Dilnot ‘very disappointed’ by social care cap announcement

The man who first proposed a cap on adult social care costs has said he “particularly regrets” the latest “big changes” the government has made to its plans for social care reform, which he warned will “find savings exclusively from the less well off”.

Jessica Hill www.lgcplus.com

The amendments, which were published yesterday by the Department for Health and Social Care with no fanfare while the government was embroiled in the fiasco over MPs’ second jobs, means that those with fewer assets will be less likely to benefit from the cap.

When the £86,000 cap on the amount anyone would pay for social care was first announced in September, it was expected to include all care costs including means-tested council funding. But now, in a blow to those receiving government help towards their care costs via the means test, only private contributions will be counted.

The announcement is part of what is being viewed as a very complex and wide-ranging set of changes. The Local Government Association is expecting to work with the government in the near future to understand the implications of the overall package.

Commenting on the plans, Sally Warren, director of policy at The King’s Fund, tweeted yesterday: “With the new government model, the state still contributes if assets are less than £100,000 but the cap is set not on total care costs but on how much the individual spends. They would still need to spend £86,000. This is barely better than current system: maximum exposure is £86,000 versus £92,000 under the current system

“It is clear that those with under £106,000 do little better than under current system and a lot worse than under the Care Act [Dilnot proposals]. It’s only when you have more than £186,000 that the government system leaves you no worse off than the Care Act.”

Sir Andrew Dilnot, who first proposed a cap through the Dilnot Commission in 2011, told the Treasury Committee this morning he was “very disappointed” by the changes – which contrast with his own recommendations in 2015 that those who already have social care need should not be expected to make any contribution – effectively what he called a “zero” cap.

“Essentially what this change does is – for those who have long care journeys, significant care needs – [it] means the less well off will not gain any benefit from the cap,” he said.

“The only change as a result of all of these reforms will be that instead of running your assets down to your last £14,250, you’d run your assets down to your last £20,000.

“The people most harshly affected by this change will be those with assets of exactly £106,000 – that is, the £86,000 of cap plus £20,000 that is protected by the means tested system.”

Around 60% of old people who end up in adult social care have assets less than £186,000, and Mr Dilnot claimed all of this group “will do less well under what the government is proposing than under the proposals we made”.

“[The changes] find savings exclusively from the less well off group,” he said. “I regret the main parameters [of the reforms] and I particularly regret the announcement made yesterday which removes a central element of probativity which we did think was an important part of this structure.”

Mr Dilnot also highlighted a “north-south axis”, warning that areas with lower house prices such as Hull are likely to be hit hardest by the changes.

Caroline Abrahams, charity director at Age UK, shared this view. In a statement, she said: “It becomes clear that the cap will disproportionately benefit those living in the south rather than the north, where house prices are that much lower, flying in the face of the government’s ‘levelling up’ agenda.

Mr Dilnot said it was “unlikely to be a significant sum of money” that the Treasury will save through the latest changes, “which is partly what makes me regret the decision”.

But he conceded that the proposals “still take us to a better place than we are at the moment”.

“The cap is less generous than I wanted it to be and the outcome is a bit lower. But nonetheless it moves us from the world we are now, which is an entirely means tested regime which exposes the whole population to catastrophic costs, to for the first time a national risk pool for social care.”

At the committee session, Ms Warren echoed this sentiment, indicating that despite her reservations over the latest changes, the proposals are still “the right overall structure”.

But she cautioned that while the Dilnot Commission incorporated “a whole host of other recommendations”, the government’s own proposals do not. The Dilnot proposals included “the need for a public information campaign so individuals understood what their liabilities were to help them prepare”, she said, and “working with the financial services industry to make sure that different products would emerge to be able to support that individual”.

“We’ve not seen much information from the government on any of those wider set of things which are required to make the system work,” Ms Warren said. “Because if this is going to help people prepare, they need to know about it – it’s not something that they should just find out about as they get the care in.”

She also warned that the social care reforms are “building on an existing means tested system that has been underfunded for over a decade, and remains underfunded”.

“Andrew’s first report in 2011 talked about the importance of the first thing you do being to strengthen the foundations in the current system, then you make these changes to the structure. We’ve not seen that happening at the same time.”

She highlighted Age UK’s claim that as many as 1.5 million people have an unmet care need, and how the Association of Directors of Adult Social Services says £10bn a year is needed to stabilise the adult social care system, in addition to what the government has provided through the levy.

