Peers have overturned a government change to the cap on care costs that would reduce its benefit for less well-off people, and also voted to bring forward its implementation date from October to April 2023.

The House of Lords yesterday backed a cross-party amendment to remove a clause from the Health and Care Bill that would only count client contributions to personal care costs – not the full bill – towards the £86,000 cap, for those receiving means-tested council support. As a result, they would take much longer to reach the cap, and become eligible for free personal care, than wealthier self-funders.

The clause, inserted into the bill in November during its passage through the House of Commons, would hit older people in the second poorest fifth of the population hardest, found an analysis last month by think-tanks the Institute for Fiscal Studies and the Health Foundation.

The Lords vote returns the cap on care costs to the model legislated for in the Care Act 2014, under which the full costs of meeting a person’s eligible personal care needs, as assessed by the relevant local authority, would count towards the cap.

Poorer people ‘exposed to same costs as wealthiest’

Moving the amendment to remove the clause, Labour peer Baroness Wheeler said the government’s approach would leave “poorer people …exposed to the same care costs as the very wealthiest in society”.

“The [government] change would leave many poorer people still exposed to the risk of having to sell their home to fund their loved-one's care, whilst wealthier people would enjoy protection from the very high costs that can come with needing social care for long periods of time,” said Sally Warren, director of policy at the King’s Fund.

Working-age adults ‘disproportionately affected’

Among older people, those most affected are those with modest assets and wealth, and by region, those living the North East, Yorkshire and the Humber, and the Midlands. The government's changes will also disproportionately affect working age adults with disabilities.

Andrew Knight, general manager of Brunswick Supported Living, said; "Members of parliament should consider whether they want to back a policy that will save the Treasury money, but at the direct expense of poorer people living who need social care.”

Duty to consult carers before discharge reinserted

In a further change yesterday, the Lords voted to require NHS bodies to consult current or prospective carers of hospital patients before discharge to determine whether they are willing and able to provide care, if they consider it would be unlikely to be safe for the person to be discharged without care.

There is currently a requirement under the Care Act on relevant NHS trusts or NHS commissioning bodies – where a person has been placed in an independent hospital – to consult any carer where they consider it would be unlikely to be safe for the person to be discharged without care and support.

The Health and Care Bill, as drafted, would remove this requirement, along with the rest of the existing legal regime for tackling delayed discharges, as part of the shift to the discharge-to-assess model. The model, rolled out at the start of the pandemic to help clear NHS hospital beds, defers assessments of people’s needs until after discharge.

Rowing back on carers’ rights

However, moving the amendment that would retain a legal requirement, Labour peer Baroness Pitkeathley, a past chief executive of Carers UK, said that “guidance, however strongly worded, is not the same as having concrete rights in legislation that can be quoted and used”.

She added: “I cannot express how disappointed I and all who work with carers are that the government are for the first time rowing back on the rights of carers, for which we have fought so hard.”