying increased council tax bills, the search across the whole of the UK is for that sustainable 'once in a generation' settlement, - rather than the sticking-plaster afforded by council tax increments.
Care has to be funded and someone has to pay. But the political knockabout, which pervades devolved government, somehow conspires against open and honest acknowledgement that the funding system requires root and branch review. Ministers don't want to appear to be on the wrong side of the argument, to appear financially obsessed and remote from the plight of those requiring welfare, whilst those opposite them prefer to try and score political points rather than concede that current settlements are inevitably a compromise.
Whilst some high-level concensus exists that what is required is a 'once in a generation' shift to a sustainable funding formula, the political will in a policy environment crowded by competing priorities is so far lacking.
Meanwhile, throughout Wales local authorities have to make decisions as to how statutory obligations can best be met and how any additional provision is organised. Increasingly, funding responsibilities are shared between local authorities and service users making a contribution towards their care. Whilst this backdrop is the same throughout the UK, how it is achieved within each legislature is beginning to diverge. The arrangements for each country are increasingly shaped by the priorities and preferences decided therein.
In Wales, care is provided only to individuals with high or complex levels of need. However, how these decisions are made in Wales, is changing direction. The Social Services and Well-being (Wales) Act, 2014 sets out a 'can and can only' test to decide the eligibility threshold. This test measures whether the individual 'can only' realise their well-being goals with support from the local authority, although everyone has a right to an assessment including carers.
The cost of care provided at home is capped at £60 a week. Those with 'liquid' (not property) assets of less than £24,000 are subsidised further. For those residents within a care or nursing environment with 'fixed' assets (including property) of more than £24,000 have to meet their full costs. Those with under £24,000 are entitled to assistance with costs including an NHS contribution towards any nursing care.
It's not a word you will hear much in the discussion surrounding funding for social care. "Rationing" is a word which politicians and policy-makers avoid at all costs due to its evocation of extreme post-war austerity and miserly provision.
However, in 21st century Britain, there are very real and finite limits to what levels of care can be provided. With a population living longer, and with the multiple conditions common in old and very old age, the bill for social care is soaring. Other individuals live in socially excluded circumstances or suffer from conditions which limit their ability to thrive and need support if they are to live with dignity and hope... but who is picking up the tab?
If we are to continue to aspire to quality support, based upon individual need, we must have a national conversation which honestly addresses our current untenable funding position. Such a conversation would benefit all stakeholders and focus thinking upon delivering high-quality, person-centred care.