“The spending review has provided 1.8% a year spending power increase,” Ms Warren said. “Normally social care demographic pressures are around 1.82% a year. We’ve also then got additional cost pressures through the increase in national minimum wage, the increase in national insurance contributions and changes on things like energy costs, which we think means adult social care will need considerably more than the 1.8% its being provided.”

Ms Abrahams said the changes announced yesterday make “the overall scheme a lot less helpful to older people with modest assets than anyone had expected”.

“It waters down Sir Andrew Dilnot’s original proposal to save the government some money, but at the cost of protecting the finances of older home owners who are not terribly affluent if they need care for a long time.

“This feels like completely the wrong policy choice and we are extremely disappointed that the government has made it – and that it is only announcing it now, rather than two months ago when the prime minister set out his plan. Unfortunately, its impact is such that it is more than a mere ‘tweak’.”

Charles Tallack, assistant director of the REAL Centre at the Health Foundation, said: “While we support the government’s ambitions to reform social care and protect people from catastrophic care costs, these last-minute changes seem poorly conceived and are a step in the wrong direction.”

Caught red handed

From Unlock Democracy:

After an immense backlash, the Government has scrapped its plans to replace the independent watchdog that scrutinises and polices the behaviour of MPs.

But the Government’s attack on the elections watchdog continues.

The Elections Bill will end the independence of the Electoral Commission by letting the Government set the priorities for the Commission.

The Prime Minister admitted that he had ‘crashed the car’ with his handling of the Owen Paterson debacle.

With his attack on the Electoral Commission he’s driving it over the cliff.

We have written to the Prime Minister to point out the similarities and ask him to rethink the Elections Bill.

Will you add your name in support of our letter?

To maintain public confidence in our politics, we need effective and independent watchdogs that can keep the Government in check.

That’s why the Government’s plans to weaken the Electoral Commission, and more recently the Parliamentary Standards Commissioner, are dangerous.

We cannot let them dismantle the bodies that exist to protect our democracy.

Lord Evans, the Chair of the Committee on Standards in Public Life, has warned against the Government giving itself new powers over the Electoral Commission.

He said – “It is like giving a toddler a gun – it may not immediately lead to disaster, but it’s an extremely dangerous thing to do.”

That’s why we have written to the Prime Minister to ask him to ensure that the independence of the Electoral Commission is maintained.

If you agree, please add your name in support of our letter today.

Best wishes,

Tom Brake

Director, Unlock Democracy

Sajid Javid under pressure over share options in US health tech firm

The health secretary, Sajid Javid, is facing questions over share options he continues to hold in the hi-tech US company he worked for until rejoining the cabinet in June – and which operates in the healthcare sector.

Who voted for weak tweaks to parliamentary standards? – Owl

Heather Stewart www.theguardian.com 

Javid was paid the equivalent of £150,000 a year by C3.ai, a California firm specialising in artificial intelligence (AI), from October last year until he was given the job of health secretary.

As part of his remuneration package, he was also given “an option for 666.7 shares per month”.

According to the health secretary’s current entry in the register of MPs’ interests, he continues to hold these options, which he reports have a market value of approximately £45,000.

The deputy Labour leader, Angela Rayner, has written to the prime minister’s ethics adviser, Lord Geidt, to ask him whether this represents a conflict of interest.

“In September, the secretary of state’s department announced that the use of AI would shorten waiting lists in our NHS,” she wrote, suggesting the idea the Department of Health could spend taxpayers’ money on AI “could clearly be perceived as beneficial to an AI company”.

The ministerial code states that “ministers must scrupulously avoid any danger of an actual or perceived conflict of interest between their ministerial position and their private financial interest”.

Employee share options usually allow the recipient to buy a set number of shares at a predetermined price, sometimes on a particular future date.

Their value fluctuates with the company’s share price, so they are used to give staff an interest in the company’s value appreciating. Details of when Javid’s options can be cashed in have not been published.

C3.ai is a California-based tech firm which floated on the New York Stock Exchange in December 2020. Among nine industry sectors listed on its website, it includes “healthcare” and “government”.

It has a UK subsidiary, and is now recruiting sales and marketing staff in the UK. Javid advised the firm on “the global economy, geo-politics and market opportunities”.

The NHS was already increasing spending on AI before Javid arrived in post, but he recently highlighted its potential role in tackling health injustices.

“Technology, particularly AI, can be an incredible force for good. It can save valuable clinician time and help provide faster, more accurate diagnosis, so patients can access the care they need as quickly as possible,” he said. “It can also help us better understand racial differences so we can train our workforce to look for different symptoms or complicating factors, diagnose faster, and tailor treatments.”

Javid held the post at C3.ai alongside another advisory role, with US bank JP Morgan from August 2020 to June 2021, for which he was also paid the equivalent of £150,000 a year. He took up that role six months after resigning as chancellor. Javid previously worked for JP Morgan before entering parliament. Both of these jobs were cleared with the independent Advisory Committee on Business Appointments, which vets jobs for former ministers.

A spokesperson for the Department of Health and Social Care (DHSC) said: “The secretary of state has acted in line with the ministerial code and has properly declared these share options in the usual way.”

Aides suggested he had begun the process of divesting himself of the options when he became health secretary, but that the process was difficult because the market for share options is not very liquid.

Javid unexpectedly became health secretary in June, when Matt Hancock resigned after being caught on camera in a clinch with Gina Coladangelo, a longtime friend who had been brought on to the DHSC’s payroll.

Will Devon’s Blue Rosettes always miss out?

From a correspondent:

Once again the South West has missed out, in spite of Grant Shapps on Spotlight, a couple of days ago, telling us to “wait and see”.

The North and Midlands are shouting and screaming, despite receiving money from the transport swag bag. It is not enough. They need more to get their economy going.

Why is it that politicians in the South West are not “shouting and screaming” that our economy needs to get going and better transport might possibly help?  Yes, we have had the Restoring Your Railway Fund, launched in January 2020 of £300 million. This is peanuts – just think of the billions being sunk on HS2 and London’s Cross rail. 

Or perhaps they think that the London Waterloo to Exeter SINGLE TRACK is not a deterrent to economic growth. Are they happy with rail movement west of Exeter along the peninsula?

So what was Grant Shapps surprise present? Well, a letter from Boris endorsing the “Great South West has the raw materials to supply the rest of the UK with low carbon green power”.

What are these raw materials? Land for Solar Farms? Land for Wind Farms? I, amongst many others, had thought the “Great South West” was one of the prime agricultural areas of the Country. 

Or does this refer to exploitation of the “Golden Opportunity” we are supposed to be enjoying from Hinkley C which seems to have had little or no economic impact on Devon and Cornwall? 

It looks suspiciously like that this will be a very inexpensive option for the government, a bit of Magic Sauce and Catchup Ketchup.

Until we all stop voting for anything wearing a blue rosette it seems that the South West will always be the last in the line for government handouts. Just look at the 2019/20 funding per pupil in Devon. It was £4,395 compared to the national average of £4,689, a difference of £294. This gap has widened from £268 per pupil below the national average in 2018/19.

Otter Valley councillor helps secure review of ambulance service crisis

The situation has been described as ‘unprecedented’

Philippa Davies www.sidmouthherald.co.uk 

An urgent review is to explore the crisis in the South Western Ambulance Service and the issues that are causing it. 

A Devon County Council task group will look into the reasons for the extremely high demand on the service and the delays at hospitals that are hitting ambulance response times.

The review was secured by the county councillor for the Otter Valley, Jess Bailey, at a meeting of the health and adult care scrutiny committee on Thursday, November 11. 

The emergency service has been under extraordinary pressure for 18 months and since June this year has been on ‘black alert’ – the highest level. 

An executive director of the ambulance trust, Jess Cunningham, who attended the meeting remotely, described the situation as ‘unprecedented’. 

The committee heard of the serious problems around handover delays at acute hospitals, particularly at Derriford and Torbay, which has worsened significantly in the last twelve months. They were told: ‘there is definite patient harm being created’ and the environment for ambulance staff is ‘incredibly difficult’. 

Cllr Bailey proposed what is known as a ‘spotlight review’ – an in-depth consideration of a service by a small group of councillors who take evidence from relevant people and organisations. The proposal was seconded by Cllr Martin Wrigley and the committee resolved to undertake a review, looking at the delays in transfers, response times, impact on patients and personnel and the role of the NHS 111 service. 

Cllr Bailey said: “An urgent Spotlight Review is very important in order to understand the specific challenges faced by our ambulance service here in Devon.  

“The report from SWAST confirmed what I have long suspected. Paramedics are having to wait hours to admit patients to hospital. Ambulance services provide a link between the NHS – primary, community and secondary care. Pressure on ambulance services reflects the crises across the whole system and shines a light on the situation facing the NHS.” 

She said the latest data, published last week, shows that average response times to the most serious cases has continued to increase in the South West in October. The past six months has seen an increase in average response time from 8 minutes and 3 seconds to 11 minutes and 48 seconds.   

Cllr Bailey said “A Spotlight Review will enable a close examination of the issues that were touched on in the Scrutiny Meeting which are contributing to pressure on SWAST, including handover delays, and issues around community urgent care, and the 111 service.” 

Aggregate Industries’ quarrying plans for Straitgate Farm and our Climate Emergency

Correspondence from Chris Wakefield:

Aggregate Industries’ quarrying plans for Straitgate Farm (Ottery St Mary) will shortly stagger to a final reckoning at DCC on December 1st. As planning applications go, this one features such a wealth of shortcomings and unanswered questions that Councillors due to pronounce on it are spoilt for choice in how to condemn it. The most glaring contradiction lies between Devon’s declared climate emergency and AI’s incomprehensible plan to haul up to 1.5 million tonnes of Straitgate gravel (20% of which is useless waste anyway) 23 miles to Hillhead for processing – a plan about as sensitive to the climate emergency as the felling of rain forest. By any rational planning process this alone would render the application dead in the water, but institutional inertia in Devon County’s climate emergency response, its habitual resort to greenwash, and the inadequacy of a planning system built for a pre-climate crisis era could be enough, despite its obvious inadequacies, to violate the fundamental moral imperative to reject it.

I think I’m too old to contemplate sticking my face to the road in protest (doesn’t appeal much anyway), but this is in my manor, and I am disturbed that my local authority might not rise to the occasion, even to protect our shared living environment.

The writer Ben Okri says he must ‘write as if these are our last days’. I agree that a sense of extreme emergency is immensely important, because these could be our last days – unless we are all prepared to take appropriate action. If our elected representatives don’t feel that urgency – and the moral responsibilities that come with it – they’re in the wrong job.

Portable loos offered by South West Water as sewage overflow solution

The plan has been described as something from the 19th Century by local councillors.

The owners of South West Water, the Pennon Group, are the authors of a report aimed at levelling up the South West, recently praised by Boris Johnson. So is this a glimpse of the future, overdevelopment and inadequate infrastructure? – Owl


Portable loos

South West Water has apologised to the customers affected

A village flooded by sewage 11 times this year may be offered portable toilets as a short-term solution.

Some residents of Clyst St Mary, Devon, have been unable to use toilets for up to 60 hours at a time due to sewage overflows.

The plan has been described as something from the 19th Century by local councillors.

Matt Crabtree, engineering director at South West Water, said the company will “deliver the right permanent solution”.

Earlier this month, South West Water wrote to Bishops Clyst Parish Council to request a list of properties left without flushable toilets because of problems with the sewers and offered to provide portable “camping-like” toilets as a short-term solution.

Conservative Councillor Mike Howe, of East Devon District Council, said the suggestion was “hard to believe in a modern society”.

He added: “If it was the 1800s you’d sort of understand it. I struggle to understand it in this day and age.”

Mr Howe also wants all development in the West End of East Devon, to be halted until South West Water sorts out the sewage problems.

The firm has previously struggled to keep up with demand on its services, with 42,000 raw sewage discharges in 2020 alone, according to the Local Democratic Reporting Service.

Mr Howe and East Devon Conservative MP Simon Jupp recently met with South Water executives, who promised to provide monthly updates on sewage problems in the area.

“Extensive” repairs

In a letter to Bishops Clyst Parish Council, Mr Crabtree apologised to customers who had been impacted by the drainage issues.

He added: “We are continuing to investigate the cause of the issue and have been making a number of improvements to the sewer network and to the Clyst Honition pumping station, as well as adding and moving monitors to help trace the root causes.

“We are committed to delivering a permanent solution which will involve detailed works and upgrades to our network.

“These repairs will be extensive and will cause disruption to the area and because of this, we want to be absolutely sure that we have traced the cause to deliver the right permanent solution for the community.”